Delayed removal of 3M<sup>®</sup> vein coupler does not disturb the anastomosis

Hilliard, Stuart M.; Pommier, Rodney F.; Solomon, J. S.

doi:10.1002/micr.20672

Cited by 5 publications

(4 citation statements)

References 5 publications

(7 reference statements)

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“…Following full-text review and consensus, 25 studies were included for analysis using the data abstraction tool . Reasons for exclusion are listed in Figure 1 (29)(30)(31)(32)(33)(34). Overall, one included study was prospective (15) and the remaining 24 were retrospective in design.…”

Section: Resultsmentioning

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: Resultsmentioning

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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“…27 Placement of the coupler should be carefully considered and should be avoided directly under the suture line. 38 Furthermore, some have proposed construction of venous coupler with degradable or resorbable materials. 8,9,37 Source materials and designs for resorbable couplers have been evaluated in rabbit models.…”

Section: Discussionmentioning

confidence: 99%

Unique Complications of Venous Anastomotic Couplers: A Systematic Review of the Literature

Loewenstein

Mailey

et al. 2020

J Reconstr Microsurg

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Background Anastomotic couplers expedite venous microvascular anastomoses and have been established as an equivalent alternative to hand-sewn anastomoses. However, complications unique to the coupler such as palpability and extrusion can occur. The purpose of this study was to perform a systematic review of the literature to assess complications distinct to the venous anastomotic coupler. Methods A Medline, PubMed, EBSCO host search of articles involving anastomotic venous couplers was performed. Studies involving arterial anastomotic couplers, end-to-side anastomoses, and reviews were excluded. Data points of interest were flap failure, venous thrombosis, hematoma, partial flap necrosis, infection, coupler extrusion, and coupler palpability. Results The search identified 165 articles; 41 of these met inclusion criteria. A total of 8,246 patients underwent 8,955 venous-coupled anastomoses. Combined reoperation rate was 3.3% and all-cause unsalvageable flap failure was 1.0%. Complications requiring reoperation included venous thrombosis (2.0%), hematoma (0.4%), partial flap necrosis (0.4%), and infection (0.3%). Eight patients had palpable couplers and 11 patients had extrusion of couplers (head/neck, hand, and feet) and required operative management. Conclusion Venous couplers remain an equivalent alternative to conventional hand-sewn anastomosis. However, venous coupler extrusion and palpability in the late postoperative period is a complication unique to anastomotic couplers, particularly in radiated head and neck, feet and hand free flaps. Removing extruded venous couplers is safe after tissue integration 3 weeks postoperatively. Coupler palpability and extrusion should be integrated into preoperative patient counseling and assessed in follow-up examinations.

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“…The most frequently used vascular anastomosis device in current clinical practice, the MAC ® coupler, is based on a non-absorbable ring-pin system. Although anastomosis is accomplished faster and more easily than with manual suture techniques 11 , cases of the MAC ® coupler protruding have been reported because neither the polyethylene ring nor the stainless ring are absorbable 13 . To overcome this disadvantage, absorbable vascular anastomosis couplers have been developed.…”

Section: Discussionmentioning

confidence: 99%

New Absorbable Microvascular Anastomotic Devices Representing a Modified Sleeve Technique: Evaluation of Two Types of Source Material and Design

Jeong

Kim

Son

et al. 2019

Sci Rep

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The purpose of this study was to create a new absorbable vascular anastomotic coupler and evaluate the patency and degradation degree. Vascular anastomosis was performed in the jugular vein in 31 New Zealand white female rabbits. The coupler consisted of an inner and outer ring. One side of the jugular vein was passed through and overlapped the inner ring. The opposite side of the jugular vein overlapped the everted jugular vein on the inner ring. Then, the outer ring engaged with the inner ring and completed the anastomosis. The outer rings were also constructed with two shapes including an O-type that had no slit and a C-type with a slit on the outer ring of the O-type coupler to allows expandability of the diameter. A Phase I experiment was performed to evaluate the degradability of the source materials, including the poly (lactic-co-glycolic acid) (PLGA) and polycaprolactone (PCL) couplers. A Phase II experiment was performed to evaluate the patency and anastomosis time of the O-type PLGA and PCL couplers. A Phase III experiment was performed to evaluate the patency and anastomosis time of suture anastomosis (control) and the C-type PLGA coupler. The patency was determined by ultrasonography and open exploration. Histological analysis was performed to determine the degradability of the couplers. In Phase I, the PLGA couplers were completely degraded with good vascular wall remodeling at 8 months, while the PCL couplers demonstrated incomplete degradation. In Phases II and III, the anastomosis time was significantly shorter in the coupler groups than that in the control group. All of the coupler groups demonstrated complete patency of the anastomoses on ultrasonography. In Phase III, the C-type PLGA coupler also demonstrated patency and complete degradation at 8 months. PLGA is a suitable source material for absorbable couplers due to its fast degradability. We devised the O-shaped outer ring for the C-shaped outer ring to increase flexibility, which also demonstrated complete patency during the experimental period. Our absorbable microvascular anastomosis devices could provide rapid and reliable microvascular anastomosis without anastomotic failure.

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Delayed removal of 3M^® vein coupler does not disturb the anastomosis

Cited by 5 publications

References 5 publications

The utility of the microvascular anastomotic coupler in free tissue transfer

The utility of the microvascular anastomotic coupler in free tissue transfer

Unique Complications of Venous Anastomotic Couplers: A Systematic Review of the Literature

New Absorbable Microvascular Anastomotic Devices Representing a Modified Sleeve Technique: Evaluation of Two Types of Source Material and Design

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Delayed removal of 3M® vein coupler does not disturb the anastomosis

Cited by 5 publications

References 5 publications

The utility of the microvascular anastomotic coupler in free tissue transfer

The utility of the microvascular anastomotic coupler in free tissue transfer

Unique Complications of Venous Anastomotic Couplers: A Systematic Review of the Literature

New Absorbable Microvascular Anastomotic Devices Representing a Modified Sleeve Technique: Evaluation of Two Types of Source Material and Design

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Delayed removal of 3M^® vein coupler does not disturb the anastomosis