Clinical experience in end-to-side venous anastomoses with a microvascularanastomotic coupling device in head and neck reconstruction

Background: Microvascular anastomosis remains one of the most technically s ensitive aspects of free-tissue transfer reconstructions. Despite the avail ability of various mechanical anastomotic coupling systems for human clinic al use during the last 8 years, reported clinical series remain rare. Objective: To describe a clinical experience in applying a mechanical micro vascular anastomotic coupling device (MACD) to end-to-side anastomotic conf igurations in head and neck free-flap reconstruction. Methods: The MACD is a readily available high-density polyethylene ring-sta inless steel pin system that has been found to be highly effective in clini cal studies of end-to-end arterial and venous anastomosis and in laboratory studies of end-to-side anastomosis of rabbit arteries. Results: Thirty-seven end-to-side venous anastomoses were attempted, of whi ch 33 (89%) were completed. Of these, 9 patients had critical anastomoses ( only 1 venous anastomosis per patient). In patients undergoing parallel ven ous anastomoses, 6 had both anastomoses performed using the MACD; in the re maining 12 patients, 1 of the anastomoses was performed using the MACD. A v ariety of donor flaps and clinical contexts were encountered. Flap survival in the MACD series was 100%. Four anastomoses were converted to convention al suture technique intraoperatively. Conclusions: The MACD is well suited to end-to-side venous anastomosis when carefully and selectively used by experienced microvascular surgeons. The most common clinical, situation requiring this configuration and technique was the lack of ipsilateral recipient veins for end-to-end anastomosis or a ligated internal jugular vein stump that required this approach for device application. Previous radiation therapy does not appear to be a contraindi cation to its use.