title: Venous anastomoses using microvascular coupler in free flap head and neck reconstruction.
abstract: OBJECTIVE
  This study is a retrospective review of the experience using the venous coupler for head and neck reconstruction over a 3-year period at the University of Maryland Medical Center, Department of Oral and Maxillofacial Surgery.
  
  
  METHODS
  One hundred seventy-eight consecutive cases of microvascular free flaps between May 2007 and September 2010 were retrospectively reviewed. Data were collected by demographic information, flap type, recipient vessels, method of anastomosis, coupler size, coupler orientation, complications associated with coupler, and reconstruction results. Fisher exact test was used for statistical analysis.
  
  
  RESULTS
  There were 294 anastomotic coupler devices used in 173 flaps, with hand-sewn venous anastomoses performed in 5 patients. The overall flap success rate was 94.9% (169/178). Success rate among cases in which the coupler was used was 95.4% (8/173). Total coupler venous thrombosis rate was 4.0% (7/173), with a statistically significant difference (P < .05) in reference to the number of venous anastomoses performed: 58 cases had a single vein anastomosed, 5 cases developed thrombosis; while the 115 flaps with 2 venous anastomoses, only 2 cases had thrombosis.
  
  
  CONCLUSIONS
  The microvascular coupler is reliable for venous anastomosis in free flap head and neck reconstruction; dual-vein anastomoses appear to have better results than single-vein anastomoses. Flow coupler has a promising utility in monitoring buried flaps and flaps that are difficult to observe. The microvascular coupler deserves to be more commonly used in free flap head and neck reconstruction.
authors: Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China. zht1688net@yahoo.com
authors: Tao
authors: T
authors: Zhang
authors: Joshua
authors: J
authors: Lubek
authors: Andrew
authors: A
authors: Salama
authors: John
authors: J
authors: Caccamese
authors: Domenick
authors: D
authors: Coletti
authors: Donita
authors: D
authors: Dyalram
authors: Robert
authors: R
authors: Ord
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000295:instrumentation*; D004867:Equipment Design; D005145:Face / Q000098:blood supply; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D007571:Jaw Diseases / Q000601:surgery; D007601:Jugular Veins / Q000601:surgery; D008297:Male; D008446:Maxillofacial Injuries / Q000601:surgery; D008866:Microsurgery / Q000295:instrumentation*; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000295:instrumentation*; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000295:instrumentation*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation*; D014680:Veins / Q000601:surgery; D020246:Venous Thrombosis / Q000209:etiology; D055815:Young Adult