The Use Of Microvascular Coupling Device For Arterial Anastomosis In Head And Neck Reconstruction

Purpose:Microsurgery,the specialized surgical technique of observing through the microscope when operating on fine structures of the human body,has made potential significant advances in surgery on humans.Success of FTTsand clinical efficacy of reconstructionrelyon the quality of the microvascular anastomosis,which is deemed tobe the most challenging and important technique.However,advanced anastomotic devices have beendeveloped to aidmicrovascular anastomosis,and theneedle ring type anastomosis coupling devicehas been proved to be themost reliable technologies.A lot of literatures have demonstrated the ease and reliabilitywith which these devices can be used in venous anastomosis in all territories of thebody.Thus far,nevertheless,despite the ubiquitous application of couplers for venous anastomosis,there are few reports about theclinical application of couplersinarterial anastomosisbecause of the particularity of arteries.The purpose of this study is to demonstrate the efficacy of microvascular coupler for arterial anastomosis in head and neck reconstruction during a 5-year period at the Department of Oral and Maxillofacial Surgery,Shandong Province Hospital.Methods:45 cases of microvascular free flaps from October 2013 through December 2017were retrospectively reviewed.A total of 66 couplers were used in these cases while 21 in arterial anastomosisand 45 in vein anastomosis.Patients’ information,flap survival and thrombosis of the anastomoses were determined in these cases.Results:A total of 45 consecutive patients underwent microsurgical head and neck reconstructionwithout intraoperative complications.The size of couplers used in arterial anastomosis ranged from 1.5mm to 2.5mm,with most being 2.0mm.The mean time forarterialanastomosis with couplers was 5.9±1.2 min(range,4-9)and it was 21.0±1.3 min(range,18-24)in suturing arteries.There’s statistical significance between two group’smean time and the morbidity of postoperative complication(P<0.05).However,no statistical significance is showed in success rate ofoperations(P>0.05).Conclusion:Use of a coupler device shows reliability for arterial anastomosis in head and neck reconstruction free tissue transfers.With proper vessel selection and sufficient experienceusing the microvascular coupler,arterial coupling may be performed in an expeditious,safe,and reliable fashion with minimal morbidity.Though not commonly practiced,use of the coupling device for arterial anastomosis can provide significant time savings,is a viable alternative to sutured anastomoses.However,the high cost of the coupler limits its use,for the present,microvascular anastomosis with sutures still cannot be completely replaced.