Lower Extremity Microvascular Reconstruction Outcomes Using an Anastomotic Venous Coupler Device
Nilton D. Medina, John P. Fischer, MD, Joshua Fosnot, MD, Joseph M. Serletti, MD, Liza C. Wu, MD, Steven J. Kovach, III, MD.
University of Pennsylvania, Philadelphia, PA, USA.
Venous anastomosis is one of the most challenging aspects of microsurgery which has been expedited by the use of a coupler device in multiple reconstructive venues. There have been no large studies in the literature evaluating the use of the coupler in lower extremity reconstruction. We present the largest series to date examining the usage of the venous coupler in microsurgical reconstruction of the lower extremity.
A retrospective chart review was completed including all lower extremity soft tissue reconstruction over a 26 month period performed by the senior authors. The venous coupler of choice at our institution is made by Synovis Micro Companies Alliance Inc. (Birmingham, AL, USA). Patients under 18 years of age were excluded.
During this time period, 49 free flaps were performed in 48 patients (38 male, 10 female, mean age of 44). Of the 48 patients, 18 (37.5%) had wounds that were greater than 30 days old at the time of free tissue reconstruction. Average duration of follow up was 8.8 months. Wounds reconstructed included: 75% traumatic, 10.5% oncologic, 8.3% vasculopathic, and 8.3% others. Free flap choices included: 36.7% vastus lataralis, 32.7% anterior lateral thigh, 20.4% rectus abdominis, 4% latissimus, 4% fibula, and 2% gracilis. All arterial anastomoses were hand sutured, and the anastomotic venous coupler was used in 48 of 49 flaps (97.9%) with one handsewn case due to attending preference during early experience. There were no intra-operative vascular complications. Successful free flap reconstruction occurred in 47 of 49 flaps (95.9%). Of the flap losses, 1 was due to venous thrombosis, the other attributed to delayed arterial thrombosis. Of those cases where a coupler was used, only 1 resulted in venous thrombosis equating to a success rate of 97.1%. Overall flap complications were seen in 9 of 49 flaps (18.3%). Complications included: 2 complete flap losses, 3 partial flap necroses, 2 hematomas and 2 infections.
The use of the venous coupler device in lower extremity reconstruction can be performed with a high degree of success. While more prospective studies are necessary to compare outcomes, the potential for reduced operative time, more efficient anastomoses with resultant decreased ischemia, as well as reduced thrombotic rates represent potential benefits of this important tool.
Back to Program