Use of a mechanical microvascular anastomotic device in head and neck free tissue transfer

Background: The use of mechanical microvascular anastomotic systems for free tissue transfer has previously been reported. Currently, a commercially available coupling device (3M Healthcare, St Paul, Minn) is widely used for various microvascular free flaps. However, to our knowledge, there are no reports in the literature describing the efficacy of this particular device in regard to free tissue transfer in head and neck reconstruction. Objective: To describe the surgical technique, limitations, and guidelines for application of this system tot vascular anastomosis in head and neck free tissue transfer. Design: The microvascular anastomotic device was used in 79 head and neck free flaps: radial forearm (n=28), rectus abdominis (n=27), fibula (n=12), lateral thigh (n=4), iliac crest (n=3), gracilis (n=2), jejunum (n=1), pectoral (n=1), and lateral arm (n=1). Follow-up ranged from 6 months to 2.5 years. Setting: Two major teaching/referral medical centers. Participants: Seventy-six patients ranging in age from 19 to 86 years. Intervention: A total of 105 anastomoses (17 arterial and 88 venous) were performed. Outcome Measures: Anastomotic times and patency rates were evaluated. Results: The anastomotic times ranged from 8 to 18 minutes for the arteries (average, 10 minutes) and from 4- to 16 minutes for the veins (average, 5 minutes). None of the flaps resulted in venous congestion due to thrombosis at the anastomosis. Two arterial anastomoses resulted in thrombosis, one of which was detected intraoperatively and successfully salvaged with conventional suture anastomosis. Conclusions: The patency rates with the microvascular anastomotic system appear to compare favorably with those of standard suture techniques. The major advantage is that the time of venous anastomosis is reduced, thereby decreasing the total ischemic time. An additional advantage is the ease with which anastomoses can be performed when the vessels are deep within a wound, where suture placement is difficult.