Routine Use of Arterial Coupling Device for Microvascular Breast Reconstruction

Although used routinely for anastomosis of donor and recipient veins during free flap reconstruction, there are no published series demonstrating the utility of the anastomotic device for routine arterial anastomosis during free flap reconstruction. The authors described their extensive experience using the anastomotic coupling device as a routine method for performing arterial anastomoses during microvascular breast reconstruction.

They retrospectively reviewed all microvascular free flap breast reconstructions performed by the senior author over a 4-year period. Coupler size was chosen in the standard fashion with an anastomotic “sizer.” When a size discrepancy existed between donor and recipient arteries, the coupler selected for anastomosis reflected the smaller of the two diameters.

They have reviewed 41 cases of which 12 were bilateral reconstructions (53 flaps total). In 12 flaps, arterial coupling was not successfully performed or not attempted because of significant size discrepancy or other technical limitations. Of the remaining 41 flaps, in all but one case transverse rectus abdominis (muscle-sparing or deep inferior epigastric perforator) free flap reconstructions were performed by anastomosing the inferior epigastric artery and vein to the thoracodorsal artery and vein utilizing the anastomotic coupling device. In the other case, a free gluteal flap was performed. Of the 12 arterial anastomoses where using a coupler was not technically feasible, 7 were free gluteal flaps. For all arterial anastomoses, coupler sizes ranged from 2 to 2.5 mm. There were no flap failures and no returns to the OR for revision of the coupled arterial anastomoses. There was one case of necrosis of a minor portion of the flap which did not require return to the OR. Average anastomotic time per artery was 5 min.

Use of the anastomotic device has proven extremely useful in microvascular free flap reconstruction of the breast. The authors described a technique for performing arterial anastomosis in an expeditious, safe, and reliable fashion with minimal morbidity. Although not commonly practiced, use of the coupling device for arterial anastomosis can provide significant time saving, especially in bilateral breast reconstruction.