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Early Experience Using Anastomotic Couplers in Digital Replantation and Revascularization
Stephen L. Viviano, M.D., Jonathan D. Keith, MD, FACS.
Rutgers-New Jersey Medical School, Newark, NJ, USA.

PURPOSE: Anastomotic couplers are widely used for venous anastomoses in free tissue transfer with excellent patency rates. Other studies have demonstrated that these everting ring-pin couplers can also be used for arterial anastomosis. However, no published studies describe the use of couplers for digital revascularization and replantation.
METHODS: A total of nine digital replantations/revascularizations were performed on three hands in three patients over a period of 1 month at a single replantation center. Two hands sustained industrial crush/avulsion injuries, while the third hand sustained table saw lacerations. All venous, and some arterial, anastomoses were performed using ring-pin anastomotic couplers ranging from 1.0-2.0 mm in size.
RESULTS: Eleven couplers were used to perform nine venous and two arterial anastomoses. All other arterial anastomoses were hand sewn. Two digits (22%) required leech therapy for venous congestion. Both cases of venous congestion occurred in hands injured with a crush/avulsion mechanism. All (100%) of the replanted/revascularized digits survived.
CONCLUSIONS: Our early experience demonstrates that small ring-pin anastomotic couplers can be used to perform both venous and arterial anastomoses in digital replantation/revascularization. The utilization of couplers has the potential to significantly decrease operative time and the overall technical burden of digital replantation/revascularization.


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