Differences in free flaps' reconstructions with and without coupling device for venous anastomosis

Area of Science:

• Microsurgery
• Vascular Anastomosis
• Free Flap Reconstruction

Background:

• Introduction of coupler devices for neck vessel anastomoses alters surgical planning and execution.
• Rigid ring couplers maintain vein patency, potentially improving flap survival and reducing surgery duration.

Purpose of the Study:

• To compare surgical planning differences between coupler devices and sutures for venous microsurgical anastomoses.
• To evaluate the impact of coupler devices on surgery duration, flap survival, and costs in head and neck reconstructions.

Main Methods:

• Retrospective analysis of 209 patients undergoing 212 microvascular free flap reconstructions (Jan 2011-Dec 2017).
• Flap types included radial forearm, anterolateral thigh, fibula, and iliac crest free flaps.
• Comparison of 212 arterial and 127 venous anastomoses using sutures versus 104 venous anastomoses using couplers.

Main Results:

• Mean surgery duration was significantly shorter with couplers (358.88 min) compared to sutures (452.82 min) (P<0.05).
• No statistically significant differences in flap survival or partial necrosis rates were observed between the groups (P>0.05).
• Donor vessel distribution and estimated procedural costs differed significantly between the coupler and suture groups.

Conclusions:

• Coupler use for venous anastomosis in head and neck free flap reconstructions shortens operative time.
• Reduced surgery duration associated with couplers can lead to cost reductions.
• Further investigation into donor vessel distribution and cost-effectiveness is warranted.