CLINICAL-EXPERIENCE WITH A MICROVASCULAR ANASTOMOTIC DEVICE IN HEAD AND NECK RECONSTRUCTION

BACKGROUND: Despite numerous refinements in microsurgical technique an d instrumentation, the microvascular anastomosis remains one of the mo st technically sensitive aspects of free-tissue transfer reconstructio ns. MATERIALS AND METHODS: Concurrent with the development of microsur gical techniques, various anastomotic coupling systems have been intro duced in an effort to facilitate the performance and reliability of mi crovascular anastomoses. The microvascular anastomotic coupling device (MACD) studied here is a high-density, polyethylene ring-stainless st eel pin system that has been found to be highly effective in laborator y animal studies. Despite its availability for human clinical use over the last 5 years, reported clinical series remain rare. Our clinical experience with this MACD in 29 head and neck free-tissue transfers is reported herein. RESULTS: Thirty-five of 37 (95%) attempted anastomos es were completed with 100% flap survival with a variety of donor flap s, recipient vessels, and clinical contexts. Two anastomoses were conv erted to conventional suture technique intraoperatively, and one late postoperative venous thrombosis occurred after fistulization and vesse l exposure. CONCLUSIONS: We conclude that the MACD studied here is bes t suited for the end-to-end anastomosis of soft, pliable, minimally di screpant vessels. Previous radiation therapy does not appear to be a c ontraindication to its use, Interpositional vein grafts may also be we ll suited to anastomosis with the device. When carefully and selective ly employed by experienced microvascular surgeons, this MACD can be a safe, fast, and reliable adjunct in head and neck free-tissue transfer reconstructions, greatly facilitating the efficiency and ease of appl ication of these techniques.