Microvascular Coupling Device Research Articles

In Vivo Preclinical Quantitative Flow Analysis of Arterial Anastomosis Using a Microvascular Anastomotic Coupler and Clinical Application for Extracranial-to-Intracranial Bypass

Although several commercially available sutureless anastomotic techniques are available, they are not routinely used in neurosurgery. We performed an invivo flow analysis of end-to-end anastomosis using a microvascular coupler device in rats. We report our first clinical use of the microvascular anastomotic coupler. Bilateral rat common carotid arteries (CCAs) were exposed, and a microvascular coupler was used to perform 8 anastomoses. A microflow probe provided quantitative measurement of blood-flow volume. Flow augmentation was assessed with end-to-side anastomoses connecting the distal CCA to the jugular vein (JV). A patient with chronic dominant hemisphere atherosclerotic ischemic disease and progressive symptoms refractory to medical management underwent end-to-end cerebral artery bypass using the microvascular coupler. Mean preanastomosis flow in the rat CCA was 3.95 ± 0.45 mL/min; this flow was maintained at 3.99 ± 0.24 mL/min on final measurements 54-96 minutes postanastomosis. Total occlusion time for each rat CCA was 12-19 minutes. After end-to-side anastomosis, with proximal and distal JV patent, CCA flow increased 477% to 22.8 ± 3.70 mL/min (P=0.04, proximal; P= 0.01, distal). After invivo testing, we successfully used the coupler clinically in a superficial temporal artery-to-middle cerebral artery bypass for dominant hemisphere flow augmentation. Invivo quantitative flow analysis demonstrated no flow difference between an unaltered artery and artery with end-to-end anastomosis using a microvascular coupler in rats. A 1-mm coupled anastomosis achieved a 4-fold flow increase with low-resistance venous outflow in rats, simulating increased arterial demand. The coupler was successfully used for extracranial-to-intracranial bypass in a patient.

Double Thread Suspension: A Novel Technique to Facilitate End-to-Side Venous Anastomosis With a Microvascular Coupling Device in Head and Neck Reconstruction

Microvascular free tissue transfer has become a mainstay for head and neck reconstruction, and vascular anastomosis is 1 of the most challenging aspects. This study aimed to explore a safe, convenient, and efficient technique for end-to-side venous anastomosis using the coupling device. We evaluated a novel surgical strategy, double thread suspension (DTS), by reviewing data collected in a consecutive series of 60 patients who underwent free tissue grafting after surgical resection of head and neck tumors. Patients who underwent end-to-side microvascular anastomosis using the microvascular coupler device were randomly divided into the DTS group (n = 30) and the traditional procedure group (TRA, n = 30), the demographic data, coupler size, anastomosis time, microvascular complications, and flap survival were determined. The optional size range of coupler devices in the DTS group is better than that of the conventional group, ranging from 1.5 to 4.0 mm compared with 2.0 to 4.0 mm. The average anastomosis time was 4.68 ± 0.43 minutes in the DTS group which was significantly lower than the conventional group that was 9.24 ± 1.46 minutes (P < .0001) . There was no statistically significant difference between the 2 groups in coupler related complications or flap survival. The novel DTS technique provides the advantages of lowering procedure complexity, reducing operative time, and preventing tearing of vessel wall, therefore making DTS-guided end-to-side anastomosis a safe, relatively straightforward, and reliable technique.

Systematic review of microvascular coupling devices for arterial anastomoses in free tissue transfer.

BackgroundCoupling devices have become commonplace in performing venous anastomoses during microvascular free tissue transfer (FTT). However, arterial anastomoses are still most commonly performed using traditional microvascular suture techniques.ObjectiveTo describe the safety and feasibility of using microvascular coupling devices for free flap arterial anastomosis.MethodsA systematic review of English language literature was performed for studies that investigated the use of an arterial coupler for microvascular FTT in human patients. A comprehensive search of MEDLINE (January 1948 to August 2018), EMBASE (January 1974 to August 2018), and Web of Science was performed.ResultsFifteen studies were included. All studies were retrospective case series. A combined total of 395 arterial anastomoses were attempted with a coupling device. All studies except for one used the 3M Unilink/Synovis coupling device. One study used a novel absorbable coupling device. The coupling device was aborted and converted to a suture technique in 8.4% of attempted anastomoses. Rupture of the anastomotic device was reported in only 1 patient (0.3%). Thrombosis was also infrequent at 1.9%. The quality assessment showed a high risk of bias in all studies.ConclusionIn selected patients, coupling devices for arterial anastomoses have a good success rate with low rates of thrombosis based on limited quality evidence.

Preliminary report of the use of a microvascular coupling device for arterial anastomoses in oral and maxillofacial reconstruction.

Our aim was to record our preliminary use of a microvascular coupler for arterial anastomoses with free flap transfer in the reconstruction of oral and maxillofacial defects in 45 patients with defects that were repaired with anterolateral thigh, fibular, and radial forearm flaps. The microvascular coupler was used for both the venous and the arterial anastomoses. The site of the defect, type of flap, recipient artery, duration of operating time for the anastomosis, size of coupler, and survival of the flap were recorded and analysed. A total of 45 consecutive patients had microsurgical reconstructions in the head and neck, including 16 radial forearm, 18 fibular, and 11 anterolateral thigh free flaps. The sizes of coupler required ranged from 1.5-2.5 mm, with most flaps (n = 30) requiring a 2.0 mm coupler. The mean (SD) operating time for arterial anastomoses was 7 (2) mins. One arterial crisis occurred during an operation, and required a sutured anastomosis instead. There were no complications related to the technical performance of the coupler. The coupler is reliable for arterial anastomoses of free tissue transfers in reconstructions of the head and neck. With proper selection of vessels and enough experience in using the microvascular coupler, it may be used in an expeditious, safe, and reliable fashion with minimal morbidity. Though not common, the use of the coupler for arterial anastomoses saves a lot of time, and is a viable alternative to a sutured anastomosis.

Safety and Efficacy of MRI Scans in Patients With Implanted Microvascular Coupling Devices.

To demonstrate the safety and compatibility of microvascular couplers in patients undergoing postoperative magnetic resonance imaging (MRI) scans. Retrospective case series. A consecutive review of 1,252 patients undergoing free tissue transfer for head and neck reconstruction at Oregon Health and Sciences University (OHSU) between 2010 and 2017 who had microvascular coupler Synovis, Baxter Deerfield, IL (Synovis Life Technologies, Saint Paul, MN) implantation were reviewed. One hundred fifteen patients had a subsequent MRI scan, which consisted of a variety of Phillips (Amsterdam, Netherlands) MRI machines ranging from 1.0 to 3.0 Tesla (T) in magnetic strength. These 115 patients underwent 121 free flaps with 131 couplers (including 32 flow couplers) utilized for venous anastomoses. Couplers ranged in size from 1.5 to 4.0 mm (3.0 mm [42%] followed by 3.5 mm [21%], 2.5 mm [19%], 2.0 mm [10%], 4.0 mm [6%], and 1.5 mm [2%]. Three hundred fifty-nine MRI scans (2 days to 91 months postoperatively) were obtained with 233 MRIs for cancer surveillance, and the remaining were obtained for neurologic disease, injury, or evaluation for metastases. No complications occurred related to the MRI and the metallic components of the coupler or other metal implants, such as reconstruction bars, vascular clips, or metallic surgical mesh. Additionally, no radiology report commented on MRI distortion due to the coupler placement, which contrasts the distortion seen with the other metallic implants. Microvascular couplers and their constitutive stainless-steel pins have not been found to cause any complications in a large series of consecutive patients undergoing multiple MRIs with magnetic strength up to 3 T. The U.S. Food and Drug Administration advocates medical alert notification for patients with couplers; however, hesitation regarding potential MRI scanning for surveillance or otherwise is unwarranted. 4 Laryngoscope, 130:1428-1430, 2020.

Use of a microvascular coupler device for end-to-side venous anastomosis in oral and maxillofacial reconstruction

The aim of this study was to compare the use of a microvascular coupler device (MCD) for end-to-side venous anastomosis (ETS group) and phleboplasties combined with MCD for end-to-end venous anastomosis (ETE group) in free tissue transfer for oral and maxillofacial reconstruction, with regard to the anastomosis time and occurrence of postoperative vascular crisis. The ETS group included 22 patients and the ETE group included 40 patients. Patient demographic data, anastomotic time, coupler size, microvascular complications, and flap survival rates were collected and analyzed. In the ETS group, the most suitable donor vessel size was greater than 2mm, varying from 2mm to 4mm. The average anastomosis time was 3.35±0.89min in the ETS group and 7.80±2.93min in the ETE group; the difference between the groups was statistically significant (p<0.0001). There were no statistically significant differences in complications or outcomes between the two groups. The ETS venous anastomosis with MCD technique is a better choice for anastomosis when the donor vessel size is greater than 2mm. In those cases with mismatched veins, ETS venous anastomosis with MCD could significantly reduce the anastomosis time compared to ETE venous anastomosis with MCD after phleboplasties.

Microvascular coupling devices: neglected resource with a short learning curve

Microvascular couplers have a record of efficiency and efficacy. They have been used in anastomoses in the head and neck in Sunderland since November 2013, where we have investigated the time taken for anastomosis, patency, and cost. We also completed a national survey of the use of couplers in the United Kingdom, in which we recorded the time of anastomosis. The mean (range) time was 4minutes (2minutes 40seconds – 4minutes 10seconds). One flap partially failed. This shows that couplers can save time, they have successful outcomes, and the technique is quick and easy to learn.

Analysis of service provision for patients with nail bed injuries

s / International Journal of Surgery 12 (2014) S13eS117 S71 referenced to PACS Radiology reports to determine: FNAs performed by radiologists and/or ultrasound-guidance; diagnostic sufficiency and reasons for inadequacy. Results: 104 FNAs were carried out on 89 patients 74% for melanoma and 21% for squamous cell carcinoma primaries. 38% of FNAs were in the head and neck region, 31% axillary, and 27% in the groin. Surgeons performed 58%, of which 37% were ‘unsatisfactory for diagnosis’, versus 25% of those by radiologists. Anatomical region did not influence rates of unsatisfactory specimens. 36% of unsatisfactory specimens were acellular/hypocellular, whilst 12% were poorly preserved. Conclusions: Radiologist-performed FNA ismore likely to be diagnostic, but delays and costswill be incurred to access this service.We are piloting a local training program to increase the diagnostic yield of surgeon-performed FNA. 1160: ANALYSIS OF SERVICE PROVISION FOR PATIENTS WITH NAIL BED INJURIES Zita Jessop , Matthew Gardiner, Sonya Gardiner, Neil Toft. Royal Free Hospital, London, UK. Introduction: Although viewed as minor procedures, nail bed repairs take up a significant amount of time and resources. Our aim was to assess service delivery from referral to discharge. Methods: This was a retrospective review of patients with nail bed injuries identified by hospital episode statistics. Data was collected on delays in treatment, financial performance, and patient reported outcomes via a telephone questionnaire. Results: Over one month 62 of 310 hand trauma cases underwent nail bed repair. Patients were seen in trauma clinic one day after referral, waited two days (0-4days) for an operation and 6 days for a follow up clinic (012days), attending 2.6 appointments. We had a 32% questionnaire response rate; 11% of appointments were not attended, most common reason being inability to get time off work and main suggestion was reducing waiting time for an operation. Two cases were performed in clinic and 11 were coded wrongly resulting in a lower tariff estimated to cost the department £36,000 per year. Conclusions: The data formed the basis of a business case for introducing an outpatient minor operating theatre which will streamline service provision and increase available theatre time. 1172: FEASIBLE, EFFECTIVE AND EFFICIENT; THE MICROVASCULAR COUPLER DEVICE FOR END-TO-SIDE VENOUS ANASTOMOSIS IN FREE TISSUE TRANSFER FOR HEAD AND NECK RECONSTRUCTION Jane Maraka , Nigel Abreo, Omar Hausien, Nakul Patel, Amer Durrani. Addenbrookes Hospital, Cambridge, UK. Introduction: The use of a microvascular coupling device (MCD) for venous anastomosis in free tissue transfer (RTT) in head and neck reconstruction (HN University of Edinburgh, Edinburgh, UK; National University of Singapore,

Feasible, effective and efficient; the microvascular coupler device for end-to-side venous anastomosis in free tissue transfer for head and neck reconstruction

Feasible, effective and efficient; the microvascular coupler device for end-to-side venous anastomosis in free tissue transfer for head and neck reconstruction

Routine Use of Microvascular Coupling Device for Arterial Anastomosis in Breast Reconstruction

Although microvascular coupling devices are used routinely and successfully for venous anastomosis, there are few published reports demonstrating their efficacy for performing arterial anastomosis. It has been the senior author's (C.Y.A.) preference to perform arterial anastomosis using the microvascular coupling device when feasible. All microsurgical breast reconstructions performed by the senior author at the New York University Medical Center between 1998 and 2004 were retrospectively reviewed. A total of 60 patients underwent microsurgical breast reconstruction, of which 20 were bilateral, for a total of 80 flaps. Of the 80 flaps performed, there were 47 muscle-sparing TRAM and 22 deep inferior epigastric perforator (DIEP) flaps, and 11 were superior gluteal flaps. Arterial coupling was successfully performed in 60 of 69 flaps based on the deep inferior epigastric artery (87%) and 2 of 11 gluteal flaps (18%); arterial coupling was performed successfully 62 of 74 times (83.9%) when the thoracodorsal artery was the recipient vessel and never performed when the internal mammary artery was the recipient vessel. The overall flap success rate was 100%. In our large series, we were able to perform a coupled arterial anastomosis in nearly 80% of the cases, without the loss of any flaps. With proper vessel selection and sufficient experience using the microvascular coupler, arterial coupling may be performed in an expeditious, safe, and reliable fashion with minimal morbidity. Though not commonly practiced, use of the coupling device for arterial anastomosis can provide significant time savings, especially in bilateral breast reconstructions.

Microsurgical reconstruction of the lower extremity using the 3M microvascular coupling device in venous anastomoses.

Microsurgical reconstruction of the lower extremity presents a difficult problem to plastic surgeons; the rate of failure is higher than any other anatomical site. We reviewed our recent experience with lower extremity microsurgical reconstruction using the 3M vascular coupling device. We believe the excellent patency rate of the coupler may minimize the well-described problem of venous thrombosis in this challenging group of patients. This study involves a consecutive series of 11 patients who presented for reconstructive microsurgery of the lower extremity at NYU Medical Center hospitals between June 1 and September 1, 1994. Ten of 11 patients had free flap transfer to traumatic lower extremity injuries, whereas the remaining reconstruction was in a diabetic individual with a chronic wound. Fifteen microvascular venous anastomoses were performed; all but 1 was performed using the 3M coupler. Our experience with 11 patients, involving 14 mechanically coupled venous anastomoses, demonstrated successful use of the coupler. No intraoperative or postoperative vascular complications occurred. The overall success rate of the 3M coupler for venous anastomoses was 100%, and all microvascular free flaps were successful. We recommend using the 3M coupling device for venous anastomoses during reconstructive microsurgery of the lower extremity. Our series demonstrates the safety and effectiveness of the 3M coupler in this challenging group of patients. In addition, a secondary benefit of the 3M coupler is a significant reduction in operative time.