Clinical experience with a microvascular anastomotic device in head and neck reconstruction.
BACKGROUND
Despite numerous refinements in microsurgical technique and instrumentation, the microvascular anastomosis remains one of the most technically sensitive aspects of free-tissue transfer reconstructions.


METHODS
Concurrent with the development of microsurgical techniques, various anastomotic coupling systems have been introduced in an effort to facilitate the performance and reliability of microvascular anastomoses. The microvascular anastomotic coupling device (MACD) studied here is a high-density, polyethylene ring-stainless steel pin system that has been found to be highly effective in laboratory animal studies. Despite its availability for human clinical use over the last 5 years, reported clinical series remain rare. Our clinical experience with this MACD in 29 head and neck free-tissue transfers is reported herein.


RESULTS
Thirty-five of 37 (95%) attempted anastomoses were completed with 100% flap survival with a variety of donor flaps, recipient vessels, and clinical contexts. Two anastomoses were converted to conventional suture technique intraoperatively, and one late postoperative venous thrombosis occurred after fistulization and vessel exposure.


CONCLUSIONS
We conclude that the MACD studied here is best suited for the end-to-end anastomosis of soft, pliable, minimally discrepant vessels. Previous radiation therapy does not appear to be a contraindication to its use. Interpositional vein grafts may also be well suited to anastomosis with the device. When carefully and selectively employed by experienced microvascular surgeons, this MACD can be a safe, fast, and reliable adjunct in head and neck free-tissue transfer reconstructions, greatly facilitating the efficiency and ease of application of these techniques.
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000295:instrumentation*; D017577:Cutaneous Fistula / Q000209:etiology; D004867:Equipment Design; D005260:Female; D005402:Fistula / Q000209:etiology; D006085:Graft Survival; D006257:Head / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000295:instrumentation*; D008875:Middle Aged; D009059:Mouth Diseases / Q000209:etiology; D009333:Neck / Q000601:surgery*; D011095:Polyethylenes / Q000737:chemistry; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013193:Stainless Steel / Q000737:chemistry; D013499:Surface Properties; D013524:Surgical Flaps / Q000009:adverse effects / Q000295:instrumentation*; D013536:Suture Techniques; D013924:Thrombophlebitis / Q000209:etiology; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation*; D014680:Veins / Q000637:transplantation
D011095:Polyethylenes; D013193:Stainless Steel