Management of significant venous discrepancy with microvascular venous coupler.

Microsurgery has revolutionized the art of reconstruction, with the discovery of the ability to replace like tissue with like tissue transferred from a distant site. The evolution of the tissue transferred has also progressed. No longer are free flaps based off a dominant anatomically named vessel, but one of its later derivatives, the perforator. Perforator breast reconstruction dominates the authors' practice, and a frequently encountered problem is mismatched vessels. This situation typically requires more time and concentration for successful completion. Venous mismatches tend to be harder to overcome than arterial; the venous hand-sewn end-to-end anastomoses result in bunching of the larger vessel around the perimeter of the smaller. In this low flow system, these anastomotic imperfections can frequently result in anastomotic failure. Many other techniques have also been described in hopes of improving the anastomotic success. These are often timely or lack improvement in patency rates. The authors have found the MCA microvascular venous coupler to be a reliable method to overcome this problem. The end-to-end technique of microvascular coupling allows a perfect intima-to-intima anastomosis despite the variation in caliber of the vessels. The time to complete the end-to-end anastomoses is significantly reduced to only a matter of minutes.