Use of a microvascular coupler for repair of major distal upper extremity artery injuries

Abstract

Non-suturing alternatives to expedite a microanastomoses while still insuring maximum patency rates to date have best been achieved using everting ring-pin devices. Although these so-called couplers have heretofore primarily been used for the venous microanastomosis during free flap transfers, they have also had limited value for their arterial counterpart. Applications for use of the microanastomotic coupler has been extended to repair solitary arterial injuries in the distal upper extremity. Over the past year, 4 patients specifically with hand or forearm arterial injuries alone, had rapid coupling of the injured vessels. Direct end-to-end repair of all hand or forearm arterial injuries using a microanastomotic coupler was possible in 3 of four cases. Because of the greater extent of injury, the exception required an interposition vein graft; but that too was coupled to each end of the divided artery in end-to-end fashion. In no case was there any compromise of vascular patency. Although hand perfusion in no individual in this series was ever at jeopardy because of persistent collaterals, this demonstration of the efficiency and efficacy of this device may justify future use for critical limb revascularisation.