Section of Plastic and Reconstructive Surgery, Department of Emergency and Organ transplantation, University of Bari, Bari, Italy.
Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary Hospital Newcastle NHS Foundation Trust, Newcastle upon Tyne, UK.
Microsurgery. 2020 Jul;40(5):608-617. doi: 10.1002/micr.30585. Epub 2020 Apr 4.
Successful vascular anastomosis is essential for the survival of free tissue transfer. The aim of the study is to review the current literature and perform a meta-analysis to assess the potential advantages of a mechanical anastomosis coupler device (MACD) over the hand-sewn (HS) technique for venous anastomoses.
A systematic Medline search was performed to gather all reports of articles related to MACD from 1984 until now. The following data were extracted: first author and publication date, study design, number of patients and anastomosis, coupler size, site and type of reconstruction, venous anastomotic time, flap failure. A meta-analysis was performed on articles that met the following inclusion criteria: studies comparing MACD and HS technique in venous anastomosis, reporting anastomotic time, and postoperative complications.
Thirty-three studies were included for the analysis. Twenty-four were retrospective case series and nine were retrospective comparative studies. A total of 12,304 patients were enrolled with a mean age of 49.23 years (range 31-72). A total of 13,669 flaps were accomplished. The thrombosis rate recorded with MACD was 1.47%. The meta-analysis revealed that MACD significantly decreased anastomotic time (standard difference in means = -0.395 ± 0.105; Z = -3.776; p < .001) and postoperative flap failure risk (odds ratio [OR] = 0.362, 95% confidence interval [CI] = 0.218-0.603, Z = -3.908, p < .001), but it did not decrease postoperative venous thrombosis risk (OR = 0.504, 95% CI = 0.255-1.129, Z = -1.666, p = .096).
MACDs are a safe and effective alternative to traditional anastomosis. The anastomotic coupler is easier, much faster, and requires less technical skills than a HS microvascular anastomosis.
成功的血管吻合对于游离组织移植的存活至关重要。本研究旨在回顾当前文献，并进行荟萃分析，以评估机械吻合夹（MACD）相对于手工吻合（HS）技术在静脉吻合中的潜在优势。
系统地检索了从 1984 年至今与 MACD 相关的所有文献报道。提取了以下数据：第一作者和出版日期、研究设计、患者和吻合术数量、吻合夹大小、重建部位和类型、静脉吻合时间、皮瓣失败。对符合以下纳入标准的文章进行荟萃分析：比较 MACD 和 HS 技术在静脉吻合中的研究，报告吻合时间和术后并发症。
共纳入 33 项研究进行分析。其中 24 项为回顾性病例系列研究，9 项为回顾性对照研究。共纳入 12304 例患者，平均年龄 49.23 岁（范围 31-72 岁）。共完成 13669 个皮瓣。MACD 记录的血栓形成率为 1.47%。荟萃分析显示，MACD 显著缩短了吻合时间（平均差= -0.395±0.105；Z=-3.776；p<.001）和术后皮瓣失败风险（比值比[OR]=0.362，95%置信区间[CI] = 0.218-0.603，Z=-3.908，p<.001），但并未降低术后静脉血栓形成风险（OR=0.504，95%CI=0.255-1.129，Z=-1.666，p=0.096）。
MACD 是一种安全有效的传统吻合术替代方法。与 HS 微血管吻合术相比，吻合夹更容易、更快，且技术要求更低。
