Abstract
The present meta-analysis aimed to investigate the differences in the incidence of thrombosis and vascular compromise in arterial anastomosis between microvascular anastomotic devices and hand-sewn techniques during free tissue transfer in the head and neck. We searched for articles in PubMed/Medline, CNKI, WANFANG DATA, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science, from January 1, 1962 till April 1, 2020 that reported data of microvascular anastomosis during free tissue transfer in the head and neck. The incidence of arterial thrombosis or vascular compromise, or both was the primary outcome. The secondary outcome was anastomotic time. We also assessed the sensitivity and the risk of bias. This meta-analysis included 583 arterial anastomoses from six studies. The group using microvascular anastomotic devices tended to have an increased incidence of arterial thrombosis and vascular compromise (risk ratio (RR), 3.42; P = 0.38; 95% confidence interval (CI), 0.91-12.77). The hand-sewn technique took significantly longer to perform the anastomosis compared with that of the microvascular anastomotic devices (weighted mean difference, 15.26 min; P<0.01; 95% CI, 14.65-15.87). Microvascular anastomotic devices might increase the risk of arterial thrombosis and vascular compromise compared with the hand-sewn technique; however, further randomized controlled trials are needed to provide a more accurate estimate. The application of microvascular anastomotic devices will help to reduce anastomotic surgery time and achieve acceptable vessel opening, benefiting from the developments of arterial couplers and microsurgical techniques.
Highlights
Microvascular free tissue transfers have achieved widespread acceptance as the gold standards to repair of complex defects in the head and neck [1, 2]
As an alternative method to hand-sewn techniques, a microvascular anastomotic device became commercially available in the 1980s, known as the Unilink coupler [4]
The weighted mean difference (WMD) value and its associated 95% confidence interval (CI) were used to compare the anastomose time between the microvascular anastomotic devices and the hand-sewn technique
Summary
Microvascular free tissue transfers have achieved widespread acceptance as the gold standards to repair of complex defects in the head and neck [1, 2]. Vascular anastomosis traditionally relies on hand-sewn techniques involving nylon microvascular sutures (8–0 to 10–0). As an alternative method to hand-sewn techniques, a microvascular anastomotic device became commercially available in the 1980s, known as the Unilink coupler [4]. There have been some reports about the clinical use of microvascular anastomotic devices in arterial anastomoses. The present meta-analysis aimed to assess the quality of microvascular anastomotic device in arterial anastomosis and the evaluate statistically the difference in the incidence of vascular compromise, thrombosis, or both, and the anastomotic time between coupler and hand-sewn techniques
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