The Microvascular Anastomotic Coupler for Venous Anastomosis in Head and Neck Reconstruction: An Institutional Experience.

Background This study aimed to identify outcome predictors with the GEM microvascular coupler system (GEM Coupler) in a series of patients undergoing free flap reconstruction for head and neck defects. Methodology In this retrospective chart review of 218 consecutive microvascular procedures performed on 204 patients at an academic tertiary care center, demographics, comorbidities, surgical data, and outcomes were retrieved. The endpoints for the analysis were microvascular revision surgery and flap survival. Results The study included 142 (70.2%) males and 62 (29.8%) females, with a mean age of 56 years, primarily treated for malignancy (76%). The anterolateral thigh and fibula were the most commonly used flaps (40.4% and 27.1%, respectively). In 21 (9.6%) cases, a double venous anastomosis was performed. There were nine flap failures requiring microvascular revision surgery; the flap was salvaged in four of these cases yielding an overall success rate of 97.7%. Factors associated with total flap loss included a history of a thrombotic or embolic event (p = 0.017), deep circumflex iliac artery flap (p < 0.001), and absence of monitoring skin paddle (p < 0.001). Conclusions Prothrombotic conditions, buried flaps, and flap type are outcome predictors in patients undergoing microvascular reconstruction with GEM Coupler.