Venous coupler size in autologous breast reconstruction - Does it matter?

P. Niclas Broer, Katie E. Weichman, Neil Tanna, Stelios Wilson, Reuben Ng, Christina Ahn, Mihye Choi, Nolan S. Karp, Jamie P. Levine, Robert J. Allen

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background Autologous microvascular breast reconstruction is an increasingly common procedure. While arterial anastomoses are traditionally being hand-sewn, venous anastomoses are often completed with a coupler device. The largest coupler size possible should be used, as determined by the smaller of either the donor or recipient vein. While its efficacy has been shown using 3.0-mm size and greater couplers, little is known about the consequences of using coupler sizes less than or equal to 2.5 mm. Methods: A retrospective chart review of patients undergoing autologous breast reconstruction was conducted at NYU Medical Center between November 2007 and November 2011. Flaps were divided into cohorts based on coupler size used: 2.0 mm, 2.5 mm, and 3.0 mm. Outcomes included incidence of arterial or venous insufficiency, hematoma, fat necrosis, partial flap loss, full flap loss, and need for future fat grafting. Results: One-hundred ninety-seven patients underwent 392 flaps during the study period. Patients were similar in age, type of flap, smoking status, and radiation history. Coupler size less than or equal to 2.0 mm was found to be a significant risk factor for venous insufficiency (P = 0.038), as well as for development of fat necrosis (P = 0.041) and future need for fat grafting (P = 0.050). In multivariate analysis, body mass index was found to be an independent risk factor for skin flap necrosis (P = 0.010) and full flap loss (P = 0.035). Conclusions: Complications were significantly increased in patients where couplers of 2.0 mm or less were used, therefore to be avoided whenever possible. When needed, more aggressive vessel exposure through rib harvest, the use of thoracodorsal vessels or hand-sewing the anastomosis should be considered in cases of internal mammary vein caliber of 2.0 mm or less. Clinical Question Therapeutic Level of Evidence Level III.

Original languageEnglish (US)
Pages (from-to)514-518
Number of pages5
JournalMicrosurgery
Volume33
Issue number7
DOIs
StatePublished - Oct 2013
Externally publishedYes

Fingerprint

Mammaplasty
Fat Necrosis
Venous Insufficiency
Veins
Hand
Fats
Ribs
Hematoma
Breast
Body Mass Index
Necrosis
Multivariate Analysis
Smoking
Tissue Donors
Radiation
Equipment and Supplies
Skin
Incidence
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Broer, P. N., Weichman, K. E., Tanna, N., Wilson, S., Ng, R., Ahn, C., ... Allen, R. J. (2013). Venous coupler size in autologous breast reconstruction - Does it matter? Microsurgery, 33(7), 514-518. https://doi.org/10.1002/micr.22169

Venous coupler size in autologous breast reconstruction - Does it matter? / Broer, P. Niclas; Weichman, Katie E.; Tanna, Neil; Wilson, Stelios; Ng, Reuben; Ahn, Christina; Choi, Mihye; Karp, Nolan S.; Levine, Jamie P.; Allen, Robert J.

In: Microsurgery, Vol. 33, No. 7, 10.2013, p. 514-518.

Research output: Contribution to journalArticle

Broer, PN, Weichman, KE, Tanna, N, Wilson, S, Ng, R, Ahn, C, Choi, M, Karp, NS, Levine, JP & Allen, RJ 2013, 'Venous coupler size in autologous breast reconstruction - Does it matter?', Microsurgery, vol. 33, no. 7, pp. 514-518. https://doi.org/10.1002/micr.22169
Broer, P. Niclas ; Weichman, Katie E. ; Tanna, Neil ; Wilson, Stelios ; Ng, Reuben ; Ahn, Christina ; Choi, Mihye ; Karp, Nolan S. ; Levine, Jamie P. ; Allen, Robert J. / Venous coupler size in autologous breast reconstruction - Does it matter?. In: Microsurgery. 2013 ; Vol. 33, No. 7. pp. 514-518.
@article{a4a46e3f64734e589cf28192634c74e9,
title = "Venous coupler size in autologous breast reconstruction - Does it matter?",
abstract = "Background Autologous microvascular breast reconstruction is an increasingly common procedure. While arterial anastomoses are traditionally being hand-sewn, venous anastomoses are often completed with a coupler device. The largest coupler size possible should be used, as determined by the smaller of either the donor or recipient vein. While its efficacy has been shown using 3.0-mm size and greater couplers, little is known about the consequences of using coupler sizes less than or equal to 2.5 mm. Methods: A retrospective chart review of patients undergoing autologous breast reconstruction was conducted at NYU Medical Center between November 2007 and November 2011. Flaps were divided into cohorts based on coupler size used: 2.0 mm, 2.5 mm, and 3.0 mm. Outcomes included incidence of arterial or venous insufficiency, hematoma, fat necrosis, partial flap loss, full flap loss, and need for future fat grafting. Results: One-hundred ninety-seven patients underwent 392 flaps during the study period. Patients were similar in age, type of flap, smoking status, and radiation history. Coupler size less than or equal to 2.0 mm was found to be a significant risk factor for venous insufficiency (P = 0.038), as well as for development of fat necrosis (P = 0.041) and future need for fat grafting (P = 0.050). In multivariate analysis, body mass index was found to be an independent risk factor for skin flap necrosis (P = 0.010) and full flap loss (P = 0.035). Conclusions: Complications were significantly increased in patients where couplers of 2.0 mm or less were used, therefore to be avoided whenever possible. When needed, more aggressive vessel exposure through rib harvest, the use of thoracodorsal vessels or hand-sewing the anastomosis should be considered in cases of internal mammary vein caliber of 2.0 mm or less. Clinical Question Therapeutic Level of Evidence Level III.",
author = "Broer, {P. Niclas} and Weichman, {Katie E.} and Neil Tanna and Stelios Wilson and Reuben Ng and Christina Ahn and Mihye Choi and Karp, {Nolan S.} and Levine, {Jamie P.} and Allen, {Robert J.}",
year = "2013",
month = "10",
doi = "10.1002/micr.22169",
language = "English (US)",
volume = "33",
pages = "514--518",
journal = "Microsurgery",
issn = "0738-1085",
publisher = "Wiley-Liss Inc.",
number = "7",

}

TY - JOUR

T1 - Venous coupler size in autologous breast reconstruction - Does it matter?

AU - Broer, P. Niclas

AU - Weichman, Katie E.

AU - Tanna, Neil

AU - Wilson, Stelios

AU - Ng, Reuben

AU - Ahn, Christina

AU - Choi, Mihye

AU - Karp, Nolan S.

AU - Levine, Jamie P.

AU - Allen, Robert J.

PY - 2013/10

Y1 - 2013/10

N2 - Background Autologous microvascular breast reconstruction is an increasingly common procedure. While arterial anastomoses are traditionally being hand-sewn, venous anastomoses are often completed with a coupler device. The largest coupler size possible should be used, as determined by the smaller of either the donor or recipient vein. While its efficacy has been shown using 3.0-mm size and greater couplers, little is known about the consequences of using coupler sizes less than or equal to 2.5 mm. Methods: A retrospective chart review of patients undergoing autologous breast reconstruction was conducted at NYU Medical Center between November 2007 and November 2011. Flaps were divided into cohorts based on coupler size used: 2.0 mm, 2.5 mm, and 3.0 mm. Outcomes included incidence of arterial or venous insufficiency, hematoma, fat necrosis, partial flap loss, full flap loss, and need for future fat grafting. Results: One-hundred ninety-seven patients underwent 392 flaps during the study period. Patients were similar in age, type of flap, smoking status, and radiation history. Coupler size less than or equal to 2.0 mm was found to be a significant risk factor for venous insufficiency (P = 0.038), as well as for development of fat necrosis (P = 0.041) and future need for fat grafting (P = 0.050). In multivariate analysis, body mass index was found to be an independent risk factor for skin flap necrosis (P = 0.010) and full flap loss (P = 0.035). Conclusions: Complications were significantly increased in patients where couplers of 2.0 mm or less were used, therefore to be avoided whenever possible. When needed, more aggressive vessel exposure through rib harvest, the use of thoracodorsal vessels or hand-sewing the anastomosis should be considered in cases of internal mammary vein caliber of 2.0 mm or less. Clinical Question Therapeutic Level of Evidence Level III.

AB - Background Autologous microvascular breast reconstruction is an increasingly common procedure. While arterial anastomoses are traditionally being hand-sewn, venous anastomoses are often completed with a coupler device. The largest coupler size possible should be used, as determined by the smaller of either the donor or recipient vein. While its efficacy has been shown using 3.0-mm size and greater couplers, little is known about the consequences of using coupler sizes less than or equal to 2.5 mm. Methods: A retrospective chart review of patients undergoing autologous breast reconstruction was conducted at NYU Medical Center between November 2007 and November 2011. Flaps were divided into cohorts based on coupler size used: 2.0 mm, 2.5 mm, and 3.0 mm. Outcomes included incidence of arterial or venous insufficiency, hematoma, fat necrosis, partial flap loss, full flap loss, and need for future fat grafting. Results: One-hundred ninety-seven patients underwent 392 flaps during the study period. Patients were similar in age, type of flap, smoking status, and radiation history. Coupler size less than or equal to 2.0 mm was found to be a significant risk factor for venous insufficiency (P = 0.038), as well as for development of fat necrosis (P = 0.041) and future need for fat grafting (P = 0.050). In multivariate analysis, body mass index was found to be an independent risk factor for skin flap necrosis (P = 0.010) and full flap loss (P = 0.035). Conclusions: Complications were significantly increased in patients where couplers of 2.0 mm or less were used, therefore to be avoided whenever possible. When needed, more aggressive vessel exposure through rib harvest, the use of thoracodorsal vessels or hand-sewing the anastomosis should be considered in cases of internal mammary vein caliber of 2.0 mm or less. Clinical Question Therapeutic Level of Evidence Level III.

UR - http://www.scopus.com/inward/record.url?scp=84885949515&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84885949515&partnerID=8YFLogxK

U2 - 10.1002/micr.22169

DO - 10.1002/micr.22169

M3 - Article

C2 - 24038542

AN - SCOPUS:84885949515

VL - 33

SP - 514

EP - 518

JO - Microsurgery

JF - Microsurgery

SN - 0738-1085

IS - 7

ER -