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An Algorithmic Approach to Arterial Coupler Use in Microsurgical Breast Reconstruction: Comparison with Hand-Sewn
Hyung Bae Kim1, Hyun Ill Kang1, Hyun Ho Han1
1Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Journal of Reconstructive Microsurgery
|November 24, 2025
Summary
Arterial couplers in microsurgical breast reconstruction significantly reduce microanastomosis time compared to sutures. When used with strict criteria, they offer comparable outcomes and enhance surgical efficiency.
Area of Science:
- Microsurgery
- Plastic and reconstructive surgery
- Vascular surgery
Background:
- Microsurgical breast reconstruction provides excellent outcomes but requires technically demanding vascular microanastomosis.
- Venous couplers are common, but arterial coupler use is debated.
- Standardizing arterial coupler use is crucial for improving efficiency and outcomes.
Purpose of the Study:
- To establish an algorithmic approach for arterial coupler use in deep inferior epigastric perforator flap breast reconstruction.
- To compare the outcomes of arterial coupler use versus traditional hand-sewn sutures.
Main Methods:
- Retrospective review of 105 patients undergoing deep inferior epigastric perforator flap breast reconstruction.
- Patients were divided into an arterial coupler group (n=62) and a hand-sewn suture group (n=43).
- An intraoperative algorithm guided arterial coupler selection based on vessel quality; outcomes and microanastomosis time were analyzed.
Main Results:
- The arterial coupler group had a significantly shorter microanastomosis time (19.6 vs. 26.1 minutes, p<0.01).
- Flap survival rates were comparable between groups (96.8% vs. 100%, p=0.512).
- Complication rates (arterial/venous insufficiency, hematoma, infection) and overall outcomes were similar.
Conclusions:
- Arterial couplers, when applied using strict algorithmic criteria, are reliable and reduce operative time in microsurgical breast reconstruction.
- This approach yields outcomes comparable to hand-sewn sutures, enhancing surgical efficiency.
- The findings support the integration of arterial couplers into standardized microsurgical breast reconstruction practices.
