Microvascular coupler device versus hand‐sewn venous anastomosis: A systematic review of the literature and data meta‐analysis

Abstract

BackgroundSuccessful vascular anastomosis is essential for the survival of free tissue transfer. The aim of the study is to review the current literature and perform a meta‐analysis to assess the potential advantages of a mechanical anastomosis coupler device (MACD) over the hand‐sewn (HS) technique for venous anastomoses.MethodsA systematic Medline search was performed to gather all reports of articles related to MACD from 1984 until now. The following data were extracted: first author and publication date, study design, number of patients and anastomosis, coupler size, site and type of reconstruction, venous anastomotic time, flap failure. A meta‐analysis was performed on articles that met the following inclusion criteria: studies comparing MACD and HS technique in venous anastomosis, reporting anastomotic time, and postoperative complications.ResultsThirty‐three studies were included for the analysis. Twenty‐four were retrospective case series and nine were retrospective comparative studies. A total of 12,304 patients were enrolled with a mean age of 49.23 years (range 31–72). A total of 13,669 flaps were accomplished. The thrombosis rate recorded with MACD was 1.47%. The meta‐analysis revealed that MACD significantly decreased anastomotic time (standard difference in means = −0.395 ± 0.105; Z = −3.776; p < .001) and postoperative flap failure risk (odds ratio [OR] = 0.362, 95% confidence interval [CI] = 0.218–0.603, Z = −3.908, p < .001), but it did not decrease postoperative venous thrombosis risk (OR = 0.504, 95% CI = 0.255–1.129, Z = −1.666, p = .096).ConclusionsMACDs are a safe and effective alternative to traditional anastomosis. The anastomotic coupler is easier, much faster, and requires less technical skills than a HS microvascular anastomosis.

Technological advancements in head and neck free tissue transfer reconstruction

“…Suturing technique certainly requires training due to the potential for back-wall placement of sutures and poor suture placement leading to thrombosis, stenosis, or anastomotic leaks. The conceptual design of the microvascular coupler was first described in 1962 by Nakayama et al [22] and was introduced into use in 1986 by Ostrup and Berggren [23] . The coupler design consists of two rings with interlocking pins and corresponding holes.…”

A retrospective evaluation of 182 free flaps in extremity reconstruction and review of the literature

“…Since its first description by Jacobson and Suarez [ 7 ], the vessel couplers have been developed and introduced in the clinical practice for the venous anastomosis, as the soft, pliable venous wall enables the use of these devices [ 8 ]. Venous couplers have proven over time a reduced flap failure risk and especially a reduced operative time, meaning a reduced flap ischemia time and the possibility of swiftly performing more venous anastomosis [ 9 ]. The question remains though if more venous anastomosis could reduce the risk of partial or total flap failure [ 10 ].…”

Reply to comments on “Microvascular coupler device versus handsewn venous anastomosis: A systematic review of the literature and data meta‐analysis”

“…This is an emerging issue resulting from the absence of clinical trials.Recently, the number of meta-analysis investigating this topic is increasing, but reliability of this study was limited by the quality of the available literature. In our study (Maruccia et al, 2020), we have tried to assess the methodological quality and/or risk of bias for nonrandomized studies using the methodological index for nonrandomized studies (MINORS;Slim et al, 2003). Studies that did not…”