Microvascular Coupling in Venous Anastomoses for Head and Neck Reconstruction: A Systematic Review and Meta-Analysis.

Abstract

We conducted a systematic review and meta-analysis to compare venous couplers and hand-sewn techniques for venous anastomosis in head and neck reconstruction. PubMed/MEDLINE and Scopus, databases were searched for relevant publications. Additionally, a manual search was performed in Google Scholar and through reference lists. Retrospective and prospective cohort studies were included. Odds ratios (ORs) and mean differences (MD) were calculated with their 95% confidence intervals (CIs) for each study comparing the 2 groups (coupler vs hand). The inverse variance method was used to combine the effect sizes from the individual studies. A total of 14,053 patients undergoing 14,270 head and neck free flap reconstructions were included from 52 studies. A total of 6080 flaps were performed using a coupling device for the venous anastomoses, while 8190 flaps were performed with the hand-sewn technique. No significant difference was found for the venous thrombosis rate (OR: 1.06, 95% CI: 0.65-1.72), and reoperation rate (OR: 0.93, 95% CI: 0.51-1.70), but a significantly lower failure rate was measured for the coupler group (OR = 0.34, 95% CI: 0.20-0.58). A nonsignificant lower operative time was found for venous anastomoses (MD: -20.5, 95% CI: -51.7 to 10.7) and total surgery (MD: -23.7, 95% CI: -344.3 to 296.8) for the coupler group. Despite the slight advantages observed with venous couplers, the overall outcomes of both techniques are excellent, and the choice of anastomotic technique should be guided by surgeon preference.