A comparative study of single versus double venous anastomosis with microvascular anastomotic coupler device (MACD) in maxillofacial reconstructions with free flaps.

Recently, venous couplers have been routinely employed for free flap surgery. Its use is justified considering the large number of backlog cases as well as for surgeon and patient benefit. However, venous thrombosis remains a worrisome problem in the use of venous couplers. Although the efficacy of venous couplers has been found to be equal to that of hand-sewn anastomosis, comparison of single versus double venous coupler anastomosis has not been reported. A prospective randomized study carried between 2020 and 2024 included 154 patients who underwent maxillofacial free flap reconstruction; these patients were divided into two groups based on the number of venous coupler anastomoses performed. (Single MACD, n = 82 vs. Double MACD, n = 72). Data were evaluated for demographics, perioperative details, vascular thrombosis, flap complications and flap loss. There were no significant differences regarding comorbidities or ASA status between the two groups. Overall, there was no significant difference regarding the rate of venous thrombosis (1 MACD: 2.44% versus 2 MACD: 2.78%, p > 0.05) or flap loss (1 MACD: 1.22% versus 2 MACD: 1.39%, p > 0.05). As our overall survivability rate was more than 97% in each group, it can be concluded that flap survivability is not dependent on the number of venous coupler anastomoses and that it would be safe to proceed with single venous coupler anastomosis with close flap monitoring. Various other factors, such as improper technique, intimal injury, hematoma and pedicle compression, may play more prominent roles in flap survivability.