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

Abstract

Background Coupling 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. Objective To describe the safety and feasibility of using microvascular coupling devices for free flap arterial anastomosis. Methods A 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. Results Fifteen 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. Conclusion In selected patients, coupling devices for arterial anastomoses have a good success rate with low rates of thrombosis based on limited quality evidence.

Israeli Innovations in the Field of Plastic Surgery

“…These devices have been proven to reduce operative time, flap failure rate, and technical skill needed to perform microsurgery. [17][18][19] Perfect intima-to-intima contact, vessel eversion, and rigid external stenting are all factors that contribute to the success of microvascular anastomosis when performed with an anastomotic coupler device. 20,21 These elements function to reduce the risk of vessel collapse and spasm, minimize intima tears, and prevent contact between thrombogenic foreign bodies and the vessel lumen.…”

“…These devices have been proven to reduce operative time, flap failure rate, and technical skill needed to perform microsurgery. 17 18 19…”

Technological advancements in head and neck free tissue transfer reconstruction

“…Arteries have thicker walls and may be affected by atherosclerotic disease and radiation induced thrombosis in patients with prior radiation to the field. Earlier literature on microvascular coupling of the artery has reported concerns for increased thrombosis rates [32][33][34] . However, recent studies have provided more support for arterial coupling.…”

Comparison of a coupling system and the suture method in end‐to‐side microvascular anastomosis in head and neck reconstruction

“…Since the introduction of an instrument for anastomosis of small blood vessels by Nakayama in 1962 (Nakayama et al, 1962), repeated improvements have been introduced, and use of the microvascular anastomotic coupling device has increased. This device has an excellent success rate and can achieve anastomosis in a shorter time than the suture method (Grewal et al, 2012; Gundale et al, 2020). End‐to‐end (ETE) anastomoses using this device are performed widely, but end‐to‐side (ETS) anastomoses are not as common because there is no established standard method.…”