The utility of microvascular anastomotic devices in head and neck reconstruction

The use of microvascular anastomotic devices remains controversial in head and neck reconstructive surgery. Although more acceptable in venous anastomosis, their use in arterial anastomosis remains limited. We review the literature to evaluate the evidence both for and against their use, in both venous and arterial anastomoses.

The current literature supports the use of anastomotic coupling devices in head and neck reconstructive surgery. They have been reported as consistently reducing the anastomotic time with an associated reduction in cold ischaemic time. There is no evidence available to date that shows different thrombotic rates between anastomotic devices and hand sewing or between the different anastomotic devices available in the market.

The current literature would support the use of these devices in both arterial and venous anastomoses. Many microvascular surgeons would prefer to maintain their skills with hand sewing, as the use of an anastomotic coupling device is not always possible. Therefore, a hand-sewn arterial anastomosis and coupled venous anastomosis is a good compromise until larger series of results are available.