J Reconstr Microsurg 2021; 37(02): 132-135
DOI: 10.1055/s-0040-1715585
Original Article

Safety of Coupled Arterial Anastomosis in Autologous Breast Reconstruction

Mariel McLaughlin
1   College of Medicine, University of Florida, Gainesville, Florida
,
Brooke E. Porter
1   College of Medicine, University of Florida, Gainesville, Florida
,
Rachel Cohen-Shohet
2   Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida, Gainesville, Florida
,
Mark M. Leyngold
2   Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida, Gainesville, Florida
› Author Affiliations

Abstract

Background This study compares the outcomes of coupled versus hand-sewn arterial anastomosis in microvascular breast reconstruction.

Methods Retrospective chart review of breast reconstruction free flaps performed between 2013 and 2018 was conducted. Primary end points included flap loss, intraoperative arterial anastomosis revision, and operating room takeback. The decision to couple the arterial anastomosis was based on patient's age, surgeon's preference, history of radiation, and vessel quality. All anastomoses were performed under ×3.5 loupe magnification to internal mammary or thoracodorsal vessels.

Results Authors reviewed 104 free flaps; two were lost in hand-sewn group; no flaps were lost in coupled group. There was no significant difference in anastomotic revision rate between coupled and hand-sewn arterial anastomosis (p = 0.186) or return to operating room (OR) between coupled and hand-sewn flaps (p = 1.000). Reasons for takeback included venous congestion and hematoma.

Conclusion This study reflects that coupled arterial anastomosis in breast reconstruction may be safely performed without increased risk in anastomotic revision, takeback, or flap loss. Decision to couple should be based on surgeon skill, patient age and history, and assessment of flap and recipient site vasculature.



Publication History

Received: 13 April 2020

Accepted: 23 June 2020

Article published online:
20 August 2020

© 2020. Thieme. All rights reserved.

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  • References

  • 1 Grewal AS, Erovic B, Strumas N, Enepekides DJ, Higgins KM. The utility of the microvascular anastomotic coupler in free tissue transfer. Can J Plast Surg 2012; 20 (02) 98-102
  • 2 Shindo ML, Costantino PD, Nalbone VP, Rice DH, Sinha UK. Use of a mechanical microvascular anastomotic device in head and neck free tissue transfer. Arch Otolaryngol Head Neck Surg 1996; 122 (05) 529-532
  • 3 Chernichenko N, Ross DA, Shin J, Chow JY, Sasaki CT, Ariyan S. Arterial coupling for microvascular free tissue transfer. Otolaryngol Head Neck Surg 2008; 138 (05) 614-618
  • 4 Ross DA, Chow JY, Shin J. et al. Arterial coupling for microvascular free tissue transfer in head and neck reconstruction. Arch Otolaryngol Head Neck Surg 2005; 131 (10) 891-895
  • 5 Ross DA, Ariyan S, Restifo R, Sasaki CT. Use of the operating microscope and loupes for head and neck free microvascular tissue transfer: a retrospective comparison. Arch Otolaryngol Head Neck Surg 2003; 129 (02) 189-193
  • 6 Sando IC, Plott JS, McCracken BM. et al. Simplifying arterial coupling in microsurgery-a preclinical assessment of an everter device to aid with arterial anastomosis. J Reconstr Microsurg 2018; 34 (06) 420-427
  • 7 Fitzgerald O'Connor E, Rozen WM, Chowdhry M. et al. The microvascular anastomotic coupler for venous anastomoses in free flap breast reconstruction improves outcomes. Gland Surg 2016; 5 (02) 88-92
  • 8 Zeebregts C, Acosta R, Bölander L, van Schilfgaarde R, Jakobsson O. Clinical experience with non-penetrating vascular clips in free-flap reconstructions. Br J Plast Surg 2002; 55 (02) 105-110
  • 9 Rozen WM, Whitaker IS, Acosta R. Venous coupler for free-flap anastomosis: outcomes of 1,000 cases. Anticancer Res 2010; 30 (04) 1293-1294
  • 10 Yap LH, Constantinides J, Butler CE. Venous thrombosis in coupled versus sutured microvascular anastomoses. Ann Plast Surg 2006; 57 (06) 666-669
  • 11 Spector JA, Draper LB, Levine JP, Ahn CY. Routine use of microvascular coupling device for arterial anastomosis in breast reconstruction. Ann Plast Surg 2006; 56 (04) 365-368
  • 12 Ahn CY, Shaw WW, Berns S, Markowitz BL. Clinical experience with the 3M microvascular coupling anastomotic device in 100 free-tissue transfers. Plast Reconstr Surg 1994; 93 (07) 1481-1484
  • 13 Lee ZH, Alfonso AR, Stranix JT. et al. Vein size mismatch increases flap failure in lower extremity trauma free flap reconstruction. J Reconstr Microsurg 2019; 35 (08) 587-593
  • 14 Colakoglu S, Johnson A, Anderson J, Mathes DW, Chong TW. Changes to venous flow coupler signal during DIEP flap inset can be predictive of poor clinical outcomes in autologous breast reconstruction. J Reconstr Microsurg 2020; 36 (06) 466-470