Surgical oncology and reconstruction
Venous Anastomoses Using Microvascular Coupler in Free Flap Head and Neck Reconstruction

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Purpose

This study is a retrospective review of the experience using the venous coupler for head and neck reconstruction over a 3-year period at the University of Maryland Medical Center, Department of Oral and Maxillofacial Surgery.

Materials and Methods

One hundred seventy-eight consecutive cases of microvascular free flaps between May 2007 and September 2010 were retrospectively reviewed. Data were collected by demographic information, flap type, recipient vessels, method of anastomosis, coupler size, coupler orientation, complications associated with coupler, and reconstruction results. Fisher exact test was used for statistical analysis.

Results

There were 294 anastomotic coupler devices used in 173 flaps, with hand-sewn venous anastomoses performed in 5 patients. The overall flap success rate was 94.9% (169/178). Success rate among cases in which the coupler was used was 95.4% (8/173). Total coupler venous thrombosis rate was 4.0% (7/173), with a statistically significant difference (P < .05) in reference to the number of venous anastomoses performed: 58 cases had a single vein anastomosed, 5 cases developed thrombosis; while the 115 flaps with 2 venous anastomoses, only 2 cases had thrombosis.

Conclusions

The microvascular coupler is reliable for venous anastomosis in free flap head and neck reconstruction; dual-vein anastomoses appear to have better results than single-vein anastomoses. Flow coupler has a promising utility in monitoring buried flaps and flaps that are difficult to observe. The microvascular coupler deserves to be more commonly used in free flap head and neck reconstruction.

Section snippets

Materials and Methods

We retrospectively reviewed 184 consecutive cases of microvascular free flaps performed at the University of Maryland Medical Center, Department of Oral and Maxillofacial Surgery between May 2007 and September 2010. This study was granted exemption by the institutional review board. Surgeries were performed by 4 attending surgeons (J.L., A.S., J.C., D.C.) with fellows and residents. Patient data were collected from hospital records and operative reports. The following specific data points were

Results

In total, 178 microvascular free flaps were performed on 164 patients, including 56 females and 108 males. The mean age of patients was 56 years (range 13 to 88). Eight patients underwent 2 separate free flap procedures, and 1 patient underwent 3 free flaps. Simultaneous free flaps (double flaps) were performed on 4 patients. Thirty-four patients received preoperative external beam radiotherapy. Surgical defects were due to malignant pathology (66.3%, 118/178), benign pathology (29.2%, 52/178),

Discussion

The microvascular anastomosis coupler device is currently manufactured by Synovis Micro Companies Alliance. The device consists of 2 disposable rings made of high-density polyethylene, with a series of 6 to 8 (depending on the size of the coupler) stainless steel pins evenly spaced around each ring. The inner diameter of the rings range in size from 1.0 to 4.0 mm, allowing anastomoses of vessels that are 1.0 to 4.5 mm in diameter.

A series of 178 free flaps were reviewed in this study. The

Acknowledgment

We are grateful to Dr Cyrus Mistry and Dr Biraj Shah for their work on data collection.

References (10)

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    A flow diagram of the study selection process is presented in Fig. 1. All 27 articles reported retrospective studies13–19,34–53. The included studies involved a total of 7389 flaps for head and neck reconstruction.

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