The Application Of Microvascular Anastomotic Coupler Device In End-to-end Venous Anastomosis With Diameter Discrepancy And End-to-side Venous Anastomosis

Objective:To explore the application of microvascular anastomotic coupler device(MACD)in end-to-end anastomosis and end-to-end anastomosis.Method:21 patients who underwent free flap repair and reconstruction after head and neck tumor resection in the department of oral and maxillofacial surgery of Second Xiangya Hospital of Central South University from February 2022 to April 2022 were enrolled.According to the method of vascular remodeling,they were divided into 6 groups,including mechanical expansion group(n=5),lateral incision group(n=4),fish-mouth incision group(n=3),Y-T enlargement group(n=4),Y-shaped anastomosis group(n=3)and wedge excision group(n=2).And then,the size of MACD,anastomotic time,vascular crisis,flap survival and MACD-related complications were recorded in each group.In addition,a total of 60 patients who underwent free flap transplantation after head and neck tumor resection in the department of oral and maxillofacial surgery of Second Xiangya Hospital of Central South University from January 2018 to December 2020 were recruited.According to the adoption of Double Thread suspension(DTS),which is a new auxiliary technology,it is divided into DTS group(n=30),traditional procedure(TRA)group(n=30).the size of MACD,anastomotic time,vascular crisis,flap survival and MACD-related complications were recorded in the two groups,and were analyzed by SPSS software.Results:Vascular remodeling combined with MACD was used for end-to-end venous anastomosis of different caliber.The MACD size of mechanical expansion was distributed in 2.5mm and 3.0mm,the MACD size of lateral incision and fish-mouth incision was 3.0mm,the MACD size of Y-T enlargement and Y-shaped anastomosis were distributed in 3.0mm and 3.5mm,and the MACD size of wedge excision was distributed in3.0mm and 3.5mm.The anastomosis time of the six groups were 4.30±0.32min(mechanical expansion),4.59 ±0.24min(lateral incision),4.70±0.58 min(fish-mouth incision),4.38 ±0.09 min(Y-T enlargement),5.16±0.33 min(Y-shaped anastomosis)and 5.50 ±0.66min(wedge excision).Among the six methods,there was 1 case of vascular crisis in lateral incision group and Y double anastomosis group respectively.In the Y-shaped anastomosis group,1 case of flap necrosis,the rest of the flap survival.There were no MACD-related complications in all groups.In end-to-end vascular anastomosis,the size range of MACD was1.5-4.0mm in the DTS group and 2.0-4.0mm in the TRA group,with no statistical difference between the two groups.The anastomosis time of DTS group was 4.68±0.43 min,and that of TRA group was 9.24±1.46 min,the difference was statistically significant.The anastomosis time of DTS group was significantly lower than that of TRA group.There was 1 case of vascular crisis in two groups,but there was no statistical difference in the incidence of vascular crisis.There were no significant differences in the success rate of free flap and MACD-related complications between DTS group and TRA group.Conclusions:1.Different vascular remodeling methods combined with MACD can achieve end-to-end venous anastomosis with different diameters.2.DTS technology combined with MACD in end-to-side vein anastomosis can reduce the degree of surgical difficulties,shorten the anastomosis time,and has good safety and reliability.