title: The utility of the microvascular anastomotic coupler in free tissue transfer.
abstract: BACKGROUND
  The microvascular anastomosis remains a technically sensitive and critical determinant of success in free tissue transfer. The microvascular anastomotic coupling device is an elegant, friction-fit ring pin device that is becoming more widely used.
  
  
  OBJECTIVE
  To systematically review the literature to examine the utility of the microvascular coupler in free tissue transfer.
  
  
  METHODS
  A comprehensive database search was performed to identify eligible publications. Inclusion criteria were anastomotic coupler utilization and free-tissue transfer. Recorded information from eligible studies included patient age, follow-up, radiation history, number of free-flaps and failure rates, reconstruction subsites, number of coupled venous and arterial anastomoses, coupling time, conversion to sutured anastomosis, coupler size and thrombosis rates.
  
  
  RESULTS
  Twenty-five studies reporting on 3207 patients were included in the analysis. A total of 3576 free-flaps were performed within the following subsites: 1103 head and neck, 2094 breast, 300 limb or body, and 79 nonspecified. There were only 26 reported flap failures (0.7%). A total of 3497 venous and 342 arterial coupled anastomoses were performed. The primary outcome measure was thrombosis rates, and there were 61 venous (1.7%) and 12 arterial (3.6%) thromboses reported. Mean coupling time was 5 min, and 30 anastomoses (0.8%) were converted to suture.
  
  
  CONCLUSIONS
  Flap survival and revision-free application of the microvascular coupler occurred in more than 99% of cases. There is a substantial time savings with coupler use. Venous and arterial thrombosis rates are comparable with the best results achieved by sutured anastomosis and, when used by experienced surgeons, the coupler achieves superior results.
authors.affiliation: University of Toronto, Sunnybrook Health Sciences Centre, Department of Otolaryngology, Head and Neck Surgery,Toronto;
authors.forename: Amandeep S
authors.initials: AS
authors.lastname: Grewal
authors.forename: Boban
authors.initials: B
authors.lastname: Erovic
authors.forename: Nick
authors.initials: N
authors.lastname: Strumas
authors.forename: Danny J
authors.initials: DJ
authors.lastname: Enepekides
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Higgins
keywords: Free tissue transfer; Microvascular anastomosis; Ring pin; Venous coupler