P26 The utility of coupler devices for arterial anastomosis in free tissue transfer

Abstract

Introduction Microvascular free-tissue transfer remains a reliable method for head and neck reconstruction particularly when dealing with extensive oncological resection. The microvascular anastomosis is a technically sensitive and critical determinant of success in free-tissue transfer. In Europe hand-sewn anastomosis is widely used, especially for the arterial anastomosis. Our hypothesis is that anastomotic-coupling devices offer a reliable and efficient alternative to hand-sewn anastomosis. Material and methods We performed a retrospective analysis of 68 patients who underwent a head and neck tumor resection and free-tissue transfer using the coupling system for the venous and arterial anastomosis between 2010 and 2014. Results Within the first three years (2010–2012) there were performed 37 forearm flap transplantations, three flap failures (8.1%) occurred (three venous thrombosis, no arterial thrombosis). Between 2013 and 2014 a total of 31 forearm flap transplantations were performed. Only in one patient an arterial thrombosis occurred (3.2%), thus we saw in total one flap failure. Regarding the total group (68 patients), we saw one arterial thrombosis. That is a ratio of 0.14%. This is a thrombosis rate rather similar to those reported in literature for coupled arterial anastomosis. Conclusion Regarding the decreased flap failure rate in 2013 and 2014 there is a learning curve performing microvascular free tissue transfer. After a certain experience of the surgeon the coupling system is a reliable, efficient and faster method for microvascular arterial anastomosis. Beside our own experiences the metaanalysis of Amandeep et al. shows similar results using the coupling system for arterial anastomosis. This metaanalysis included twenty-five studies with a total of 3207 patients. There were performed 342 arterial coupled anastomosis, 12 arterial thrombosis occurred (3.6%). The thrombosis rates were similar to those performing hand-sewn arterial anastomosis and coupling time was shorter. Therefore we recommend using the coupling system likewise for the arterial microvascular anastomosis.