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1000 Consecutive Venous Anastomoses Using the Microvascular Anastomotic Coupler in Breast Reconstruction

Jandali, Shareef M.D.; Wu, Liza C. M.D.; Vega, Stephen J. M.D.; Kovach, Stephen J. M.D.; Serletti, Joseph M. M.D.

Plastic and Reconstructive Surgery: March 2010 - Volume 125 - Issue 3 - p 792-798
doi: 10.1097/PRS.0b013e3181cb636d

Background: Microvascular anastomosis is one of the more critical aspects of free flap surgery. A safe, effective, and expedient method for venous anastomosis minimizes flap ischemia time, is easier on the surgical team, and saves costly operating room time. The authors report on their experience using the Synovis microvascular anastomotic coupling device in 1000 consecutive venous anastomoses in free flap breast reconstruction.

Methods: The authors retrospectively reviewed 1000 consecutive venous anastomoses that were performed using the microvascular anastomotic coupler between July of 2002 and July of 2008. Data were obtained on flap type, recipient vessel, coupler size, incidence of venous thrombosis, timing of venous thrombosis, and morbidity as a result of venous thrombosis.

Results: All anastomoses were performed in an end-to-end fashion. There were 460 unilateral cases and 270 bilateral cases of breast reconstruction. Flap types included muscle-sparing free transverse rectus abdominis myocutaneous, deep inferior epigastric perforator, superficial inferior epigastric artery, superior gluteal artery perforator, and inferior gluteal artery perforator. The vast majority of the recipient vessels were the internal mammary or thoracodorsal vessels. Most of the couplers that were used were either 3 or 2.5 mm in diameter. Overall, there were six instances of venous thrombosis (rate of 0.6 percent). There were no total flap losses due to venous thrombosis in this series, although two patients had partial flap necrosis.

Conclusions: The patency rate for venous anastomoses performed with the microvascular coupler is excellent when compared with standard suture techniques and has the advantage of overall easier application.

Philadelphia, Pa.; and Rochester, N.Y.

From the Division of Plastic Surgery, University of Pennsylvania Health System, and the Division of Plastic Surgery, University of Rochester Medical Center.

Received for publication April 20, 2009; accepted September 4, 2009.

Presented at the 2009 Annual Meeting of the American Society for Reconstructive Microsurgery, in Maui, Hawaii, January 10 through 13, 2009.

Disclosures:Funding for this study was provided by Synovis Surgical Innovations (St. Paul, Minn.). The authors have no commercial association or financial interest to disclose.

Shareef Jandali, M.D.; Division of Plastic Surgery; University of Pennsylvania Health System; 3400 Spruce Street; 10 Penn Tower; Philadelphia, Pa. 19104;

©2010American Society of Plastic Surgeons