Lower Extremity Free Flap Outcomes Using an Anastomotic Venous Coupler Device

Introduction: Venous anastomosis is one of the most challenging technical aspects of microsurgery. Recently, it has been expedited by the use of an anastomotic coupler device in multiple reconstructive venues. However, there are few studies in the literature evaluating the use of the coupler in lower extremity reconstruction. We present one of the largest series to date examining the use of the venous coupler in microsurgical reconstruction of the lower extremity. Methods: A retrospective chart review was completed including all lower extremity soft tissue reconstruction over a 26-month period performed by the senior authors. The Synovis venous coupler was used in all coupled venous anastomoses (Synovis Micro Companies Alliance Inc, Birmingham, Alabama). Patients under 18 years of age were excluded. Results: Forty-nine free flaps were performed in 48 patients. All arterial anastomoses were hand sewn. The anastomotic venous coupler was used in 48 of 49 flaps (97.9%) with 1 hand-sewn case due to attending preference during early experience. There were no intraoperative vascular complications. Successful free flap reconstruction occurred in 47 of 49 flaps (95.9%). Of the flap losses, one was due to delayed venous thrombosis, the other attributed to delayed arterial thrombosis. Venous thrombosis rate was 2.1% when the coupler was used (1 failure in 48 flaps). Conclusions: The use of the venous coupler device in lower extremity reconstruction can be performed with a high degree of success. The potential of the venous coupler for reduced operative time, more efficient anastomoses with decreased ischemia, and reduced thrombotic rates represents potential benefits of this important tool.