Reliability and Efficacy of Microvascular Coupler Devices for End-to-Side Venous Anastomosis in Head and Neck Reconstruction: A Systematic Review and Meta-Analysis.

BACKGROUND

While the efficacy of coupling devices in venous anastomosis has been well-studied, most evidence focuses on end-to-end techniques. In head and neck reconstruction, end-to-side (ETS) venous anastomoses involving the internal/external jugular vessels are common, yet evidence for using couplers in this context is limited. This study systematically evaluates the reliability and efficacy of couplers versus the hand-sewn method for ETS venous anastomosis in head and neck reconstruction.

METHODS

A literature search was conducted for articles reporting outcomes of ETS anastomosis in head and neck reconstruction. Studies were divided into two groups based on the anastomosis method: Hand-sewn and couplers. Pooled analysis was performed to compare the outcomes between the two groups. Using double-arm studies reporting outcomes for both methods, meta-analysis was conducted.

RESULTS

Forty studies representing 2,664 cases were included, with 663 using couplers and 2,001 using hand-sewn methods. Most studies were retrospective cohorts. In the pooled analysis, the venous thrombosis rate was 1.8% for hand-sewn anastomoses and 2.5% for couplers, while the flap failure rate was 2.5% for hand-sewn and 1.9% for couplers, with no significant differences in either outcome. Meta-analysis based on four studies showed comparable venous thrombosis rates between the two groups. Anastomosis time was significantly shorter with couplers (standardized mean difference -3.93, p < 0.0001).

CONCLUSION

ETS venous anastomosis using a coupler device in head and neck reconstruction seems to be as safe as the hand-sewn method and may offer time-saving benefits. However, additional well-designed studies are needed to confirm these findings.