Microsuction or “Micropusher”—Facilitating Venous Microvascular Venous Anastomosis

Venous coupling devices are used by many reconstructive microsurgeons as an aid in their microvascular venous anastomoses during free tissue transfer. They offer an effective, reliable, and fast method for anastomosis with equivalent patency rates when compared with standard suture techniques.[1] The coupling device consists of two rings made of high-density polyethylene, with a series of six to eight (depending on the size of the coupler) stainless steel pins evenly spaced around each ring. The rings are manufactured with inner diameters that range in size from 1.0 to 4.0 mm, allowing anastomoses of vessels of the same diameter. The coupler application process involves several steps. First, an appropriately sized device needs to be selected and the two veins put into close proximity. The next step involves connecting the donor and recipient veins to their individual coupling components. This is done by pulling each end of the vessels through the opposing rings and hooking them on the pins. The aim is to ensure that the vessel wall is completely everted over the ring and that the pins completely pierce the vessel wall. This makes it easier to hook on subsequent pins. Various techniques and instruments have been employed to achieve this, including microforceps and hockey-stick devices. None of these instruments or techniques meet these demands completely. We therefore propose a new technique using a readily available piece of equipment, the lacrimal cannula attached to a 2-ml syringe, which we concomitantly use for microirrigation. The hollow microirrigation cannula slides easily over the pin for pushing the vessel wall down to the base of the pin in a safe and controlled fashion ([Fig. 1]). Furthermore, the pin size does not vary like the ring diameter; therefore, this technique can be used ubiquitously with all sized coupling devices. We frequently use this as an additional technique during venous coupler anastomoses. To date, we have experienced no complications with the use of this technique and found that it facilitates the integration of the coupling device into venous microanastomoses.

Figure 1 Use of microirrigation cannula to facilitate microvascular venous anastomosis.

We describe a technique, involving safe and secure fixation of the venous wall onto the coupler device prior to coaptation. This is one of the fundamental steps in venous coupler device use and thus has relevance to the field of microsurgery. It utilizes a piece of equipment that is readily available and a device that microsurgeons are used to handling so that the learning curve is a fairly shallow one. We would advocate the readership to attempt this and include it in their palette of techniques.

• Reference

• 1 Jandali S, Wu LC, Vega SJ, Kovach SJ, Serletti JM. 1000 consecutive venous anastomoses using the microvascular anastomotic coupler in breast reconstruction. Plast Reconstr Surg 2010; 125: 792-798