Anastomotic Systems in Head and Neck Reconstruction

Abstract

Objective: To assess the advantages of using mechanical anastomotic systems in head and neck free tissue transfer. Method: A review of mechanical venous coupler devices in head and neck reconstruction performed at a university-based tertiary care facility from 2004 to 2006. A total of 261 venous anastomosis performed in 234 consecutive patients. Five types of flaps were performed, and outcomes measured were flap survival and microvascular complications. Results: A total of 261 venous anastomosis were performed, size ranging from 2.0 to 4.0 mm, with the majority being 3.0 mm (56%) followed by 3.5 mm (23%). The most common vein used for anastomosis was a stump of the internal jugular vein (75%), followed by the external jugular (18%). Microvascular complications were experienced in 8 patients (3%). The series produced 7 total flap failures (2.6%), 4 (1.5%) classified as acute failure (<5 days) and 3 as late unspecified failure. Of the acute failures, there was 1 confirmed venous congestion and 3 confirmed arterial insufficiencies. The venous coupler used in the 7 failures was 3.0 mm in diameter. The 3 flap failures resulting from arterial insufficiency involved coupling to the external jugular vein, while the remaining 4 failures used the internal jugular. The flap failure secondary to venous congestion involved a 3.0 mm coupler anastomosing the internal jugular vein to the inferior epigastric vessels of the rectus abdominus tissue transfer. Conclusion: With an early venous failure rate of 0.38%, mechanical anastomosis is an adequate alternative to hand-sewn anastomotic techniques.