Blood flow through sutured and coupled microvascular anastomoses: A comparative computational study

Salvage arterial anastomosis using a microvascular coupler in head and neck free flap reconstruction

“…These advocates cite several advantages of the coupling technique: avoidance of uneven suturing and backwalling, elimination of intraluminal foreign material (suture), complete intimal view prior to coupling, stent‐like effect preventing spasm at the anastomosis, considerable time‐saving, and increased anastomotic strength. Improved flow through and less thrombogenic potential of coupled compared to sutured arteries has been further supported by computational fluid dynamics studies . Additionally, Chernichenko et al recommend aggressive arterial dilation to accommodate at least a 2.5‐mm coupler.…”

The Use of Venous Coupler Device in Free Tissue Transfers for Oral and Maxillofacial Reconstruction

“…[18][19][20] Several investigators have analyzed the hemodynamics at anastomotic sites and reported less thrombogenic possibility in a coupled anastomosis compared with a sutured anastomosis. 21 Thus, based on the evidence described, the authors conclude that application of a microvascular anastomotic coupler for free flap head and neck reconstruction could lower the thrombosis formation rate and play an indirect role in the success of FTTs.…”

Clinical experience with 80 microvascular couplers in 64 free osteomyocutaneous flap transfers for mandibular reconstruction

“…The flap survival rate of 100% in the present series is attributed to the following key points: (1) the vessels (donor and recipient) had no tension during the procedure of anastomosis; (2) there was no adventitia around the nozzle of vessels; (3) there was no torsion of the vascular pedicle; (4) the nozzle of the vessels (donor and recipient vessels provided) were as close in size as possible; (5) an end-to-end anastomosis was performed; (6) haemostasis was performed (to prevent blood clots oppressing the vascular pedicle); (7) appropriate drainage was applied. 13,14 Although the coupler device is convenient and reliable, we believe that a hand-sewn microvascular anastomosis is essential for several indications in which the coupler device cannot be used, including vessels that are thickened from repeated venipuncture, in an irradiated neck, or where there is a lack of vessel pliability.…”

“…For a traditional handsewn anastomosis, the intimal-penetrating technique presents a risk for intravascular thrombosis, which can lead to eventual flap loss in some patients. 3,7 Over the past 20 years, the successful use of microvascular anastomotic coupling devices for venous anastomoses has been well documented in breast and head-neck reconstruction, but data focusing on mandibular reconstruction are lacking. 8 This study represents the largest series to date examining the use of microvascular anastomotic couplers in the microsurgical reconstruction of mandibular defects.…”

“…2 However, this intimal-penetrating technique poses a risk for intravascular thrombosis, which can lead to eventual flap loss in some patients. 3 In recent years, microvascular couplers have been introduced as an alternative method for anastomosis in free flap head and neck reconstruction. The use of microvascular couplers has been proven to be a safe, time-saving, and reliable non-suture technique with a high patency rate.…”