JSUR Journal

Summary

A Mechanical Anastomosis Coupler Device (MACD) is a useful tool for safe and rapid venous anastomosis for free tissue transfer. However, many case series reporting favourable MACD utility in head and neck reconstruction have included only a few cases of Free Jejunal Transfer (FJT). We retrospectively examined cases of free tissue transfer in head and neck reconstruction over five years and checked whether MACDs could be used safely in cases of FJT. This is the largest series examining venous thromboses associated with MACDs in the field of head and neck reconstruction at a single centre. Data were collected from 537 patients, including 205 with FJT. Among 101 patients with single-vein anastomoses with MACD, including 46 with FJT, 2 underwent postoperative venous thrombosis, both of whom were FJT cases. The relationship between MACD use and venous thrombosis was stronger in the FJT group (odds ratio 6.91) than in the other cases (odds ratio 2.42). In cases of FJT, the proximal and distal parts of the anastomosis site are vulnerable to compression from the ring of MACDs and the mesentery, which leads to a risky pedicle geometry and postoperative venous thrombosis.

Microvascular coupler devices can be risky for free jejunum transfer. To avoid clot formation when MACDs are used, caution should therefore be exercised to align the artery and vein along a similar axis in the longitudinal access of the neck, if possible, to avoid excess redundancy.

Keywords: Coupler device; Free jejunum transfer; Geometry of the vascular pedicle; Mechanical anastomosis; venous thrombosis;