• Archives of Reconstructive Microsurgery
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• v.24 no.1
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• pp.20-23
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• 2015

Despite increased utilization of microvascular anastomotic coupler (MAC) devices, the consequences have yet to be fully explored in terms of vascular regeneration. Removal of an exposed venous coupler is described herein, documenting normal circulatory flow through the remodeled site of application. A 25-year-old man who underwent open reduction and rigid fixation elsewhere for traumatic calcaneal fracture ultimately presented with a necrotic postoperative wound. The debrided defect was treated by free thigh perforator flap, incorporating a MAC device. Three months later, the flap remained viable, but the MAC itself was exposed. Structural integrity of the vessel and blood flow were sustained as the device was carefully removed, confirming true vascular remodeling in this example of MAC usage.

• Archives of Plastic Surgery
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• v.44 no.2
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• pp.95-100
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• 2017

Background Intima-to-intima microanastomotic vascular remodeling was explored, utilizing a polylactide-caprolactone absorbable vein coupler model (PAVCM), which was designed to simulate a non-absorbable counterpart system with the sole exception of being absorbable. Methods Six New Zealand white rabbits were used. After transection of the jugular vein, 2 PAVCMs were placed, 1 at each transected end. The stumps were slipped through the PAVCMs, and the venous wall was everted $90^{\circ}$ to achieve intima-to-intima contact. Reanastomosis of the transected jugular vein was performed bilaterally in 3 rabbits. In the other 3 rabbits, the jugular vein (20 mm) harvested from one side was interpositionally grafted to the jugular vein on the opposite side to ease the anastomotic tension. Patency testing, ultrasonography, and histologic assessments were conducted postoperatively at weeks 2, 4, 12, 16, 22, and 26. Results All anastomotic sites were patent, without stenosis, occlusion, or dilatation. In the histologic sections, immature endothelial regeneration was observed at week 2, which was completed by week 4. Regeneration of the tunica media was noted at week 12. Between week 22 and week 26, the tunica media fully regenerated and the coupler dissipated entirely. Conclusions Despite the absence of a coupler to act as an anastomotic buttress, the structure and function of all the vessels appeared normal, even histologically. These outcomes are true milestones in the development of an absorbable vein coupler.

• Archives of Reconstructive Microsurgery
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• v.15 no.2
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• pp.51-57
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• 2006

Free flap having been used for reconstruction of skin and soft tissue defect in various areas in a body is spreading up its application for not only functional reconstruction but also aesthetic reconstruction. Authors met with good results minimizing the demerits of anastomosis using suture through microvascular anastomotic device, hereupon, we intend to report this. We worked with 27 cases that used microvascular anastomotic device for venous anastomoses among patients who were processed free flap in our hospital. Age ranged from 12 to 63 (average 43.2), and there were 12 females and 15 males. As a result of a follow-up by 3 months - 5years (average 11.3 months), there was no particular complication in the anastomosed vein except 1 cases among 27 cases that sutured their veins through microvascular anastomotic device. Use of microvascular anastomotic device at free flap shortened the time required for vascular anastomoses to reduce ischemic time of tissue, and minimized the damage of intima during anastomoses and made easy anastomoses possible even in case the difference of diameters of blood vessels being sutured is wide. As well, even for survival rate of flap, satisfactory results were obtained compared with using suture. Consequently, it is concluded that use of microvascular anastomotic device in free flap is a useful way that can substitute existing anastomosis using suture.

• Archives of Reconstructive Microsurgery
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• v.17 no.2
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• pp.94-100
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• 2008

In the past decade, there has been increasing breast reconstructions after mastectomy, and the abdomen has been the gold standard for donor site. TRAM (transverse rectus abdominis myocutaneous), MSTRAM (muscle sparing transverse rectus abdominis myocutaneous), DIEP (deep inferior epigastric artery perforator), SIEA (superficial inferior epigastric artery) flap has been widely used nowadays. Among them, DIEP free flap spares the whole rectus abdominis muscle and anterior rectus sheath resulting in decreased donor site morbidity. Between March of 2006 and February of 2008, six patients had undergone immediate breast reconstructions using DIEP free flap. The mean age of patients was 48.5 years. All patients had unilateral breast reconstructions. We dissected two perforators which were included in the unilateral pedicle. Thoracodorsal artery and its venae comitantes were chosen as recipient vessels. For venous anastomosis, we used the GEM Microvascular Anastomotic Coupler System (Synovis Micro Companies Alliance, Inc., Birmingham, Ala.) in four cases. All flaps were survived completely except one who showed fatty abdomen in old age. She showed repetitive vascular spasm intraoperatively. None of the patients had abdominal hernia, bulge or weakness. We believe that DIEP free flap provides a reliable method for autologous breast reconstruction if the patients are selected appropriately and performed by a skillful surgeon.