Use of venous couplers in microsurgical lower extremity reconstruction: A systematic review and meta-analysis
Valentin Haug MD
Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorAdriana C. Panayi MD
Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorNikita Kadakia BS
Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorObada Abdulrazzak BA
Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorYori Endo MD
Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorKodi Udeh MS
Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
The University of Connecticut School of Medicine, Farmington, Connecticut, USA
Search for more papers by this authorBranislav Kollar MD
Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorGabriel Hundeshagen MD, MMS
Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
Search for more papers by this authorBohdan Pomahac MD
Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorUlrich Kneser MD
Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
Search for more papers by this authorCorresponding Author
Christoph Hirche MD
Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
Correspondence
Christoph Hirche, Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany.
Email: [email protected]
Search for more papers by this authorValentin Haug MD
Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorAdriana C. Panayi MD
Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorNikita Kadakia BS
Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorObada Abdulrazzak BA
Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorYori Endo MD
Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorKodi Udeh MS
Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
The University of Connecticut School of Medicine, Farmington, Connecticut, USA
Search for more papers by this authorBranislav Kollar MD
Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorGabriel Hundeshagen MD, MMS
Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
Search for more papers by this authorBohdan Pomahac MD
Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorUlrich Kneser MD
Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
Search for more papers by this authorCorresponding Author
Christoph Hirche MD
Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
Correspondence
Christoph Hirche, Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany.
Email: [email protected]
Search for more papers by this authorFunding information: Plastic Surgery Foundation Research Fellowship Grant; United States Department of Defense, Grant/Award Number: #W911QY-09-C-0216
Abstract
Background
Free tissue transfer for lower limb reconstruction has become a workhorse procedure for limb-salvage. Compared with other recipient sites, the lower extremity has a higher risk of microvascular complications, in particular with venous anastomosis. The study's objective is to evaluate the evidence, safety, and efficacy of venous coupler use in microsurgical anastomosis in lower limb reconstruction to provide objective appraisal of the surgical techniques.
Methods
A systematic review (SR) and meta-analysis (MA) were performed analyzing articles from PubMed, Cochrane, Embase, and Web of Science from January 1990, to August 2018. Abstracts and titles were screened and assessed for eligibility by independent reviewers. Following full-text review, articles were included in the SR and MA. Case reports were excluded. Cochrane Collaboration and the Quality of Reporting of Meta-analyses (QUOROM) guidelines were followed.
Results
Out of 15 included studies that met the inclusion criteria for the SR, 9 were included in MA. Patients treated with venous couplers did not experience more surgical complications (risk ratio (RR) 0.79; 95% confidence interval (CI) 0.48–1.33; p = .38), total failure (RR 0.61; 95% CI 0.22–1.70; p = .34), venous compromise (RR 0.72; 95% CI 0.23–2.27; p = .57), arterial compromise (RR 0.85; 95% CI 0.25–2.88; p = .80), partial failure (RR 0.77; 95% CI 0.33–1.77; p = .54), or reoperation (RR 11.79; 95% CI 0.49–286.55; p = .13) in comparison with hand-sewn anastomosis.
Conclusions
Outcomes of venous couplers in lower limb reconstruction are comparable to those of hand-sewn anastomosis. However, this study was limited by the quality of the available literature. Additional prospective studies should aim to directly compare both techniques and potential further benefits in clinical trials.
Supporting Information
| Filename | Description |
|---|---|
| micr30581-sup-0001-TableS1.docxWord 2007 document , 14.3 KB | Table S1 Inclusion and exclusion criteria. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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