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Hand-sewn, coupler and Doppler-assisted venous anastomosis in free flap surgery: a systematic review and meta-analysis

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Abstract

Background

Microvascular free tissue transfer is the gold standard technique for the repair and reconstruction of soft tissue defects. This systematic review and meta-analysis aims to evaluate the rate of free flap failure and venous thrombosis when venous anastomosis is done using a hand-sewn, coupler or implantable Doppler coupler method.

Methods

A systematic review of English language literature from 1990 to 2018, reporting free flap failure and venous thrombosis rates for the three methods of venous anastomosis, was performed.

Results

Overall flap failure rate is 1.9% (95% confidence interval: 1.3–2.7) and venous thrombosis is 3.5% (95% confidence interval: 2.3–4.8). Flap failure rate for hand sewn is 2.6%, for coupler 1.0% and for implantable Doppler coupler 2.8%. Venous thrombosis rates for hand sewn is 3.6%, for coupler 2.2% and for implantable Doppler coupler 11.1%

Conclusions

The current evidence suggests that there is no significant difference in the rate of free flap failure or venous thrombosis when using the three methods of venous anastomosis.

Level of evidence: Not gradable.

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Correspondence to Bhavika Himat Khera.

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Bhavika Himat Khera, Kate Evans and Joseph Thomas Hardwicke declare no competing interests.

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Appendix

Appendix

Table 4 Summary of studies included in the meta-analysis

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Khera, B.H., Evans, K. & Hardwicke, J.T. Hand-sewn, coupler and Doppler-assisted venous anastomosis in free flap surgery: a systematic review and meta-analysis. Eur J Plast Surg 45, 27–38 (2022). https://doi.org/10.1007/s00238-021-01854-w

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