Abstract
Background Microvascular reconstruction of the lower extremity has the highest reported complication
and flap failure rates of any anatomical region. Despite widespread adoption of the
mechanical anastomotic venous coupler and encouraging results in other anatomical
regions, there are limited reports examining its use in the lower extremity. This
study compares outcomes between coupled and hand-sewn venous anastomoses in traumatic
lower extremity reconstruction.
Methods Retrospective review of our institutional flap registry from 1979 to 2016 identified
soft tissue free flaps performed for the reconstruction of Gustilo type IIIB/IIIC
open tibial fractures. Patient demographics, flap characteristics, use of a venous
anastomotic coupler, and perioperative outcomes were examined. Analysis was performed
using chi-square and Student's t-tests.
Results A total of 361 patients received a microvascular free flap for coverage of a Gustilo
type IIIB or IIIC tibial fracture following traumatic injury. After excluding cases
that lacked adequate information on coupler use, 358 free flaps were included in the
study. There were 72 (20%) free flaps performed using a venous coupler and 286 (80%)
performed with hand-sewn venous anastomoses. There were comparable rates of major
complications (22.2 vs. 26.1%; p = 0.522), total flap failure (6.5%, vs. 10.2%; p = 0.362), and partial flap failure (9.7 vs. 12.2%; p = 0.579) between venous coupler and hand-sewn anastomoses, respectively. Furthermore,
use of the venous coupler was not associated with increased rates of operative take
backs (22.8 vs. 23.0%; p = 0.974). However, reconstructions performed using a venous coupler were significantly
more likely to have a second venous anastomosis performed (37.5 vs. 21.3%; p = 0.004).
Conclusion Complication and flap failure rates were similar between reconstructions performed
with a venous coupler and those performed with hand-sewn venous anastomoses. These
findings suggest that use of the venous anastomotic coupler is safe and effective
in lower extremity reconstruction, with comparable outcomes to conventional sutured
anastomoses.
Keywords
venous coupler - lower extremity - microvascular anastomosis
