Technique And Clinical Experience Of The Unilink/3M? Microvascular Anastomotic Coupling Device In Free Flap Surgery.

摘要

We report our experience using the Unilink/3M? microvascular anastomotic coupling device in free flap surgery. Ninety-nine anastomoses were performed in 99 free flaps using the Unilink/3M? coupling device between June 1995 and August 2000. The device was used for the venous anastomosis in 95 flaps, and for both the arterial and venous anastomoses in 4 flaps. All anastomoses were performed in an end-to-end fashion. Ninety-one flaps were performed for breast reconstruction and 8 for head and neck reconstruction. There were 54 TRAM flaps, 18 bilateral TRAM, 4 VRAM, 2 fibula, 1 DCIA, 1 latissimus dorsi, and 1 scapular flap. Flap survival was 100%.Anastomoses using the Unilink/3M? coupling device were completed successfully in 99 out of 104 attempted cases (95%). Two venous anastomoses were revised intraoperatively (1 for twisting) using the coupler for the second anastomosis, and 5 attempted anastomoses required intraoperative conversion to sutured anastomoses. There was 1 late venous thrombosis (23 days postoperatively), but this did not result in any flap loss. The average time for anastomosis was less than 5 minutes. The Unilink/3M? coupling device is a safe, reliable method for performing microvascular venous anastomoses, allowing reduced operating time in free flap surgery. INTRODUCTION A number of microvascular anastomotic systems have been developed as alternatives to sutures in an attempt to reduce both the anastomotic complication rate and ischaemic time in free flap surgery. Nakayama et al. in 19621,2 first developed an microvascular anastomotic device consisting of 2 metallic rings with 12 interlocking pins, and this was later modified by Ostrup and Berggren in 19863 into the current Unilink/3M? microvascular anastomotic coupling device. Experimental studies have demonstrated patency rates5,6 and histological features similar to conventional sutured anastomoses, with the added advantage of greater mechanical strength4. The clinical effectiveness of this device has also been demonstrated in the setting of breast and head and neck reconstruction 8,9,10,11. OPERATIVE TECHNIQUE/METHODS A retrospective review of operative reports and clinical records was undertaken for patients who had undergone free flap reconstruction using the Unilink/3M? microvascular anastomotic coupling device at the MD Anderson Cancer Center between June 1995 and August 2000. Data was obtained on the success rate of anastomoses using the coupler and any intraoperative or postoperative flap complications. The Unilink/3M? microvascular anastomotic coupling device consists of 2 high density polyethylene ring with 12 stainless steel locking pins, and is available in 1.0mm, 1.5mm, 2.0mm, and 2.5mm sizes. There is a vessel-measuring gauge (Fig1) to allow determination of the vessel diameter and the correct coupler size.