title: Microvascular anastomotic coupler assessment in head and neck reconstruction.
abstract: OBJECTIVE
  To assess the advantages of using mechanical anastomotic systems in head and neck free tissue transfer.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  A university-based tertiary care center.
  
  
  METHODS
  A retrospective review of mechanical venous coupler devices in head and neck reconstruction performed between October 2004 and December 2006. A total of 261 venous anastomoses were performed in 234 consecutive patients. Five types of flaps were performed: radial forearm (66%), anterior lateral thigh (12%), fibula (9%), rectus abdominis (8%), and latissimus dorsi (2%). Demographic data were collected, and the outcomes measured were flap survival and microvascular complications.
  
  
  RESULTS
  The size of the venous anastomosis ranged from 1.5 to 4.0 mm, with most being 3.0 mm (56%) followed by 3.5 mm (23%). The most common recipient vein used was a stump off the internal jugular vein (76%) followed by the external jugular vein (17%). Microvascular complications occurred in <5% (n = 11) of patients, with >50% of those being arterial insufficiency (n = 7). Total failures occurred in 3% (n = 7) of patients: 1.5% (n = 4) acute failures (<5 days) and 1.5% (n = 3) late failures. Of the acute failures, causes included venous congestion (n = 1) and arterial insufficiencies (n = 3). The venous coupler used in the failures was 3.0 mm in diameter. Free flap failures resulting from arterial insufficiency involved coupling to the external jugular vein, while the remaining free flap failures (n = 4) used the internal jugular vein.
  
  
  CONCLUSIONS
  With an early venous failure rate of 0.38%, mechanical anastomosis is an adequate alternative to hand-sewn techniques.
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294-0012, USA. jwfred@uab.edu
authors.forename: John W
authors.initials: JW
authors.lastname: Frederick
authors.forename: Larissa
authors.initials: L
authors.lastname: Sweeny
authors.forename: William R
authors.initials: WR
authors.lastname: Carroll
authors.forename: Eben L
authors.initials: EL
authors.lastname: Rosenthal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000295:instrumentation; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000295:instrumentation*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000295:instrumentation*; D012189:Retrospective Studies; D013536:Suture Techniques / Q000295:instrumentation*; D016896:Treatment Outcome
keywords: head and neck; mechanical anastomosis; microvascular; outcomes; reconstruction