Double Thread Suspension: A Novel Technique to Facilitate End-to-Side Venous Anastomosis With a Microvascular Coupling Device in Head and Neck Reconstruction

Abstract Background There is a steep learning curve to attain a consistently good result in microvascular surgery. The venous anastomosis is a critical step in free-tissue transfer. The margin of error is less and the outcome depends on the surgeon’s skill and technique. Mechanical anastomotic coupling device (MACD) has been proven to be an effective alternative to hand-sewn (HS) technique for venous anastomosis, as it requires lesser skill. However, its feasibility of application in emerging economy countries is yet to be established. Material and Method We retrospectively analyzed the data of patients who underwent free-tissue transfer for head and neck reconstruction between July 2015 and October 2020. Based on the technique used for the venous anastomosis, the patients were divided into an HS technique and MACD group. Patient characteristics and outcomes were measured. Result A total of 1694 venous anastomoses were performed during the study period. There were 966 patients in the HS technique group and 719 in the MACD group. There was no statistically significant difference between the two groups in terms of age, sex, prior radiotherapy, prior surgery, and comorbidities. Venous thrombosis was noted in 62 (6.4%) patients in the HS technique group and 7 (0.97%) in the MACD group (p = 0.000). The mean time taken for venous anastomosis in the HS group was 17 ± 4 minutes, and in the MACD group, it was 5 ± 2 minutes (p = 0.0001). Twenty-five (2.56%) patients in the HS group and 4 (0.55%) patients in MACD group had flap loss (p = 0.001). Conclusion MACD is an effective alternative for HS technique for venous anastomosis. There is a significant reduction in anastomosis time, flap loss, and return to operation theater due to venous thrombosis. MACD reduces the surgeon’s strain, especially in a high-volume center. Prospective randomized studies including economic analysis are required to prove the cost-effectiveness of coupler devices.

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End-to-Side Venous Anastomosis With an Anastomotic Coupling Device for Microvascular Free-Tissue Transfer in Head and Neck Reconstruction

The Laryngoscope ◽

10.1097/mlg.0b013e3181839b75 ◽

2008 ◽

Vol 118 (12) ◽

pp. 2146-2150 ◽

Cited By ~ 18

Author(s):

Natalya Chernichenko ◽

Douglas A. Ross ◽

Joseph Shin ◽

Clarence T. Sasaki ◽

Stephen Ariyan

Keyword(s):

Head And Neck ◽

Free Tissue Transfer ◽

Head And Neck Reconstruction ◽

Venous Anastomosis ◽

Neck Reconstruction ◽

Coupling Device ◽

Tissue Transfer

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The “Rolled-Up Sleeve” Technique for Microvascular Venous Anastomosis in Head and Neck Reconstruction

Annals of Plastic Surgery ◽

10.1097/sap.0000000000000686 ◽

2016 ◽

Vol 76 ◽

pp. S121-S124 ◽

Cited By ~ 1

Author(s):

Mario F. Scaglioni ◽

Yur-Ren Kuo ◽

Yen-Chou Chen

Keyword(s):

Head And Neck ◽

Head And Neck Reconstruction ◽

Venous Anastomosis ◽

Neck Reconstruction

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Single Versus Double Venous Anastomosis Microvascular Free Flaps for Head and Neck Reconstruction

Journal of Craniofacial Surgery ◽

10.1097/scs.0000000000008288 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Daniel Boczar ◽

Ricardo Rodriguez Colon ◽

Lavinia Anzai ◽

David A. Daar ◽

Bachar F. Chaya ◽

...

Keyword(s):

Head And Neck ◽

Free Flaps ◽

Head And Neck Reconstruction ◽

Venous Anastomosis ◽

Neck Reconstruction ◽

Microvascular Free Flaps ◽

Single Versus

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Poster Board Number: 49: Retrograde Arterial and Venous Anastomosis in Microvascular Recipient Site for Head and Neck Reconstruction: Solving Approach to the Absence of Appropriate Recipient Vessels

Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.joms.2010.06.132 ◽

2010 ◽

Vol 68 (9) ◽

pp. e88-e89

Author(s):

A. Kheradmand ◽

A. Garajei

Keyword(s):

Head And Neck ◽

Head And Neck Reconstruction ◽

Venous Anastomosis ◽

Recipient Site ◽

Neck Reconstruction

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Intraoral Hirudotherapy for Venous Congestion following Free Flap Head and Neck Reconstruction: Novel Intraoral Technique

ORL ◽

10.1159/000516576 ◽

2021 ◽

pp. 1-4

Author(s):

Ameen Amanian ◽

Oleksandr Butskiy ◽

Kevin Zhao ◽

Donald W. Anderson

Keyword(s):

Head And Neck ◽

Free Flap ◽

Venous Congestion ◽

Healthcare Team ◽

Head And Neck Reconstruction ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Healthcare Teams ◽

Neck Reconstruction ◽

Novel Technique

Intraoral hirudotherapy is traditionally used for venous congestion following head and neck free flap reconstruction. Many institutions and healthcare teams have been reluctant to use intraoral leech therapy due to risks such as migration into the airway, increased infection from intraoral manipulation, and patient discomfort. Several protocols recommend blocking the path to the oropharynx via gauze or leaving a tracheotomy in place to protect the airway. This report presents a novel technique for intraoral hirudotherapy that is safe and simple for treatment of free flap venous congestion. The base of a clear cup or a plastic lid is utilized, and the leech is attached onto the inside of the lid with 2 sutures near each end. Several cups with leeches attached are made at a time to reduce delay and difficulty of application by less experienced clinical staff. The leech is then applied onto the compromised flap and then simply removed once it has unlatched from the flap. This method allows the leech to be applied with ease by multiple members of the healthcare team, decreases the need for intraoral manipulation, and reduces the risk of migration into the aerodigestive tract. Future prospective studies are warranted to assess the efficacy of this technique.

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Complications and Cost Analysis of Intraoperative Arterial Complications in Head and Neck Free Flap Reconstruction

Journal of Reconstructive Microsurgery ◽

10.1055/s-0037-1598618 ◽

2017 ◽

Vol 33 (05) ◽

pp. 318-327 ◽

Cited By ~ 6

Author(s):

Michael Chu ◽

Jonas Nelson ◽

Marten Basta ◽

Patrick Gerety ◽

Suhail Kanchwala ◽

...

Keyword(s):

Regression Analysis ◽

Head And Neck ◽

Free Flap ◽

Free Flaps ◽

Head And Neck Reconstruction ◽

Venous Anastomosis ◽

Factors Associated ◽

Neck Reconstruction ◽

Arterial Complications ◽

The Impact

Background Microvascular anastomotic patency is fundamental to head and neck free flap reconstructive success. The aims of this study were to identify factors associated with intraoperative arterial anastomotic issues and analyze the impact on subsequent complications and cost in head and neck reconstruction. Methods A retrospective review was performed on all head and neck free flap reconstructions from 2005 to 2013. Patients with intraoperative, arterial anastomotic difficulties were compared with patients without. Postoperative outcomes and costs were analyzed to determine factors associated with microvascular arterial complications. A regression analysis was performed to control for confounders. Results Total 438 head and neck free flaps were performed, with 24 (5.5%) having intraoperative arterial complications. Patient groups and flap survival between the two groups were similar. Free flaps with arterial issues had higher rates of unplanned reoperations (p < 0.001), emergent take-backs (p = 0.034), and major surgical (p = 0.002) and respiratory (p = 0.036) complications. The overall cost of reconstruction was nearly double in patients with arterial issues (p = 0.001). Regression analysis revealed that African American race (OR = 5.5, p < 0.009), use of vasopressors (OR = 6.0, p = 0.024), end-to-side venous anastomosis (OR = 4.0, p = 0.009), and use of internal fixation hardware (OR =3.5, p = 0.013) were significantly associated with arterial complications. Conclusion Intraoperative arterial complications may impact complications and overall cost of free flap head and neck reconstruction. Although some factors are nonmodifiable or unavoidable, microsurgeons should nonetheless be aware of the risk association. We recommend optimizing preoperative comorbidities and avoiding use of vasopressors in head and neck free flap cases to the extent possible.

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