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

Jandali, Shareef; Wu, Liza C.; Vega, Stephen J.; Kovach, Stephen J.; Serletti, Joseph M.

doi:10.1097/prs.0b013e3181cb636d

Cited by 121 publications

(122 citation statements)

References 19 publications

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“…One example is the University of Pennsylvania (Philadelphia, USA) experience, from which several interesting conclusions can be drawn. Their recently published MACD series reports on 1000 consecutive FTT breast reconstructions with coupled venous anastomosis (16), in which they observed only six instances of venous thrombosis (0.6%) and zero flap failures. These success rates are outstanding, representing the best results within the present review.…”

Section: Discussionmentioning

confidence: 99%

The utility of the microvascular anastomotic coupler in free tissue transfer

Grewal

Erovic

Strumas

et al. 2012

Canadian Journal of Plastic Surgery

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T he transfer of autogenous, vascularized free-tissue is a cornerstone of modern reconstructive surgery, particularly when dealing with extensive oncological ablations and large post-traumatic defects. A half-century after Jacobson and Suarez (1) described the first sutured microvascular anastomosis, the cumulative efforts of surgeons and researchers have refined free tissue transfer (FTT) into a reliable modality that often provides excellent cosmetic and functional results.In addition to adequate presurgical planning and meticulous dissection technique, the microvascular anastomosis is critically important for successful reconstruction. The reported success rate of FTT ranges from 91% to 99%, with the majority of failures being due to technical errors with vessel anastomosis (2). Indeed, a hand-sewn anastomosis is a technically demanding procedure, particularly when dealing with veins, which prompted investigation into alternative strategies to suture. One example is the microvascular anastomotic coupling device (MACD), an interlocking ring-pin design that is becoming more widely used in FTT. Initial animal studies demonstrated favourable tensile characteristics and healing of coupled vessels (3), and subsequent case series in head and neck, breast and limb reconstructive surgery have reported favourably on MACD utilization. These case series have been limited by smaller numbers and variability in reconstructive subsites; however, recently, several larger series have been published. We sought to systematically review the literature to examine the utility of MACD use in FTT with regard to success rates and optimal applications of this device. MethodsA search of PubMed, Ovid MEDLINE, and EMBASE databases (inception to January 2011) was performed using major search terms including "microvascular anastomotic coupler", "anastomotic device", "venous coupler", "Nakayama ring pin" and "free tissue transfer". Two independent reviewers performed the title and abstract review, identifying relevant articles for retrieval. Inclusion criteria were MACD utilization and FTT reconstruction. There was no limitation placed on BACKGrouNd: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. oBJeCtive: To systematically review the literature to examine the utility of the microvascular coupler in free tissue transfer. Methods: 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. results: Twenty-five studies reporting on 3207 patients were inc...

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Section: Discussionmentioning

confidence: 99%

The utility of the microvascular anastomotic coupler in free tissue transfer

Grewal

Erovic

Strumas

et al. 2012

Canadian Journal of Plastic Surgery

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“…13,16,17,19 There is a significant body of literature demonstrating faster and easier microanastomoses and a shorter learning curve when these devices are used. 8,11,13,14,[16][17][18][20][21][22]25,33 Statistically similar patency rates have been found as compared to traditional sutured anastomoses. 8,11,[13][14][15][16][17][18][20][21][22][23][24]34 Anastomotic strength has been tested in animal models and found to generally exceed that of traditional anastomoses.…”

Section: Couplermentioning

confidence: 84%

“…Jandali et al 25 published a series of 1,000 consecutive venous anastomoses in breast reconstruction using the Synovis TM coupler. Although this series had no control arm, a venous thrombosis rate of 0.6% was reported.…”

Section: Couplermentioning

confidence: 99%

Technology‐assisted and sutureless microvascular anastomoses: Evidence for current techniques

et al. 2011

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Of the available forms of assisted microvascular anastomoses, there is level 2b evidence suggesting a positive outcome with the use of the Unilink™/3M™ coupler and the Autosuture™ VCS® clip applicator. Other techniques such as cyanoacrylates, fibrin glues, the Medtronic™ U-Clip®, and laser bonding have low levels of evidence supporting their use. Further research is required to establish any role for these techniques.

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“…Arterial anastomoses were sown with 8-0 or 9-0 interrupted nylon and veins were coupled with a coupling device. At least one vein, usually two, was connected with the largest possible coupler (3 mm average) [24]. Monitoring was by visual assessment or hand held Doppler.…”

Section: Methodsmentioning

confidence: 99%

Anatomy of Free Flap Failures: Dissection of a Series

Davison¹,

Clemens²,

Kochuba³

2013

MPS

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Introduction: Free flap success rates have remained stable in recent years ranging 93% to 98%. Historically, the causes of free flap failures were attributed to the surgeon's inexperience and technique. However, there are factors beyond the surgical anastomosis that contribute to flap failure. The purpose of this study is to review each case of total flap loss in detail to develop a better understanding of complications. Methods: A retrospective study was performed over eleven years in a single surgeon's practice, a predominantly head and neck reconstructive practice. All charts were independently reviewed. In patients who sustained total flap loss, a review was conducted of patient comorbidites, anesthesia records, perioperative and follow-up notes. Results: A total of 514 free flaps were performed. 76% (392) of these flaps were for head and neck reconstruction. There were 22 total flap losses (4%) and 26 partial flap losses (5%). Of the 22 total flap losses, four flaps were avulsed, five flaps were in patients later found to have coagulation disorders (homozygous mutations of the MTHFR gene and factor V Leiden), four patients were exposed to neosynephrine, two patients remained hypotensive perioperatively, and four delayed flap losses were attributed to pseudomonal infection. Five losses were technical or related to flap inexperience. Several representative case scenarios are illustrated. Conclusion: Careful review of free flap failures indicates that a thorough workup (particularly coagulation disorders), flap selection, surgeon to anesthesia communication, proper securing of the flap, and postoperative patient blood pressure and infection control have a greater part to play in this new era of anastomotic success.

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

Abstract: 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.

Cited by 121 publications

References 19 publications

The utility of the microvascular anastomotic coupler in free tissue transfer

The utility of the microvascular anastomotic coupler in free tissue transfer

Technology‐assisted and sutureless microvascular anastomoses: Evidence for current techniques

Anatomy of Free Flap Failures: Dissection of a Series

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