Relaxing fish-mouth incision for a tight coupler anastomosis

The microvascular coupler device has reduced operative times and increased patency rates. Attempting to place a smaller tightly fitting vessel around a larger coupler ring can tear vessels and may require substitution with a smaller coupler device, which can not only add additional cost but also compromise the flap. We describe the theoretic and clinical aspects of the 'fish-mouthing' technique that we employ to help with the discrepancy in size of a smaller vessel compared to the coupler ring. The technique involves a longitudinal fish-mouth opening incision into the vessel lumen, prior to impaling the vessels' last three pins on the coupler ring creates two wings and increases the absolute vessel circumference to ease anastomosis .