Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany.
Department of Plastic and Esthetic Surgery, Hand Surgery, Helios Hospital Emil von Behring, Berlin, Germany.
Microsurgery. 2022 Jan;42(1):5-12. doi: 10.1002/micr.30686. Epub 2020 Nov 26.
Venous anastomosis remains to be a challenging step in microsurgical tissue transfer and venous complications constitute to a common reason for free flap failure. While several studies have compared mechanical vs. hand-sewn venous anastomoses, there is no large-series study comparing the type of anastomosis exclusively in DIEP flap breast reconstructions.
Between 2011 and 2019, 3926 female patients underwent 4577 free DIEP-flap breast reconstructions in 22 different breast cancer centers. Patient data was collected via an online database, files were screened and cases were divided into a hand- (HA) and a coupler-anastomosis (CA) group. Complications were accounted for and the two groups were then compared.
Mean ischemia time was significantly shorter in the CA group (46.88 ± 26.17 vs. 55.48 ± 24.70 min; p < .001), whereas mean operative time was comparable (316 ± 134.01 vs. 320.77 ± 120.29 minutes; p = .294). We found no significant difference between both groups regarding the rate of partial (CA: 1.0% vs. HA: 1.3%) and total flap loss (CA: 2.2% vs. HA: 1.8%). However, revision rates were significantly higher in the CA group (CA: 10.5% vs. HA: 7.9%; p = .003), with higher numbers of arterial (2.3 vs. 0.9%; p < .001) and venous thromboses (3.4 vs. 1.8%; p = .001) accounting for this finding.
All taken into account, our findings do support the feasibility of venous coupler anastomoses in principle, however the inflationary use of coupler devices should be evaluated critically.
静脉吻合仍然是显微外科组织移植中的一个挑战性步骤，静脉并发症是游离皮瓣失败的常见原因。虽然有几项研究比较了机械吻合与手工缝合的静脉吻合，但没有大系列研究专门比较 DIEP 皮瓣乳房重建中吻合的类型。
2011 年至 2019 年间，22 家不同的乳腺癌中心的 3926 名女性患者共进行了 4577 例游离 DIEP 皮瓣乳房重建。通过在线数据库收集患者数据，筛选文件并将病例分为手工吻合（HA）和吻合器吻合（CA）组。记录并发症并比较两组。
CA 组的平均缺血时间明显更短（46.88±26.17 与 55.48±24.70 分钟；p<0.001），而平均手术时间相似（316±134.01 与 320.77±120.29 分钟；p=0.294）。两组在部分（CA：1.0%与 HA：1.3%）和完全皮瓣坏死（CA：2.2%与 HA：1.8%）的发生率方面无显著差异。然而，CA 组的再手术率明显更高（CA：10.5%与 HA：7.9%；p=0.003），动脉（2.3 与 0.9%；p<0.001）和静脉血栓形成（3.4 与 1.8%；p=0.001）的数量更高是导致这一发现的原因。
综合考虑，我们的研究结果确实支持静脉吻合器吻合在理论上的可行性，但应批判性地评估吻合器装置的过度使用。
