Arora Rajan, Mishra Kripa Shanker, Bhoye Hemant T, Dewan Ajay Kumar, Singh Ravi K, Naalla Ravikiran
Reconstructive Microsurgery Unit, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.
Indian J Plast Surg. 2021 Apr;54(2):118-123. doi: 10.1055/s-0041-1731622. Epub 2021 Jul 5.
There is a steep learning curve to attain a consistently good result in microvascular surgery. The venous anastomosis is a critical step in free-tissue transfer. The margin of error is less and the outcome depends on the surgeon's skill and technique. Mechanical anastomotic coupling device (MACD) has been proven to be an effective alternative to hand-sewn (HS) technique for venous anastomosis, as it requires lesser skill. However, its feasibility of application in emerging economy countries is yet to be established. We retrospectively analyzed the data of patients who underwent free-tissue transfer for head and neck reconstruction between July 2015 and October 2020. Based on the technique used for the venous anastomosis, the patients were divided into an HS technique and MACD group. Patient characteristics and outcomes were measured. A total of 1694 venous anastomoses were performed during the study period. There were 966 patients in the HS technique group and 719 in the MACD group. There was no statistically significant difference between the two groups in terms of age, sex, prior radiotherapy, prior surgery, and comorbidities. Venous thrombosis was noted in 62 (6.4%) patients in the HS technique group and 7 (0.97%) in the MACD group ( = 0.000). The mean time taken for venous anastomosis in the HS group was 17 ± 4 minutes, and in the MACD group, it was 5 ± 2 minutes ( = 0.0001). Twenty-five (2.56%) patients in the HS group and 4 (0.55%) patients in MACD group had flap loss ( = 0.001). MACD is an effective alternative for HS technique for venous anastomosis. There is a significant reduction in anastomosis time, flap loss, and return to operation theater due to venous thrombosis. MACD reduces the surgeon's strain, especially in a high-volume center. Prospective randomized studies including economic analysis are required to prove the cost-effectiveness of coupler devices.
要在微血管手术中持续取得良好效果存在一条陡峭的学习曲线。静脉吻合是游离组织移植中的关键步骤。误差范围较小，结果取决于外科医生的技能和技术。机械吻合耦合装置（MACD）已被证明是静脉吻合手工缝合（HS）技术的一种有效替代方法，因为它所需技能较低。然而，其在新兴经济体国家的应用可行性尚未确立。
我们回顾性分析了2015年7月至2020年10月期间接受游离组织移植进行头颈部重建的患者数据。根据静脉吻合所使用的技术，将患者分为HS技术组和MACD组。对患者特征和结果进行了测量。
在研究期间共进行了1694例静脉吻合。HS技术组有966例患者，MACD组有719例患者。两组在年龄、性别、既往放疗、既往手术和合并症方面无统计学显著差异。HS技术组有62例（6.4%）患者出现静脉血栓形成，MACD组有7例（0.97%）（P = 0.000）。HS组静脉吻合的平均时间为17±4分钟，MACD组为5±2分钟（P = 0.0001）。HS组有25例（2.56%）患者出现皮瓣丢失，MACD组有4例（0.55%）患者出现皮瓣丢失（P = 0.001）。
MACD是静脉吻合HS技术的一种有效替代方法。吻合时间、皮瓣丢失以及因静脉血栓形成返回手术室的情况均显著减少。MACD减轻了外科医生的负担，尤其是在高流量中心。需要进行包括经济分析在内的前瞻性随机研究来证明耦合装置的成本效益。
