Venous coupler use for free‐flap breast reconstructions: Specific analyses of <scp>TMG</scp> and <scp>DIEP</scp> flaps

Bodin, F.; Brunetti, S; Dissaux, C.; Sauleau, Erik-André; Facca, S.; Bruant-Rodier, C.; Liverneaux, Philippe

doi:10.1002/micr.22350

Cited by 14 publications

(5 citation statements)

References 30 publications

(57 reference statements)

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“…In our cohort, median coupler size was 2.5 mm, without any statistically significant differences between ms1-TRAM, ms2-TRAM, and DIEP flaps. In accordance with other groups, the coupler size varied between 2.5 and 3.0 mm for most abdominal free flaps (23)(24)(25)(26). We believe that venous coupler systems reduce the operation time, flap ischemia, venous thrombosis, and consequently flap failure.…”

Section: Discussionsupporting

confidence: 78%

“…We believe that venous coupler systems reduce the operation time, flap ischemia, venous thrombosis, and consequently flap failure. In the pertinent literature, venous thrombosis rate using venous coupler devices ranges between 0 and 4% (23)(24)(25)(27)(28)(29)(30). In our cohort, we encountered three cases (1.4%) in which venous congestion was the main cause for revision surgery.…”

Section: Discussionmentioning

confidence: 99%

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Interdisciplinary Treatment of Breast Cancer After Mastectomy With Autologous Breast Reconstruction Using Abdominal Free Flaps in a University Teaching Hospital—A Standardized and Safe Procedure

et al. 2020

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Background: Breast cancer is the most common malignancy in women. The interdisciplinary treatment is based on the histological tumor type, the TNM classification, and the patient's wishes. Following tumor resection and (neo-) adjuvant therapy strategies, breast reconstruction represents the final step in the individual interdisciplinary treatment plan. Although manifold flaps have been described, abdominal free flaps, such as the deep inferior epigastric artery perforator (DIEP) or the muscle-sparing transverse rectus abdominis myocutaneous (ms-TRAM) flap, are the current gold standard for autologous breast reconstruction. This retrospective study focuses on the safety of autologous breast reconstruction upon mastectomy using abdominal free flaps. Methods: From April 2012 until December 2018, 193 women received 217 abdominal free flaps for autologous breast reconstruction at the University Hospital of Erlangen. For perforator mapping, we performed computed tomography angiography (CTA). Venous anastomosis was standardized using a ring pin coupler system, and flap perfusion was assessed with fluorescence angiography. A retrospective analysis was performed based on medical records, the surgery report, and follow-up of outpatient course. Results: In most cases, autologous breast reconstruction was performed as a secondary reconstructive procedure after mastectomy and radiotherapy. In total, 132 ms1-TRAM, 23 ms2-TRAM, and 62 DIEP flaps were performed with 21 major complications (10%) during hospital stay including five free flap losses (2.3%). In all cases of free flap loss, we found an arterial thrombosis as the main cause. In 24 patients a bilateral breast reconstruction was performed without free flap loss. The majority of free flaps (96.7%) did not need additional supercharging or turbocharging to improve venous outflow. Median venous coupler size was 2.5 mm (range, 1.5-3.5 mm). Steiner et al. Interdisciplinary Breast Reconstruction Conclusion: Using CTA, intraoperative fluorescence angiography, titanized hernia meshes for rectus sheath reconstruction, and venous coupler systems, autologous breast reconstruction with DIEP or ms-TRAM free flaps is a safe and standardized procedure in high-volume microsurgery centers.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Interdisciplinary Treatment of Breast Cancer After Mastectomy With Autologous Breast Reconstruction Using Abdominal Free Flaps in a University Teaching Hospital—A Standardized and Safe Procedure

et al. 2020

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“…A vascular coupling device for microanastomosis is also one of the most useful devices for breast reconstruction. 7,8 However, the procedure of putting the vessel wall on the device is not easy, and the fragile vessel wall will sometimes tear in small caliber vessels. We have rarely used the device in DIEP flap reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Stabilizer for Microanastomoses of Internal Thoracic Vessels during DIEP Flap Breast Reconstruction

Hamahata

Kubo

Matsumoto

et al. 2016

J Reconstr Microsurg Open

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Background?Internal mammary arteries and veins are some of the most useful recipient vessels for autologous breast reconstruction. However, the internal mammary vessels are relatively small, which requires a high magnification power during microanastomoses, and respiratory fluctuations often disturb surgeons' focus on the vessels and affect performance of precise microanastomoses. Therefore, we developed a stabilizer for use during deep inferior epigastric artery perforator (DIEP) flap breast reconstructions. Methods?From April 2013 to March 2015, 23 patients underwent DIEP flap breast reconstructions. In 15 of the patients (22 venous anastomoses, 15 arterial anastomoses), the microanastomoses were performed without the stabilizer. In eight of the patients (10 venous anastomoses, 8 arterial anastomoses), the microanastomoses were performed with the stabilizer. Times for each microanastomosis procedure (from the first suture to the last suture) were measured using retrospective intraoperative video in the two groups. Results?All flaps survived without any microanastomosis problems. The average arterial microanastomosis times were 13 minutes 56?seconds (SD, 0 minute 53 seconds) in the stabilizer group and 15 minutes 25?seconds (SD, 4 minutes 11 seconds) in the nonstabilizer group (p?

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“…Ten included studies were retrospective cohort and twenty-two were retrospective case series. The studies were conducted in the United States of America 5, 6, 8, 23, 25-39 , China [40][41][42] , Germany 24,43,44 , United Kingdom 22,45 , France 46,47 , Sweden 48 , Japan 49 and Taiwan 9 . A total of 10 851 patients with a mean age of 35-65 years received 12 769 free flaps (1.18 free flaps per patient) in reconstructive free tissue transfer procedures.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Meta-analysis of venous anastomosis techniques in free flap reconstruction

Geierlehner

Rodi

Mosahebi

et al. 2020

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Venous coupler use for free‐flap breast reconstructions: Specific analyses of TMG and DIEP flaps

Abstract: The coupler size used was smaller for the TMG procedure and when double venous anastomosis was performed. Additionally, anastomotic time was not affected by the flap type or coupler size used or by anastomosis number.

Cited by 14 publications

References 30 publications

Interdisciplinary Treatment of Breast Cancer After Mastectomy With Autologous Breast Reconstruction Using Abdominal Free Flaps in a University Teaching Hospital—A Standardized and Safe Procedure

Interdisciplinary Treatment of Breast Cancer After Mastectomy With Autologous Breast Reconstruction Using Abdominal Free Flaps in a University Teaching Hospital—A Standardized and Safe Procedure

Usefulness of Stabilizer for Microanastomoses of Internal Thoracic Vessels during DIEP Flap Breast Reconstruction

Meta-analysis of venous anastomosis techniques in free flap reconstruction

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