Anastomotic Coupling Device Research Articles

Adverse events associated with anastomotic coupling devices in microvascular reconstruction

ObjectiveIn light of the recent US Food and Drug Administration (FDA) Class 2 safety recall notice for anastomotic coupling devices, it is important to understand related adverse events. The aim of this study was to characterize adverse events in anastomotic coupling devices for microvascular reconstruction. MethodsA retrospective cross-sectional analysis using the 2011 to 2021 US FDA Manufacturer and User Facility Device Experience (MAUDE) database. All reports of adverse events involving anastomotic coupling devices were retrieved from the MAUDE database. Descriptive statistics were used to analyze categorized events. ResultsThere were a total of 293 documented adverse events related to anastomotic coupling devices. These adverse events resulted in 91 (31.1 %) patient injuries and 239 (81.6 %) device malfunctions. The most frequent patient problems were thrombosis/hematoma (n = 38; 41.8 %), unspecified injury (n = 31; 34.1 %), and failure to anastomose (n = 13; 14.3 %). Free flap necrosis was reported in 42 % of thrombosis/hematoma cases (n = 16). The most common malfunctions were devices operating differently than expected (n = 74; 31.0 %), connection problems (n = 41; 17.2 %), and twisted/bent material (n = 19; 7.9 %). There was no significant trend in the number of adverse events over the study period (p > 0.05). ConclusionsAdverse events from anastomotic coupling devices represent an important and modifiable factor in free tissue failure. Adverse events are predominately related to devices operating differently than expected and may result in vascular compromise of the free flap. Reconstructive surgeons should be cognizant of defective anastomotic coupling devices and be prepared to utilize traditional hand-sewn anastomosis.

A Novel Vascular Anastomotic Coupling Device for End-to-End Anastomosis of Arteries and Veins.

Hand-sutured (HS) techniques remain the gold standard for most microvascular anastomoses in microsurgery. HS techniques can result in endothelial lacerations and back wall suturing, leading to complications such as thrombosis and free tissue loss. A novel force-interference-fit vascular coupling device (FIF-VCD) system can potentially reduce the need for HS and improve end-to-end anastomosis. This study aims to describe the development and testing of a novel FIF-VCD system for 1.5 to 4.0 mm outside diameter arteries and veins. Benchtop anastomoses were performed using porcine cadaver arteries and veins. Decoupling force and anastomotic leakage were tested under simulated worst-case intravital physiological conditions. The 1.5 mm FIF-VCD system was used to perform cadaver rat abdominal aorta anastomoses. Benchtop testing showed that the vessels coupled with the FIF-VCD system could withstand simulated worst-case intravital physiological conditions with a 95% confidence interval for the average decoupling force safety factor of 8.2 ± 1.0 (5.2 ± 1.0 N) and a 95% confidence interval for the average leakage rate safety factor of 26 ± 3.6 (8.4 ± 0.14 and 95 ± 1.4 μL/s at 150 and 360 mmHg, respectively) when compared to HS anastomotic leakage rates (310 ± 14 and 2,100 ± 72 μL/s at 150 and 360 mmHg, respectively). The FIF-VCD system was successful in performing cadaver rat abdominal aorta anastomoses. The FIF-VCD system can potentially replace HS in microsurgery, allowing the safe and effective connection of arteries and veins. Further studies are needed to confirm the clinical viability and effectiveness of the FIF-VCD system.

Mechanical Anastomotic Coupling Device versus Hand-sewn Venous Anastomosis in Head and Neck Reconstruction-An Analysis of 1694 Venous Anastomoses.

Background There is a steep learning curve to attain a consistently good result in microvascular surgery. The venous anastomosis is a critical step in free-tissue transfer. The margin of error is less and the outcome depends on the surgeon’s skill and technique. Mechanical anastomotic coupling device (MACD) has been proven to be an effective alternative to hand-sewn (HS) technique for venous anastomosis, as it requires lesser skill. However, its feasibility of application in emerging economy countries is yet to be established. Material and Method We retrospectively analyzed the data of patients who underwent free-tissue transfer for head and neck reconstruction between July 2015 and October 2020. Based on the technique used for the venous anastomosis, the patients were divided into an HS technique and MACD group. Patient characteristics and outcomes were measured. Result A total of 1694 venous anastomoses were performed during the study period. There were 966 patients in the HS technique group and 719 in the MACD group. There was no statistically significant difference between the two groups in terms of age, sex, prior radiotherapy, prior surgery, and comorbidities. Venous thrombosis was noted in 62 (6.4%) patients in the HS technique group and 7 (0.97%) in the MACD group ( p = 0.000). The mean time taken for venous anastomosis in the HS group was 17 ± 4 minutes, and in the MACD group, it was 5 ± 2 minutes ( p = 0.0001). Twenty-five (2.56%) patients in the HS group and 4 (0.55%) patients in MACD group had flap loss ( p = 0.001). Conclusion MACD is an effective alternative for HS technique for venous anastomosis. There is a significant reduction in anastomosis time, flap loss, and return to operation theater due to venous thrombosis. MACD reduces the surgeon’s strain, especially in a high-volume center. Prospective randomized studies including economic analysis are required to prove the cost-effectiveness of coupler devices.

Thrombose genähter vs. gekoppelter Anastomosen bei mikrovaskulären Kopf- und Halsrekonstruktionen

The Anastomotic Coupling Device for microvascular anastomoses has become widely used in free tissue transplantation. This study compares the thrombosis rate and flap failure as a function of the anastomosis technique at a large head and neck cancer center. Retrospective analysis of all patients receiving free flap reconstructions in the period 2001-2019. Reconstruction type, recipient vessels, number of venous anastomoses, coupler size, and operation time were investigated. We compared the rates of venous thrombosis between hand sewn and coupled anastomoses, as well as the rate of flap failure. A total of 403 free flap reconstructions were performed for over 17 years. The venous anastomosis was sewn in 113 flaps in single suture technique, and in 290 cases, coupler device was used. The rate of venous thrombosis requiring immediate surgical revision was 6.2 % (7/113) in the sewn group compared to 7.6 % in the coupled group (22/290; p = 0.627). With an overall success rate of 95.0 % (383/403), the rate of flap failure was 3.6 % (4/113) and 5.5 % (16/290; p = 0.421), respectively. Surgical time is comparable with 680 ± 144 minutes in the hand-sewn group and 688 ± 167minutes in the coupled group (p = 0.678). With similar success rates, the coupler device is an effective alternative to venous anastomosis in single suture technique. Due to the generally low rate of pedicle thrombosis in both groups, we cannot separate the influence of the anastomosis technique from possible interfering variables.

Microvascular Anastomotic Coupler Devices (MACD) Versus Hand-Sewn Technique for Arterial Anastomosis: A Systematic Review

Background: Microvascular anastomotic coupling devices (MACD) are an established technique for venous anastomosis. Arterial MACD literature is conflicting. We report the first registered systematic review of its kind, evaluating the safety and efficiency of arterial MACD in free flaps. Methods: We performed a PRISMA-guided systematic review (PROSPERO-registered). Reports were identified using a search algorithm in MEDLINE/EMBASE. The rate of arterial thrombosis was set as the primary outcome. Secondary outcomes included flap survival, failure rates and comparison between MACD vs. the conventional hand-sewn technique. Findings: From the 17 studies identified, 2672 free flap reconstructions were performed and 640 arterial MACD were attempted (622 completed-97.2%). The pooled incidence of arterial thrombosis was 2.1% (13/622). The overall flap failure rate was 4.34% (116/2672). The total number of arterial MACD performed first time, with no perioperative complications/revisions/thrombosis, was 88.9% (569/640). GRADE quality-analysis revealed low quality and significant heterogeneity. Interpretation: Arterial MACD are a safe and efficient alternative to hand-sewn anastomosis, with more recent literature showing excellent results. However, further evaluation is required with controlled trials. Funding: There was no funding or financial incentive for any author in this paper. Declaration of Interests: No conflict of interest.

Northwestern and Other Historical Vignettes regarding the Vascular Anastomotic Coupling Device.

The vascular anastomotic coupling device is a widely used and effective aid to reconstructive microsurgery. Although there is a long history of innovators connected with this device, the current design of 6 interdigitating holes and pins was created de novo by a Northwestern medical student in 1960.

3D-Printed Sugar-Based Stents Facilitating Vascular Anastomosis.

Microvascular anastomosis is a common part of many reconstructive and transplant surgical procedures. While venous anastomosis can be achieved using microvascular anastomotic coupling devices, surgical suturing is the main method for arterial anastomosis. Suture-based microanastomosis is time-consuming and challenging. Here, dissolvable sugar-based stents are fabricated as an assistive tool for facilitating surgical anastomosis. The nonbrittle sugar-based stent holds the vessels together during the procedure and are dissolved upon the restoration of the blood flow. The incorporation of sodium citrate minimizes the chance of thrombosis. The dissolution rate and the mechanical properties of the sugar-based stent can be tailored between 4 and 8 min. To enable the fabrication of stents with desirable geometries and dimensions, 3D printing is utilized to fabricate the stents. The effectiveness of the printed sugar-based stent is assessed ex vivo. The fabrication procedure is fast and can be performed in the operating room.

Mechanical versus Hand-Sewn Venous Anastomoses in Free Flap Reconstruction: A Systematic Review and Meta-Analysis.

Venous complications are the primary reason for flap loss in massive defect reconstructions; therefore, the quality and reliability of microvascular anastomoses are significant. The aim of this systematic review was to evaluate venous anastomotic time, the venous complication rate, and the flap failure rate with the mechanical anastomotic coupling device versus the hand-sewn technique in venous anastomoses of microvascular free flap operations. Chinese and English databases were searched for eligible articles published between their inception and July of 2017. The pooled relative risk was calculated for dichotomous variables, and the weighted mean difference was calculated for continuous data. Whether to use the fixed effects or random effects model depended on the heterogeneity evaluation among the studies. Twelve studies were selected, including 3788 flaps (mechanical anastomotic coupling device, n = 1667; hand-sewn, n = 2121). Using the mechanical anastomotic coupling device significantly decreased venous anastomotic time (weighted mean difference, -13.50; 95 percent CI, -17.09 to -9.91; p < 0.01) and the incidence of venous complications (relative risk, 0.40; 95 percent CI, 0.25 to 0.65; p < 0.01). There was a significant difference in terms of flap failure between the groups (relative risk, 0.56; 95 percent CI, 0.32 to 0.97; p = 0.04); thus, flap survival improved with the assistance of the mechanical anastomotic coupling device. No publication bias was detected in those analyses. This meta-analysis suggests that the mechanical anastomotic coupling device contributes to reduced operative time, decreased probability of surgical reexploration, and mitigation of flap loss.

Smaller Diameter Anastomotic Coupling Devices Have Higher Rates of Venous Thrombosis in Microvascular Free Tissue Transfer.

Smaller anastomotic coupling devices may increase the risk of complications in free flap reconstructions; however, the relationship between coupler size and venous thrombosis rates has not been adequately evaluated. The authors hypothesized that smaller diameter coupling devices are associated with higher rates of venous thrombosis than larger diameter devices in free tissue transfer. The authors reviewed a prospectively maintained database for all patients who underwent microsurgical free tissue transfer at their institution from 2001 to 2013. The primary outcome measured was venous thrombosis, and the primary objective was to assess the relationship between venous coupler diameter and the rate of venous thrombosis. The secondary objective was to compare venous thrombosis rates between coupled and hand-sewn venous anastomoses. A total of 5643 consecutive free flap reconstructions were evaluated; 3257 (57.7 percent) had coupled venous anastomoses. The 1.5-mm-diameter coupler had an overall thrombosis rate of 6.9 percent, significantly higher than that of all other coupler sizes (p = 0.04). In multivariable regression with generalized estimating equations analysis, both use of a 1.5-mm coupler (OR, 7.75; 95 percent CI, 3.20 to 18.76; p < 0.0001) and preoperative radiation therapy (OR, 1.62; 95 percent CI, 1.04 to 2.52; p = 0.03) were significant independent predictors of venous thrombosis. The authors found a significantly higher rate of venous thrombosis with the 1.5-mm-diameter coupler than with larger diameter devices or hand-sewn venous anastomoses. This evidence suggests that surgeons should choose an outflow vessel that does not require a coupler diameter smaller than 2.0 mm or perform a hand-sewn anastomosis in situations where this is not possible. Therapeutic, III.

Arterial and venous coupling by microvascular anastomotic coupling device in head and neck reconstruction

Objective To assess the value of using microvascular anastomotic coupling device(MACD) in head and neck reconstruction, especially in arterial coupling. Our experience was summed up to improve the success rate of anastomosis. Methods This research had enrolled all patients performed free flap reconstruction in our department from January, 2015 to Auguest, 2016. The data were obtained on type of free flap, donor and recipient vessels, type of MACD, time of anastomosis and so on. Results 169 patients were included in this study. Free flap reconstructions were done by manual suture in 25 patients and MACD in 144 patients. Coupling the arteries and veins by MACD[(5.7 ± 1.2)min and (5.1 ± 1.0) min, respectively] had taken less time than manual suture[(21.4 ± 3.1)min and (23.2 ± 4.2)min, respectively]. 223 MACD were used totally to couple 44 arteries and 179 veins. There was no significant statistical difference in vascular crisis and flap survival between manual suture and MACD(P > 0.05). One arterial crisis (2.3%) and on flap loss was found in the patients coupling arteries by MACD. Conclusion MACD is a optimal method for coupling veins of free flap in head and neck reconstruction, because of high success rate and shortening surgery time. As well MACD can be a important option in arterial anastomosis after appropriate vessels choosing and pretreatments. Key words: Microvascular anastomotic device; Head and neck; Reconstruction; Surgical flap; Arterial anastomosis

Reduced venous thrombosis and re-exploration time with anastomotic coupling device: A cohort study.

In the anastomotic coupling device literature, no comparative study has reported operative times, included consecutive patients, or used a matched comparison group. Our objective was to analyze patency and operative time in free flaps with venous anastomoses performed with ACD versus hand-sewn. For consecutive free flaps, re-explorations and complications were reviewed in duplicate. Operative times for ACD versus hand-sewn were compared for: (1) matched unilateral DIEPs, and (2) re-explorations. Overall, 147 ACD and 144 hand-sewn flaps were included. Venous thrombosis was significantly lower with ACD (1/147[1%] vs.9/144[6%], P < 0.01). There was no difference in re-exploration for venous insufficiency, or overall re-exploration. Re-exploration time was significantly shorter with ACD (69mins vs.205mins, P = 0.009). ACD significantly decreases venous thrombosis compared to hand-sewn veins, and significantly shortens re-exploration time. Outcomes allow an estimate of cost utility for the ACD in decreasing venous thromboses and shortening re-exploration time. © 2015 Wiley Periodicals, Inc. Microsurgery 36:372-377, 2016.

Economic Comparison of Hand-Sutured and Coupler-Assisted Microvascular Anastomoses

Background Compared with hand-sewn anastomoses, microvascular anastomotic coupling devices (MACDs) provide equivalent flap survival and reduced operative time. To date, an economic analysis of MACDs has not been reported. The objective of this study was to evaluate the economics of a venous anastomosis performed using a coupling device compared with a hand-sewn anastomosis. Methods Economics were modeled for a single free tissue transfer (FTT) requiring one venous anastomosis performed with either hand-sewn sutures or with a coupler-assisted anastomosis using the GEM COUPLER. Fixed and variable costs incurred with each anastomotic technique were identified with an activity-based cost analysis. Price lists were retrieved from suppliers to quantify disposable costs and capital expenditures. Two literature reviews were executed to identify microsurgical operating room (OR) costs and operating time reductions with coupler-assisted anastomoses. Results For each venous anastomosis, the use of the anastomotic coupler increased disposable costs by $284.40 compared with a hand-sutured anastomosis. Total fixed and variable OR costs were $30.82 per minute. Operating time was reduced by a mean of 16.9 minutes with a coupler-assisted anastomosis, decreasing OR costs by $519.29. Total savings of $234.89 were generated for each coupler-assisted anastomosis, recuperating the device's capital expenditure after 13 uses. Conclusion Compared with a hand-sewn venous anastomosis, an MACD produces savings with each case and quickly recoups the device's capital expenditure. Despite its limitations and simplicity, this study provides a practical economic analysis that can help inform purchasing decisions, particularly for smaller volume centers where the economic rationale may be less clear.

Venous Thrombosis in Handsewn versus Coupled Venous Anastomoses in 857 Consecutive Breast Free Flaps.

The anastomotic coupling device has demonstrated safety and efficacy; however, the coupler has never been compared directly to handsewn venous anastomoses exclusively in breast reconstruction. We hypothesized that rates of venous thrombosis would be lower using the coupler versus handsewn anastomoses in free flap breast reconstruction. We performed a retrospective review utilizing clinic records, hospital records, and operative reports for 857 consecutive breast free flaps at a single institution from 1997 to 2012. Data were collected on reconstruction type, recipient vessels, timing, laterality, preoperative radiation, chemotherapy, venous thrombosis, and flap outcome. We compared rates of venous thrombosis between handsewn and coupled anastomoses for breast free flaps. Chi-square test was used to calculate statistical significance. A total of 857 consecutive free flaps were performed for breast reconstruction in 647 patients over 16 years. The venous anastomosis was handsewn in 303 flaps, and the anastomotic coupler was used in 554 flaps. The rate of venous thrombosis requiring anastomotic revision in the handsewn group was 0.04% (12/303), compared with 0.01% in the coupled group (8/554; p = 0.02). The anastomotic coupler was more effective in preventing venous thrombosis than handsewn anastomoses in our series. While our study demonstrates improved patency rates using the venous coupler in breast reconstruction, we were unable to definitively separate this finding from potential confounding variables due to the low rates of thrombosis in both the groups. Our data are consistent with current literature, which suggests that the coupler is a safe and effective alternative to hand sutured anastomoses.

The Use of Venous Coupler Device in Free Tissue Transfers for Oral and Maxillofacial Reconstruction

Microvascular anastomosis remains the most challenging and important technique affecting the success of free tissue transfers. A microvascular anastomotic coupling device is often used. This study is a retrospective review of the use of a venous coupler for head and neck reconstruction during a 2-year period at the Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University (Zhengzhou, China). Sixty-nine consecutive cases of microvascular free flaps from December 2012 through December 2014 were retrospectively reviewed. Patients' demographic information (age and gender), defect location, flap type, recipient vein, anastomotic time, coupler size, microvascular complications, and flap survival rate were collected and analyzed. Sixty-nine anastomotic coupler devices were used for 69 flaps. Of the 69 flaps performed, there were 26 anterior lateral thigh flaps (37.68%), 25 radial forearm flaps (36.23%), 17 fibula flaps (24.64%), and 1 deep inferior epigastric perforator flap (1.45%). The branch of the internal jugular vein was the most common recipient vein (n= 29; 40.03%), followed by the facial vein (n= 25; 36.23%) and the external jugular vein (n= 15; 21.74%). Coupler sizes ranged from 1.5 to 3.5mm, with most being 2.5mm (n= 41; 59.42%), followed by 3.0mm (n= 19; 27.54%), 2.0mm (n= 7; 10.14%), 1.5mm (n= 1; 1.45%), and 3.5mm (n= 1; 1.45%). The average operation time was 3 to 11minutes for venous anastomosis (∼6minutes on average). Postoperative complications were seen in 7 of 69 flaps (10.14%), and no complications led to complete flap loss. The overall flap success rate was 100%. Total coupler venous thrombosis rate was 4.35% (3 of 69). The microvascular coupler shows reliability for venous anatomosis in head and neck reconstruction free tissue transfers. Use of a microvascular anastomotic coupler could simplify vascular anatomosis, considerably shorten operative time, and achieve excellent vessel patency and flap success rate.

Use of an Anastomotic Coupling Device for the Creation of Spliced Autogenous Grafts in Lower Extremity Revascularization.

Despite a recent rise in popularity of endovascular techniques, open bypass surgery is still required for treating many lower extremity vascular lesions. Greater saphenous vein (GSV) of adequate length and caliber for successful infrainguinal lower extremity bypass is unavailable in 15% to 45% of patients. To overcome limitations imposed by absent vein due to prior use, short vessel length, or sclerotic segments, both alternate (ie, basilic and cephalic) and GSV conduits may be "spliced" together in series via venovenostomy. Although vascular surgeons typically perform a hand-sewn venovenostomy, device-based venous coupling has been performed by plastic surgeons for many years. We therefore sought to review our experience with venous coupling for segmental lower extremity bypass graft assembly. A retrospective review was performed in all patients who underwent lower extremity revascularization using autogenous vein grafts spliced together with the Synovis (Birmingham, Alabama) anastomotic coupler at a single institution over a 5-year period. The anastomotic coupler device was used on 5 patients for 7 venovenostomies. The mean age of patients was 66 years, and the mean follow-up period was 751 days. Two patients were lost to follow-up, while 2 other patients died of causes unrelated to their lower extremity bypass. The average time to perform venovenostomy was 3 minutes. Three patients developed stenosis of their composite graft at a site other than the venovenostomy, who were successfully treated with either angioplasty or bypass revision. One-year primary and primary-assisted patency rates were 50% and 75%, respectively. Given the known benefits of the anastomotic coupling device when used for venous anastomoses in microsurgical reconstruction, transition of this device to the vascular surgery realm represents a logical progression. Although small, our series demonstrates that the anastomotic coupler can successfully be used for the formation of spliced autogenous grafts for lower extremity revascularization in the absence of adequate GSV.

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

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.

End-to-side venous anastomosis with an anastomotic coupling device coupler: The flower petal stenting technique

MicrosurgeryVolume 34, Issue 1 p. 80-81 Letter to the Editor End-to-side venous anastomosis with an anastomotic coupling device coupler: The flower petal stenting technique Julian Vitse M.D., Julian Vitse M.D. Oral and maxillo-facial and plastic surgery department, Gui de Chauliac hospital, Montpellier, FranceSearch for more papers by this authorMakram Ziade M.D., Makram Ziade M.D. Oral and maxillo-facial and plastic surgery department, Gui de Chauliac hospital, Montpellier, FranceSearch for more papers by this authorJacques Yachouh M.D., Ph.D., Jacques Yachouh M.D., Ph.D. Oral and maxillo-facial and plastic surgery department, Gui de Chauliac hospital, Montpellier, FranceSearch for more papers by this authorLaure Frison M.D., Laure Frison M.D. Oral and maxillo-facial and plastic surgery department, Gui de Chauliac hospital, Montpellier, FranceSearch for more papers by this authorSophie Domergue M.D., Corresponding Author Sophie Domergue M.D. Oral and maxillo-facial and plastic surgery department, Gui de Chauliac hospital, Montpellier, FranceCorrespondence to: Sophie Domergue, Oral and maxillo-facial and plastic surgery department, Gui de Chauliac hospital, Avenue Augustin Fiche, 34090 Montpellier France. E-mail: s-domergue@chu-montpellier.frSearch for more papers by this author Julian Vitse M.D., Julian Vitse M.D. Oral and maxillo-facial and plastic surgery department, Gui de Chauliac hospital, Montpellier, FranceSearch for more papers by this authorMakram Ziade M.D., Makram Ziade M.D. Oral and maxillo-facial and plastic surgery department, Gui de Chauliac hospital, Montpellier, FranceSearch for more papers by this authorJacques Yachouh M.D., Ph.D., Jacques Yachouh M.D., Ph.D. Oral and maxillo-facial and plastic surgery department, Gui de Chauliac hospital, Montpellier, FranceSearch for more papers by this authorLaure Frison M.D., Laure Frison M.D. Oral and maxillo-facial and plastic surgery department, Gui de Chauliac hospital, Montpellier, FranceSearch for more papers by this authorSophie Domergue M.D., Corresponding Author Sophie Domergue M.D. Oral and maxillo-facial and plastic surgery department, Gui de Chauliac hospital, Montpellier, FranceCorrespondence to: Sophie Domergue, Oral and maxillo-facial and plastic surgery department, Gui de Chauliac hospital, Avenue Augustin Fiche, 34090 Montpellier France. E-mail: s-domergue@chu-montpellier.frSearch for more papers by this author First published: 14 August 2013 https://doi.org/10.1002/micr.22152Citations: 4Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume34, Issue1January 2014Pages 80-81 RelatedInformation

The utility of the microvascular anastomotic coupler in free tissue transfer

The microvascular anastomosis remains a technically sensitive and critical determinant of success in free tissue transfer. The microvascular anastomotic coupling device is an elegant, friction-fit ring pin device that is becoming more widely used. To systematically review the literature to examine the utility of the microvascular coupler in free tissue transfer. A comprehensive database search was performed to identify eligible publications. Inclusion criteria were anastomotic coupler utilization and free-tissue transfer. Recorded information from eligible studies included patient age, follow-up, radiation history, number of free-flaps and failure rates, reconstruction subsites, number of coupled venous and arterial anastomoses, coupling time, conversion to sutured anastomosis, coupler size and thrombosis rates. Twenty-five studies reporting on 3207 patients were included in the analysis. A total of 3576 free-flaps were performed within the following subsites: 1103 head and neck, 2094 breast, 300 limb or body, and 79 nonspecified. There were only 26 reported flap failures (0.7%). A total of 3497 venous and 342 arterial coupled anastomoses were performed. The primary outcome measure was thrombosis rates, and there were 61 venous (1.7%) and 12 arterial (3.6%) thromboses reported. Mean coupling time was 5 min, and 30 anastomoses (0.8%) were converted to suture. Flap survival and revision-free application of the microvascular coupler occurred in more than 99% of cases. There is a substantial time savings with coupler use. Venous and arterial thrombosis rates are comparable with the best results achieved by sutured anastomosis and, when used by experienced surgeons, the coupler achieves superior results.

Lower extremity free flap reconstruction outcomes using venous coupler

Microvascular anastomotic coupling devices have been available to microsurgeons for over 20 years. Many studies have validated the efficacy of these devices for venous anastomosis. To date, there have been no large reports of their success in the anatomical region with the highest free flap failure rate, the lower extremity. A retrospective review of 67 consecutive patients who underwent lower extremity microvascular reconstruction performed from August 2003 to September 2010 was performed. Patient charts were reviewed for age, sex, medical comorbidities, etiology of defect, location of defect, flap type, anastomotic technique, complications, flap survival, and limb salvage outcome. No patients returned to the operating room to have an arterial or venous anastomosis revised. Despite 100% vascular anastomosis patency rates in 67 consecutive lower extremity free flaps, flap survival rate was 95.5%. Total complication rate (13.4%) was due to two partial and one complete flap loss, three infections, two skin graft loses, and one hematoma. There were no intraoperative or perioperative complications involving the use of a microvascular anastomotic coupling device itself. Thirty-day and long term limb salvage rate was 97% and 92.5%, respectively. Microvascular anastomotic coupling devices create effective venous anastomoses in lower extremity microvascular reconstruction. Thus, it presents an important tool in the armamentarium for lower extremity microsurgical reconstruction.

1000 Consecutive Venous Anastomoses Using the Microvascular Anastomotic Coupler in Breast Reconstruction

Microvascular anastomosis is one of the more critical aspects of free flap surgery. A safe, effective, and expedient method for venous anastomosis minimizes flap ischemia time, is easier on the surgical team, and saves costly operating room time. The authors report on their experience using the Synovis microvascular anastomotic coupling device in 1000 consecutive venous anastomoses in free flap breast reconstruction. The authors retrospectively reviewed 1000 consecutive venous anastomoses that were performed using the microvascular anastomotic coupler between July of 2002 and July of 2008. Data were obtained on flap type, recipient vessel, coupler size, incidence of venous thrombosis, timing of venous thrombosis, and morbidity as a result of venous thrombosis. All anastomoses were performed in an end-to-end fashion. There were 460 unilateral cases and 270 bilateral cases of breast reconstruction. Flap types included muscle-sparing free transverse rectus abdominis myocutaneous, deep inferior epigastric perforator, superficial inferior epigastric artery, superior gluteal artery perforator, and inferior gluteal artery perforator. The vast majority of the recipient vessels were the internal mammary or thoracodorsal vessels. Most of the couplers that were used were either 3 or 2.5 mm in diameter. Overall, there were six instances of venous thrombosis (rate of 0.6 percent). There were no total flap losses due to venous thrombosis in this series, although two patients had partial flap necrosis. The patency rate for venous anastomoses performed with the microvascular coupler is excellent when compared with standard suture techniques and has the advantage of overall easier application.