Use of couplers for vascular anastomoses in 601 free flaps for reconstruction of defects of the head and neck: technique and two-year retrospective clinical study

We describe our experience with the use of 854 couplers for venous or arterial anastomoses, or both, in 601 free flaps for reconstruction of defects of the head and neck. We reviewed 601 patients who had had free flaps (with the microvascular anastomoses being made with couplers in 519) between July 2013 and December 2015. Personal details, and clinical data including the site of the defect, the tumour excised, the types of flaps, the size of the couplers, the method of anastomosis (venous or arterial) in which the coupler was used, and postoperative complications were recorded. There were 417 men (69%) and 184 women (31%), mean (range) age 53 (13-91) years. Four types of flaps were used: anterolateral thigh flap (n = 232), radial forearm flap (n = 223), fibula free flap (n = 78), and iliac crest flap (n = 68). The sizes of couplers ranged from 1-4 mm, most being 2 mm (n = 158), followed by 1.5 mm (n = 122). The recipient vessels used included a single vein (n = 348), two veins (n = 406), and both vein and artery (n = 100). The overall success rate was 99%, and eight patients required resuture, which was successful in each case. This retrospective study shows that a coupler is easy to use, and is a reliable and time-saving technique for microvascular anastomosis. However, the disadvantage is the cost of the instrument, which in less developed countries will limit its use.