Spontaneous uncoupling of microvascular anastomotic coupler device causing post-operative haematoma - salvage with re-coupling of the device: a case report

Dilip Gahankari; Fu-Yu Yang; Lincoln S. Millan

doi:10.18203/2349-2902.isj20250576

Authors

Dilip Gahankari Department of Plastic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
Fu-Yu Yang Department of Plastic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia https://orcid.org/0000-0003-1601-1938
Lincoln S. Millan Department of Plastic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia https://orcid.org/0000-0003-3776-2538

DOI:

https://doi.org/10.18203/2349-2902.isj20250576

Keywords:

MACD, Venous coupler, Spontaneous uncoupling of coupler device

Abstract

We report here a case of spontaneous uncoupling of the microvascular anastomotic coupler device (MACD), commonly known as venous coupler, causing acute post-operative bleeding and haematoma in early post-operative period, in a patient with free muscle sparing TRAM flap. This was noticed as the patient suddenly abducted her right arm post-operatively while patient tried to get up in a bed. This acute emergency was salvaged by re-engaging the coupler rings, with a simple technique with reinforced 9-0 Nylon sutures, without the need for revising the entire anastomosis.

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References

Jacobson JI, Suarea EL. Microsurgery in anastomosis of small vessels. Surg Forum. 1960;11:243-5.

Zeebregts CJ, Heijmen RH, van den Dungen JJ, van Schilfgaarde R. Non-suture methods of vascular anastomosis. Br J Surg. 2003;90:261-71. DOI: https://doi.org/10.1002/bjs.4063

Nakayama K, Yamamoto K, Tamiya T. A new simple apparatus for anastomosis of small vessels. Preliminary report. J Int Coll Surg. 1962;38:12-26.

Ostrup LT, Berggren A. The UNILINK instrument system for fast and safe microvascular anastomosis. Ann Plast Surg. 1986;17:521-5. DOI: https://doi.org/10.1097/00000637-198612000-00014

Heidekrueger P, von Fritschen U, Moellhoff N, Germann G, Giunta R, Zeman F, et al. Comparison of venous couplers versus hand-sewn technique in 4577 cases of DIEP-flap breast reconstructions – A multicenter study. Microsurgery. 2022;42:5-12. DOI: https://doi.org/10.1002/micr.30686

Kind GM, Buncke GM, Buncke HJ. Foreign-body sensation following 3M coupler use in the hand. Ann Plast Surg. 1996;37:418-21. DOI: https://doi.org/10.1097/00000637-199610000-00013

Hallock GG. The microanastomotic coupler masquerading as a foreign body. Plast Reconstr Surg. 2008;122:154e-5. DOI: https://doi.org/10.1097/PRS.0b013e318186cd42

Zomerlei TA, Komorowska-Timek E. Venous coupler migration: a near miss. Microsurgery. 2014;34:331-2. DOI: https://doi.org/10.1002/micr.22231

Kubo T, Kitamura N, Onoda M, Maeda D, Matsuda K, Hosokawa K. Exposure of a microvascular anastomotic coupler in head and neck reconstruction: a case report. Eplasty. 2014;14:e18.

Imahiyerobo TA, Spector JA. Late extrusion of a venous microvascular coupling ring. J Reconstr Microsurg. 2013;29:493-4. DOI: https://doi.org/10.1055/s-0033-1345432

Haq A, Singh V, Sharma S, Kumar A, Kumari A. A Unique Case of Venous Coupler Disruption and Salvage of Venous Anastomosis in a Case of Free Latissimus Dorsi Flap Reconstruction. J Hand Microsurg. 2024;16:1. DOI: https://doi.org/10.1055/s-0043-1761226

Kerr-Valentic MA, Gottlieb LJ, Agarwal JP. The retrograde limb of the internal mammary vein: an additional outflow option in DIEP fap breast reconstruction. Plast Reconstr Surg. 2009;124:717-21. DOI: https://doi.org/10.1097/PRS.0b013e3181b179fc

Zhang A, Kuc A, Triggs W, Dayicioglu D. Utilizing the Retrograde Descending Internal Mammary Vein in DIEP Flap Anastomosis. Eplasty. 2018;18:ic23.

Grewal AS, Erovic B, Strumas N, Enepekides DJ, Higgins KM. The utility of the microvascular anastomotic coupler in free tissue transfer. Canad J Plast Surg. 2012;20(2):98-102. DOI: https://doi.org/10.1177/229255031202000213

Jandali, S, Wu, LC, Vega, SJ, Kovach, SJ, Serletti, J. 1000 Consecutive Venous Anastomoses Using the Microvascular Anastomotic Coupler in Breast Reconstruction. Plast Reconstr Surg; 2010;125:792 –798. DOI: https://doi.org/10.1097/PRS.0b013e3181cb636d

Kisser U, Koepernik S. Microvascular anastomotic coupler for venous end‑to‑side anastomoses in head and neck reconstructive surgery. Eur Arch Oto-Rhino-Laryngol. 2023;280:4709-12. DOI: https://doi.org/10.1007/s00405-023-08136-0

Chernichenko N, Ross DA, Shin J, Chow JY, Sasaki CT, Ariyan S. Arterial coupling for microvascular free tissue transfer. Otolaryngol Head Neck Surg. 2008;138:614-8. DOI: https://doi.org/10.1016/j.otohns.2007.12.029