J Reconstr Microsurg. 2025 Sep 17. doi: 10.1055/a-2702-4335. Online ahead of print.
ABSTRACT
Background While the efficacy of coupling devices in venous anastomosis has been well-studied, most evidence focuses on end-to-end techniques. In head and neck reconstruction, end-to-side venous anastomoses involving the internal/external jugular vessels are common, yet evidence for using couplers in this context is limited. This study systematically evaluates the reliability and efficacy of couplers versus the hand-sewn method for end-to-side venous anastomosis in head and neck reconstruction. Methods A literature search was conducted for articles reporting outcomes of end-to-side anastomosis in head and neck reconstruction. Studies were divided into two groups based on the anastomosis method: hand-sewn and couplers. Pooled analysis was performed to compare the outcomes between the two groups. Using double-arm studies reporting outcomes for both methods, meta-analysis was conducted. Results Forty studies representing 2,664 cases were included, with 663 using couplers and 2,001 using hand-sewn methods. Most studies were retrospective cohorts. In the pooled analysis, the venous thrombosis rate was 1.8% for hand-sewn anastomoses and 2.5% for couplers, while the flap failure rate was 2.5% for hand-sewn and 1.9% for couplers, with no significant differences in either outcome. Meta-analysis based on four studies showed comparable venous thrombosis rates between the two groups. Anastomosis time was significantly shorter with couplers (SMD -3.93, p < 0.0001). Conclusions End-to-side venous anastomosis using a coupler device in head and neck reconstruction seems to be as safe as the hand-sewn method and may offer time-saving benefits. However, additional well-designed studies are needed to confirm these findings.
PMID:40962275 | DOI:10.1055/a-2702-4335