title: Clinical experience in end-to-side venous anastomoses with a microvascular anastomotic coupling device in head and neck reconstruction.
abstract: BACKGROUND
  Microvascular anastomosis remains one of the most technically sensitive aspects of free-tissue transfer reconstructions. Despite the availability of various mechanical anastomotic coupling systems for human clinical use during the last 8 years, reported clinical series remain rare.
  
  
  OBJECTIVE
  To describe a clinical experience in applying a mechanical microvascular anastomotic coupling device (MACD) to end-to-side anastomotic configurations in head and neck free-flap reconstruction.
  
  
  METHODS
  The MACD is a readily available high-density polyethylene ring-stainless steel pin system that has been found to be highly effective in clinical studies of end-to-end arterial and venous anastomosis and in laboratory studies of end-to-side anastomosis of rabbit arteries.
  
  
  RESULTS
  Thirty-seven end-to-side venous anastomoses were attempted, of which 33 (89%) were completed. Of these, 9 patients had critical anastomoses (only 1 venous anastomosis per patient). In patients undergoing parallel venous anastomoses, 6 had both anastomoses performed using the MACD; in the remaining 12 patients, 1 of the anastomoses was performed using the MACD. A variety of donor flaps and clinical contexts were encountered. Flap survival in the MACD series was 100%. Four anastomoses were converted to conventional suture technique intraoperatively.
  
  
  CONCLUSIONS
  The MACD is well suited to end-to-side venous anastomosis when carefully and selectively used by experienced microvascular surgeons. The most common clinical situation requiring this configuration and technique was the lack of ipsilateral recipient veins for end-to-end anastomosis or a ligated internal jugular vein stump that required this approach for device application. Previous radiation therapy does not appear to be a contraindication to its use.
authors.affiliation: Department of Otolaryngology, New York University School of Medicine, NY 10016, USA. mark.delacure@med.nyu.edu
authors.forename: M D
authors.initials: MD
authors.lastname: DeLacure
authors.forename: M A
authors.initials: MA
authors.lastname: Kuriakose
authors.forename: A L
authors.initials: AL
authors.lastname: Spies
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000295:instrumentation*; D005260:Female; D006257:Head / Q000098:blood supply / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000098:blood supply / Q000601:surgery*; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013524:Surgical Flaps; D014656:Vascular Surgical Procedures / Q000295:instrumentation*; D014680:Veins / Q000637:transplantation