Use of the Arterial Coupler for Free Flap Breast Reconstruction
Christian Subbio, MD, Stephen J. Vega, MD, Chrysa L. Charno, RPA-C, MBA.
Vega Aesthetic & Reconstructive Surgery, Pittsford, NY, USA.
BACKGROUND: Microsurgical technique is an important component of breast reconstructive surgery. The microvascular coupler has greatly improved outcomes for the venous anastamoses by saving operative time, reducing surgeon fatigue and by reducing thrombotic complications. We present a clinical series using the microvascular coupler for arterial anastamoses.
METHODS: A retrospective review was conducted of all autogenous postmastectomy reconstructions performed between January of 2009 and March of 2010. All patients receiving free flap breast reconstructions for postmastectomy defects were reviewed and those patients who received coupled anastamoses were included in this study. Office and hospital charts were reviewed.
RESULTS: One hundred twenty-three free flaps were performed by a single surgeon at two area hospitals from January 2009 to February 2010. Forty-two coupled arteries (34.1% of total flaps performed) were performed in thirty-five patients during the study period. Average patient age was 52.5 years (range, 35 to 77 years), and average body mass index was 28.8 (range, 22.1 to 47.2). Twenty-two extreme muscle sparing free TRAM flaps (MSIII- 19 immediate and 3 delayed) and twenty free DIEP (16 immediate and 4 delayed) were performed. On the right side, seventeen arteries were coupled (7 with 2.5mm and 10 with 3mm) to either the thoracodorsal artery (14) or internal mammary artery (3). On the left side, twenty-five arteries were coupled (8 with 2.5mm and 17 with 3mm) to either to the thoracodorsal artery (22), internal mammary artery (2) or subscapular artery (1). The remaining arteries were sewn with either 8-0 or 9-0 Nylon suture and all veins were coupled. Outcomes included no flap loss, arterial coupler intraoperative re-do rate of 16.6 percent (5 re-anastamoses with suture and 2 re-anastamoses with another coupler usually for spasm or poor flow), average operating time of 4.58 hours (time-in-room to time-out-of room) for unilateral (18 patients) and 6.35 hours for bilateral (17 patients) and average hospital stay of 3 days.
CONCLUSIONS: Arterial coupling is an efficacious method for anastamoses which reduces operative time and has the potential for reducing surgeon fatigue. An added benefit is the lack of a suture line in the anastamosis. This method has been less useful for the internal mammary system.
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