title: Venous Thrombosis in Handsewn versus Coupled Venous Anastomoses in 857 Consecutive Breast Free Flaps.
abstract: BACKGROUND
  The anastomotic coupling device has demonstrated safety and efficacy; however, the coupler has never been compared directly to handsewn venous anastomoses exclusively in breast reconstruction. We hypothesized that rates of venous thrombosis would be lower using the coupler versus handsewn anastomoses in free flap breast reconstruction.
  
  
  METHODS
  We performed a retrospective review utilizing clinic records, hospital records, and operative reports for 857 consecutive breast free flaps at a single institution from 1997 to 2012. Data were collected on reconstruction type, recipient vessels, timing, laterality, preoperative radiation, chemotherapy, venous thrombosis, and flap outcome. We compared rates of venous thrombosis between handsewn and coupled anastomoses for breast free flaps. Chi-square test was used to calculate statistical significance.
  
  
  RESULTS
  A total of 857 consecutive free flaps were performed for breast reconstruction in 647 patients over 16 years. The venous anastomosis was handsewn in 303 flaps, and the anastomotic coupler was used in 554 flaps. The rate of venous thrombosis requiring anastomotic revision in the handsewn group was 0.04% (12/303), compared with 0.01% in the coupled group (8/554; p = 0.02).
  
  
  CONCLUSIONS
  The anastomotic coupler was more effective in preventing venous thrombosis than handsewn anastomoses in our series. While our study demonstrates improved patency rates using the venous coupler in breast reconstruction, we were unable to definitively separate this finding from potential confounding variables due to the low rates of thrombosis in both the groups. Our data are consistent with current literature, which suggests that the coupler is a safe and effective alternative to hand sutured anastomoses.
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Anita R
authors.initials: AR
authors.lastname: Kulkarni
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Babak J
authors.initials: BJ
authors.lastname: Mehrara
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Pusic
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Cordeiro
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Evan
authors.initials: E
authors.lastname: Matros
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: McCarthy
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Disa
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D016462:Mammaplasty / Q000295:instrumentation*; D008866:Microsurgery / Q000295:instrumentation*; D012189:Retrospective Studies; D013524:Surgical Flaps; D013536:Suture Techniques; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000453:epidemiology*