Venous Anastomosis with Microvascular Coupler in Head and Neck Reconstruction: Experience in 200 Consecutive Procedures

Abstract

Objectives:

There is a scarcity of data on outcomes when GEM microvascular coupler is used for head and neck reconstruction. We sought to review our experience in a large, contemporary series.

Methods:

Retrospective chart review of 201 consecutive flaps performed in 193 patients between September 2009 and January 2013 in a tertiary academic setting.

Results:

The cohort consisted of 125 males with a mean age of 64 years (range 3-83). A double free flap was performed in 8 cases. The most common defect locations were mandible (n = 62, 30.8%); oral cavity (n = 27, 13.4%), and cutaneous (n = 24, 11.9%). Flaps included anterolateral thigh (n = 85, 42.3%); fibula (n = 53, 26.4%); radial forearm (n = 37,18.4%); scapula, latissimus, and rectus (n=5, 2.5% respectively); iliac crest and vastus (n = 4, 2% respectively); and other (n = 3, 1.5%). A double venous anastomosis was performed in 26 flaps. The entire range of couplers (1-4mm) was used, but the 2.5mm was the most commonly used (n = 83, 36.6%) followed by the 2.0mm (n = 47, 20.7%). Facial (n = 134, 59%), External jugular (n = 32, 14.1%), and superficial temporal (n = 22; 9.7%) were the most common recipient vessels. Seven cases underwent microvascular revision yielding arterial thrombosis in 1 case, pedicle torsion in 1 case, and venous thrombosis in 5 cases. The flap was successfully salvaged in 3 cases. A delayed failure in another patient yielded an overall flap success rate of 97.5%. None of the tested variables reached statistical significance for venous thrombosis or flap survival.

Conclusions:

The microvascular coupler is a reliable alternative for venous anastomosis in head and neck flaps. Given the low failure rate, a multi-institutional study could help elucidate outcome predictors in this setting.