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J Reconstr Microsurg
DOI: 10.1055/a-2751-8780
Original Article

An Algorithmic Approach to Arterial Coupler Use in Microsurgical Breast Reconstruction: Comparison with Hand-Sewn Sutures

Authors

  • Hyung Bae Kim 

    1   Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

  • Hyun Ill Kang 

    1   Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

  • Hyun Ho Han

    1   Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

  • Jin Sup Eom

    1   Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Abstract

Background

Microsurgical breast reconstruction offers superior outcomes after mastectomy, but vascular microanastomosis remains technically demanding. Venous couplers are widely adopted, whereas the use of arterial couplers remains controversial. This study aimed to establish an algorithmic approach for arterial coupler use and compare outcomes with hand-sewn sutures.

Methods

A retrospective review was performed on 105 patients undergoing deep inferior epigastric perforator flap breast reconstruction by a single surgeon. Patients were divided into an arterial coupler group (n = 62) and a hand-sewn suture group (n = 43). An intraoperative algorithm guided coupler use, requiring the absence of atherosclerosis, intact intima, and adequate vessel laxity. Demographics, operative details, microanastomosis time, and postoperative outcomes were analyzed.

Results

Patients in the coupler group were younger (47.6 ± 8.6 vs. 53.0 ± 7.9 years, p = 0.001) and underwent more robot-assisted procedures (16.1% vs. 2.3%, p = 0.025). Microanastomosis time was significantly shorter with couplers (19.6 ± 8.9 vs. 26.1 ± 6.5 minutes, p < 0.01). Flap survival was comparable between groups (96.8% vs. 100%, p = 0.512). Complication rates, including arterial/venous insufficiency, hematoma, and infection, showed no significant differences. Two coupler failures occurred: One venous congestion and one late thrombosis, both attributed to multifactorial causes rather than device failure.

Conclusion

Arterial couplers, when used under strict algorithmic selection criteria, provide reliable outcomes comparable to hand-sewn sutures while significantly reducing operative time. This approach enhances efficiency in microsurgical breast reconstruction and may guide future standardized practice.

Keywords

breast reconstruction - microanastomosis - vessel coupler


Publication History

Received: 04 September 2025

Accepted: 19 November 2025

Accepted Manuscript online:
24 November 2025

Article published online:
12 December 2025

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