Venous coupler use for free-flap breast reconstructions: specific analyses of TMG and DIEP flaps.
OBJECTIVE
The purpose of this report was to present the results of comparisons of anastomotic data and flap complications in the use of venous coupler in breast reconstruction with the transverse musculocutaneous gracilis (TMG) flap and the deep inferior epigastric perforator (DIEP) flap.


METHODS
Over a three-year period, 95 patients suffering from breast cancer were treated with mastectomy and breast reconstruction using free flaps. We performed 121 mechanical venous anastomoses for 105 flap procedures (80 DIEP and 25 TMG). The coupler size, anastomotic duration, number of anastomoses and postoperative complications were assessed for the entire series.


RESULTS
The coupling device was perfectly suitable for all end-to-end anastomoses between the vein(s) of the flap and the internal mammary vein(s). No venous thrombosis occurred. The mean anastomotic time did not significantly differ between the DIEP (330 seconds) and TMG flap procedures (352 seconds) (P = 0.069). Additionally, there were no differences in coupling time observed following a comparison of seven coupler sizes (P = 0.066). The mean coupler size used during the TMG flap procedure was smaller than that used with the DIEP (2.4 mm versus 2.8 mm) (P < 0.001). The mean size was also smaller when double venous anastomoses were required compared to single anastomosis (2.4 mm versus 2.9 mm) (P < 0.001). The double branching was more frequent with the TMG flap (28%) than with the DIEP flap (11%).


CONCLUSIONS
The coupler size used was smaller for the TMG procedure and when double venous anastomosis was performed. Additionally, anastomotic time was not affected by the flap type or coupler size used or by anastomosis number.
Department of Plastic Surgery, Strasbourg Academic Hospital, Strasbourg, France.
Frédéric
F
Bodin
Department of Hand Surgery, Strasbourg Academic Hospital, Strasbourg, France.
Stefania
S
Brunetti
Department of Plastic Surgery, Strasbourg Academic Hospital, Strasbourg, France.
Caroline
C
Dissaux
Department of Biostatistics, Strasbourg Academic Hospital, Strasbourg, France.
A Sauleau
AS
Erik
Department of Hand Surgery, Strasbourg Academic Hospital, Strasbourg, France.
Sybille
S
Facca
Department of Plastic Surgery, Strasbourg Academic Hospital, Strasbourg, France.
Catherine
C
Bruant-Rodier
Department of Hand Surgery, Strasbourg Academic Hospital, Strasbourg, France.
Philippe
P
Liverneaux
D000328:Adult; D000714:Anastomosis, Surgical; D001940:Breast / Q000098:blood supply* / Q000601:surgery; D019074:Epigastric Arteries / Q000601:surgery*; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply* / Q000637:transplantation; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D012189:Retrospective Studies; D014680:Veins / Q000033:anatomy & histology / Q000601:surgery*