Venous Coupler in Pediatric Free Tissue Transfer: Case Series and Literature Review

BACKGROUND: Venous couplers have gained widespread acceptance as an effective, safe, and time-efficient alternative for hand-sewn anastomosis in microsurgical reconstruction. The literature on venous couplers use in pediatric free tissue transfer is scant. The purpose of this study is to present our experience with coupler-assisted venous anastomosis in young pediatric free flap reconstruction. METHODS: This is a retrospective single-center review of all children younger than 10 years old who underwent free flap reconstruction over 36-month period. The primary objective was to assess flap survival rate at 30-day postoperative period. The rate of venous thrombosis, flap take back, flap salvage, and the mean coupling time were also assessed. RESULTS: Four girls and 1 boy with a mean age of 7.3 ± 2.7 years (range 4–10 years) underwent 6 free flap transfers for head and neck, upper limb, and lower limb reconstructions. Microvascular anastomotic coupler system was used for 8 out of 9 performed venous anastomoses with a size ranging from 1.5 to 2.5 mm. Primary flap survival rate was 100%. None of the flaps in our series developed venous thrombosis or required flap take back for microvascular compromise (mean follow-up of 14.4 months). The mean coupling time was 7.1 minutes. CONCLUSIONS: In the current study, venous couplers were safe and reliable in free tissue transfer in children younger than 10 years old. Future studies with larger sample size are needed to further examine the safety and efficacy of venous couplers in pediatric microsurgical anastomosis.