Resident-performed free flap reconstruction: a retrospective comparison of microvascular coupler devices versus hand-sewn anastomosis

Abstract Background Microvascular anastomotic coupling devices (MACDs) help to improve the patency and reproducibility of venous anastomosis. However, owing to the high cost of MACDs in Taiwan, surgeons seldom use them. We compared the efficacy, surgical outcomes, and benefits of using MACDs versus traditional hand-sewn sutures for anastomosis. Methods This retrospective clinical study was conducted in the Plastic Surgery Division at the Tri-Service General hospital between December 2020 and October 2022. We compared the clinical characteristics and outcomes of two groups of patients who underwent free tissue transfer and venous anastomosis using traditional hand-sewn sutures or MACDs. The Synovis venous coupler (Synovis Micro Companies Alliance Inc, Birmingham, AL) was used in all coupled venous anastomoses. Results Overall, 81 patients were included in the study. Of these, traditional hand-sewn sutures were utilized in 46 patients and MACDs were used in 35 patients (43 venous anastomoses in total, all of which were end-to-end anastomoses). The success rates for the hand-sewn and MACD groups were 97.8% and 97.1%, respectively. The mean time taken for venous and arterial anastomosis in the MACD group was 93.26 min, compared with 102.48 min in the hand-sewn group ( p = 0.12). Additionally, the lengths of stay in the intensive care unit were 12.91 days for the hand-sewn group and 7.29 days for the MACD group ( p = 0.11). No thrombosis or leakage incidents occurred when using MACDs. Conclusions In resident-performed microvascular reconstruction, MACDs offer comparable success rates to hand-sewn techniques, with potential benefits in operative efficiency and postoperative recovery. These findings support the use of MACDs as a safe and effective tool in microsurgical training and practice. Not only in surgical outcomes but also in efficiency. Collectively, our results underscore the benefits of MACD use. Level of Evidence: Level III, risk / prognostic study.