Reliability and Efficacy of Microvascular Coupler Devices for End-to-Side Venous Anastomosis in Head and Neck Reconstruction: A Systematic Review and Meta-Analysis.
Jisu Kim, Kyeong-Tae Lee
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In 30 seconds
This systematic review and meta-analysis compared microvascular couplers with hand-sewn techniques for end-to-side venous anastomosis in head and neck reconstruction. It included 40 studies representing 2,664 cases; most studies were retrospective cohorts. Pooled venous thrombosis rates were 2.5% with couplers and 1.8% with hand-sewn anastomoses, while flap failure rates were 1.9% and 2.5%, respectively, with no significant differences in either outcome. Meta-analysis of four studies found comparable thrombosis rates. Anastomosis time was significantly shorter with couplers (standardized mean difference -3.93, p < 0.0001).
Key findings
- Pooled venous thrombosis rates were 2.5% with couplers and 1.8% with hand-sewn anastomoses, with no significant difference.
- Flap failure rates were 1.9% with couplers and 2.5% with hand-sewn methods, with no significant difference.
- Anastomosis time was significantly shorter with couplers (standardized mean difference -3.93, p < 0.0001).
- Meta-analysis of four studies found comparable venous thrombosis rates between techniques.
Why it matters
End-to-side venous anastomosis is commonly used in head and neck reconstruction, but evidence for couplers in this setting has been limited. These findings suggest that couplers may reduce anastomosis time without an observed difference in thrombosis or flap failure rates, while highlighting the need for stronger comparative evidence.
What to keep in mind
Most included studies were retrospective cohorts, and the meta-analysis of thrombosis outcomes included only four studies. The authors call for additional well-designed studies.