Is there a difference in venous thrombosis rate in free flap anastomoses based on coupler diameter? A systematic review. Does Size Really Matter?

Background: The adage is to use the largest anastomotic coupler device (coupler) size possible, since smaller an anastomosis might be more susceptible to thrombosis. It is unclear if this wisdom is supported by data. This study tests the hypothesis that there is no difference in the reported literat...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	D.D. Krijgh, B. Tellier, T. Teunis, W. Maarse, J.H. Coert
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Thrombosis Anastomotic Coupler Device Microsurgery Surgery RD1-811
Acceso en línea:	https://doaj.org/article/edc7e7d978a14da6ac6a68337cbed9b7
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:edc7e7d978a14da6ac6a68337cbed9b7
record_format	dspace
spelling	oai:doaj.org-article:edc7e7d978a14da6ac6a68337cbed9b72021-12-02T05:02:02ZIs there a difference in venous thrombosis rate in free flap anastomoses based on coupler diameter? A systematic review. Does Size Really Matter?2352-587810.1016/j.jpra.2021.07.005https://doaj.org/article/edc7e7d978a14da6ac6a68337cbed9b72021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2352587821000668https://doaj.org/toc/2352-5878Background: The adage is to use the largest anastomotic coupler device (coupler) size possible, since smaller an anastomosis might be more susceptible to thrombosis. It is unclear if this wisdom is supported by data. This study tests the hypothesis that there is no difference in the reported literature in thrombosis rate between different coupler sizes. Methods: We searched PubMed, Embase, and the Cochrane Library. After screening 235 studies, we included 11 retrospective case-series. According to the criteria of Newcastle–Ottowa Scale, quality score ranged from 2 to 4 (out of 5) and funnel plots indicated publication bias. We included a total of 5930 coupled anastomoses. We calculated thrombosis rate per coupler diameter with exact confidence intervals (CIs). We regard non-overlapping CIs as a significant difference. Results: Nine studies reported no difference in thrombosis rate based on coupler size. Two studies report a potentially greater thrombosis rates in smaller sizes: (1) 2.0 mm 27% (95% CI 17%–40%, 17/62 cases) vs. 3.0 mm 6.3% (95% CI 2.8%–12%, 8/126 cases) and (2) 1.5 mm 6.9% (95% CI 2.8%–14%, 7/101 cases) vs. 3.0 mm group 1.2% (95% CI 0.64%–2.1%, 13/1079). Conclusion: There is some evidence that suggests that smaller coupler sizes are associated with greater thrombosis rate, but the current available evidence has limitations. Performing a second anastomosis, in case, the first anastomosis is performed with a coupler size of 1.0, 1.5, or even 2.0 mm, can potentially reduce this rate, however, this remains to be determined.D.D. KrijghB. TellierT. TeunisW. MaarseJ.H. CoertElsevierarticleThrombosisAnastomotic Coupler DeviceMicrosurgerySurgeryRD1-811ENJPRAS Open, Vol 30, Iss , Pp 74-83 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Thrombosis Anastomotic Coupler Device Microsurgery Surgery RD1-811
spellingShingle	Thrombosis Anastomotic Coupler Device Microsurgery Surgery RD1-811 D.D. Krijgh B. Tellier T. Teunis W. Maarse J.H. Coert Is there a difference in venous thrombosis rate in free flap anastomoses based on coupler diameter? A systematic review. Does Size Really Matter?
description	Background: The adage is to use the largest anastomotic coupler device (coupler) size possible, since smaller an anastomosis might be more susceptible to thrombosis. It is unclear if this wisdom is supported by data. This study tests the hypothesis that there is no difference in the reported literature in thrombosis rate between different coupler sizes. Methods: We searched PubMed, Embase, and the Cochrane Library. After screening 235 studies, we included 11 retrospective case-series. According to the criteria of Newcastle–Ottowa Scale, quality score ranged from 2 to 4 (out of 5) and funnel plots indicated publication bias. We included a total of 5930 coupled anastomoses. We calculated thrombosis rate per coupler diameter with exact confidence intervals (CIs). We regard non-overlapping CIs as a significant difference. Results: Nine studies reported no difference in thrombosis rate based on coupler size. Two studies report a potentially greater thrombosis rates in smaller sizes: (1) 2.0 mm 27% (95% CI 17%–40%, 17/62 cases) vs. 3.0 mm 6.3% (95% CI 2.8%–12%, 8/126 cases) and (2) 1.5 mm 6.9% (95% CI 2.8%–14%, 7/101 cases) vs. 3.0 mm group 1.2% (95% CI 0.64%–2.1%, 13/1079). Conclusion: There is some evidence that suggests that smaller coupler sizes are associated with greater thrombosis rate, but the current available evidence has limitations. Performing a second anastomosis, in case, the first anastomosis is performed with a coupler size of 1.0, 1.5, or even 2.0 mm, can potentially reduce this rate, however, this remains to be determined.
format	article
author	D.D. Krijgh B. Tellier T. Teunis W. Maarse J.H. Coert
author_facet	D.D. Krijgh B. Tellier T. Teunis W. Maarse J.H. Coert
author_sort	D.D. Krijgh
title	Is there a difference in venous thrombosis rate in free flap anastomoses based on coupler diameter? A systematic review. Does Size Really Matter?
title_short	Is there a difference in venous thrombosis rate in free flap anastomoses based on coupler diameter? A systematic review. Does Size Really Matter?
title_full	Is there a difference in venous thrombosis rate in free flap anastomoses based on coupler diameter? A systematic review. Does Size Really Matter?
title_fullStr	Is there a difference in venous thrombosis rate in free flap anastomoses based on coupler diameter? A systematic review. Does Size Really Matter?
title_full_unstemmed	Is there a difference in venous thrombosis rate in free flap anastomoses based on coupler diameter? A systematic review. Does Size Really Matter?
title_sort	is there a difference in venous thrombosis rate in free flap anastomoses based on coupler diameter? a systematic review. does size really matter?
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/edc7e7d978a14da6ac6a68337cbed9b7
work_keys_str_mv	AT ddkrijgh isthereadifferenceinvenousthrombosisrateinfreeflapanastomosesbasedoncouplerdiameterasystematicreviewdoessizereallymatter AT btellier isthereadifferenceinvenousthrombosisrateinfreeflapanastomosesbasedoncouplerdiameterasystematicreviewdoessizereallymatter AT tteunis isthereadifferenceinvenousthrombosisrateinfreeflapanastomosesbasedoncouplerdiameterasystematicreviewdoessizereallymatter AT wmaarse isthereadifferenceinvenousthrombosisrateinfreeflapanastomosesbasedoncouplerdiameterasystematicreviewdoessizereallymatter AT jhcoert isthereadifferenceinvenousthrombosisrateinfreeflapanastomosesbasedoncouplerdiameterasystematicreviewdoessizereallymatter
_version_	1718400804608540672

Is there a difference in venous thrombosis rate in free flap anastomoses based on coupler diameter? A systematic review. Does Size Really Matter?

Ejemplares similares