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Microvascular Anastomotic Coupler Devices (MACD) Versus Hand-Sewn Technique for Arterial Anastomosis: A Systematic Review

21 Pages Posted: 16 Oct 2020

See all articles by Danny Adam

Danny Adam

Pennine Acute Hospitals NHS Trus - Department of Oral and Maxillofacial Surgery

Damian Broderick

Pennine Acute Hospitals NHS Trus - Department of Oral and Maxillofacial Surgery

Panayiotis Kyzas

East Lancashire Hospitals NHS Trust - Department of Oral and Maxillofacial Surgery

Leandros Vassiliou

East Lancashire Hospitals NHS Trust - Department of Oral and Maxillofacial Surgery

More...

Abstract

Background: Microvascular anastomotic coupling devices (MACD) are an established technique for venous anastomosis. Arterial MACD literature is conflicting. We report the first registered systematic review of its kind, evaluating the safety and efficiency of arterial MACD in free flaps.

Methods: We performed a PRISMA-guided systematic review (PROSPERO-registered). Reports were identified using a search algorithm in MEDLINE/EMBASE. The rate of arterial thrombosis was set as the primary outcome. Secondary outcomes included flap survival, failure rates and comparison between MACD vs. the conventional hand-sewn technique.

Findings: From the 17 studies identified, 2672 free flap reconstructions were performed and 640 arterial MACD were attempted (622 completed-97.2%). The pooled incidence of arterial thrombosis was 2.1% (13/622). The overall flap failure rate was 4.34% (116/2672). The total number of arterial MACD performed first time, with no perioperative complications/revisions/thrombosis, was 88.9% (569/640). GRADE quality-analysis revealed low quality and significant heterogeneity.

Interpretation: Arterial MACD are a safe and efficient alternative to hand-sewn anastomosis, with more recent literature showing excellent results. However, further evaluation is required with controlled trials. 

Funding: There was no funding or financial incentive for any author in this paper.

Declaration of Interests: No conflict of interest.

Keywords: Microvascular anastomotic coupling device (MACD), couplers, anastomosis, free tissue transfer

Suggested Citation

Adam, Danny and Broderick, Damian and Kyzas, Panayiotis and Vassiliou, Leandros, Microvascular Anastomotic Coupler Devices (MACD) Versus Hand-Sewn Technique for Arterial Anastomosis: A Systematic Review (8/24/2020). Available at SSRN: https://ssrn.com/abstract=3681503 or http://dx.doi.org/10.2139/ssrn.3681503

Danny Adam

Pennine Acute Hospitals NHS Trus - Department of Oral and Maxillofacial Surgery

Manchester
United Kingdom

Damian Broderick

Pennine Acute Hospitals NHS Trus - Department of Oral and Maxillofacial Surgery

Manchester
United Kingdom

Panayiotis Kyzas (Contact Author)

East Lancashire Hospitals NHS Trust - Department of Oral and Maxillofacial Surgery

Blackburn
United Kingdom

Leandros Vassiliou

East Lancashire Hospitals NHS Trust - Department of Oral and Maxillofacial Surgery

Blackburn
United Kingdom

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