Reliability of Venous Couplers for Microanastomosis of the Venae Comitantes in Free Radial Forearm Flaps for Head and Neck Reconstruction

Patel, Sameer A.; Pang, Jianing; Natoli, Noel; Gallagher, Sidhbh; Topham, Neal S.

doi:10.1055/s-0033-1343835

Cited by 22 publications

(1 citation statement)

References 15 publications

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“…They postulate that the coupler size may have a role in the flap-related outcomes. Furthermore, Patel et al 12 demonstrated that MVCD can overcome a discrepancy of up to 3:1. In our experience, when vessel diameter size was lower than 1,5 mm we changed to the HSA technique.…”

Section: Discussionmentioning

confidence: 99%

The coupling device for venous anastomosis: a retrospective comparative study.

Pampin Martínez,

González Martin Moro,

Rodríguez Arias

et al. 2024

j.maxilo

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Introduction:The anastomosis is the most critical component of free tissue transfer in head and neck reconstruction. The classical hand-sewn technique ensures high success rates. Nonetheless, it is technically demanding. In the last decades, several alternatives have been proposed, of which the coupler device has undoubtedly demonstrated the best results. We aim to compare our experience in head and neck free tissue transfer either using the hand sewn technique (HSA) or the microvascular coupler device (MVCD) Material and methods: A total of 89 patients met the inclusion criteria. Of these, 42 underwent the MVCD technique and 47 the HSA technique. Results in terms of flap loss and venous thrombosis were analysed.Results: In the first group (HSA) 3 cases of venous thrombosis were found (6,3 %). On the other hand, in the second group (MVCD) 2 cases of venous thrombosis were found (4,7 %) and 4 flaps were lost (9,5 %). In the MVCD group, the coupler size most frequently used in the anastomosis was the 2 mm coupler device (60 %). Conclusion:We found a lower rate of venous thrombosis in the MVCD group (4,7 % vs. 6,3 %). Nonetheless, the success rate in the HSA group regarding flap loss was higher (4,2 % vs. 9,5 % flap loss). Overall complication rate was 14,28 % in the MVCD group, compared to 14,89% in the HSA group. Interestingly, three of the four flaps lost in the MVCD group were used in reconstruction of maxillary defects (two FFF and one RFFF).

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Section: Discussionmentioning

confidence: 99%

The coupling device for venous anastomosis: a retrospective comparative study.

Pampin Martínez,

González Martin Moro,

Rodríguez Arias

et al. 2024

j.maxilo

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Microvascular coupler device versus hand‐sewn venous anastomosis: A systematic review of the literature and data meta‐analysis

et al. 2020

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BackgroundSuccessful vascular anastomosis is essential for the survival of free tissue transfer. The aim of the study is to review the current literature and perform a meta‐analysis to assess the potential advantages of a mechanical anastomosis coupler device (MACD) over the hand‐sewn (HS) technique for venous anastomoses.MethodsA systematic Medline search was performed to gather all reports of articles related to MACD from 1984 until now. The following data were extracted: first author and publication date, study design, number of patients and anastomosis, coupler size, site and type of reconstruction, venous anastomotic time, flap failure. A meta‐analysis was performed on articles that met the following inclusion criteria: studies comparing MACD and HS technique in venous anastomosis, reporting anastomotic time, and postoperative complications.ResultsThirty‐three studies were included for the analysis. Twenty‐four were retrospective case series and nine were retrospective comparative studies. A total of 12,304 patients were enrolled with a mean age of 49.23 years (range 31–72). A total of 13,669 flaps were accomplished. The thrombosis rate recorded with MACD was 1.47%. The meta‐analysis revealed that MACD significantly decreased anastomotic time (standard difference in means = −0.395 ± 0.105; Z = −3.776; p < .001) and postoperative flap failure risk (odds ratio [OR] = 0.362, 95% confidence interval [CI] = 0.218–0.603, Z = −3.908, p < .001), but it did not decrease postoperative venous thrombosis risk (OR = 0.504, 95% CI = 0.255–1.129, Z = −1.666, p = .096).ConclusionsMACDs are a safe and effective alternative to traditional anastomosis. The anastomotic coupler is easier, much faster, and requires less technical skills than a HS microvascular anastomosis.

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Comparison of venous couplers versus hand‐sewn technique in 4577 cases of DIEP‐flap breast reconstructions – A multicenter study

Heidekrueger

Fritschen

Moellhoff³

et al. 2020

Microsurgery

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Introduction: Venous anastomosis remains to be a challenging step in microsurgical tissue transfer and venous complications constitute to a common reason for free flap failure. While several studies have compared mechanical vs. hand-sewn venous anastomoses, there is no large-series study comparing the type of anastomosis exclusively in DIEP flap breast reconstructions. Patients and Methods: Between 2011 and 2019, 3926 female patients underwent 4577 free DIEP-flap breast reconstructions in 22 different breast cancer centers. Patient data was collected via an online database, files were screened and cases were divided into a hand-(HA) and a coupler-anastomosis (CA) group. Complications were accounted for and the two groups were then compared.Results: Mean ischemia time was significantly shorter in the CA group (46.88 ± 26.17 vs. 55.48 ± 24.70 min; p < .001), whereas mean operative time was comparable (316 ± 134.01 vs. 320.77 ± 120.29 minutes; p = .294). We found no significant difference between both groups regarding the rate of partial (CA: 1.0% vs. HA: 1.3%) and total flap loss (CA: 2.2% vs. HA: 1.8%). However, revision rates were significantly higher in the CA group (CA: 10.5% vs. HA: 7.9%; p = .003), with higher numbers of arterial (2.3 vs. 0.9%; p < .001) and venous thromboses (3.4 vs. 1.8%; p = .001) accounting for this finding.Conclusions: All taken into account, our findings do support the feasibility of venous coupler anastomoses in principle, however the inflationary use of coupler devices should be evaluated critically. | INTRODUCTIONMicrosurgical technique and a patent microvascular anastomosis are keys for free flap outcome. Venous anastomosis remains to be a challenging step in microsurgical tissue transfer and venous complications Paul Heidekrueger and Uwe Fritschen have contributed equally to the preparation of the manuscript.

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Reliability of Venous Couplers for Microanastomosis of the Venae Comitantes in Free Radial Forearm Flaps for Head and Neck Reconstruction

Cited by 22 publications

References 15 publications

The coupling device for venous anastomosis: a retrospective comparative study.

The coupling device for venous anastomosis: a retrospective comparative study.

Microvascular coupler device versus hand‐sewn venous anastomosis: A systematic review of the literature and data meta‐analysis

Comparison of venous couplers versus hand‐sewn technique in 4577 cases of DIEP‐flap breast reconstructions – A multicenter study

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