{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T23:03:42Z","timestamp":1789513422045,"version":"build-2803163510"},"reference-count":54,"publisher":"Georg Thieme Verlag KG","issue":"08","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>While the efficacy of coupling devices in venous anastomosis has been well-studied, most evidence focuses on end-to-end techniques. In head and neck reconstruction, end-to-side (ETS) venous anastomoses involving the internal\/external jugular vessels are common, yet evidence for using couplers in this context is limited. This study systematically evaluates the reliability and efficacy of couplers versus the hand-sewn method for ETS venous anastomosis in head and neck reconstruction.<\/jats:p>\n                  <jats:p>A literature search was conducted for articles reporting outcomes of ETS anastomosis in head and neck reconstruction. Studies were divided into two groups based on the anastomosis method: Hand-sewn and couplers. Pooled analysis was performed to compare the outcomes between the two groups. Using double-arm studies reporting outcomes for both methods, meta-analysis was conducted.<\/jats:p>\n                  <jats:p>Forty studies representing 2,664 cases were included, with 663 using couplers and 2,001 using hand-sewn methods. Most studies were retrospective cohorts. In the pooled analysis, the venous thrombosis rate was 1.8% for hand-sewn anastomoses and 2.5% for couplers, while the flap failure rate was 2.5% for hand-sewn and 1.9% for couplers, with no significant differences in either outcome. Meta-analysis based on four studies showed comparable venous thrombosis rates between the two groups. Anastomosis time was significantly shorter with couplers (standardized mean difference \u22123.93, p\u2009&lt;\u20090.0001).<\/jats:p>\n                  <jats:p>ETS venous anastomosis using a coupler device in head and neck reconstruction seems to be as safe as the hand-sewn method and may offer time-saving benefits. However, additional well-designed studies are needed to confirm these findings.<\/jats:p>","DOI":"10.1055\/a-2702-4335","type":"journal-article","created":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T23:19:57Z","timestamp":1758151197000},"page":"631-639","source":"Crossref","is-referenced-by-count":0,"title":["Reliability and Efficacy of Microvascular Coupler Devices for End-to-Side Venous Anastomosis in Head and Neck Reconstruction: A Systematic Review and Meta-Analysis"],"prefix":"10.1055","volume":"42","author":[{"given":"Jisu","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyeong-Tae","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South 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Maruccia","year":"2020","journal-title":"Microsurgery"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/j.bjps.2019.11.033","article-title":"Meta-analysis of venous anastomosis techniques in free flap reconstruction","volume":"73","author":"A Geierlehner","year":"2020","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"05","key":"ref10","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1001\/archotol.1996.01890170063012","article-title":"Use of a mechanical microvascular anastomotic device in head and neck free tissue transfer","volume":"122","author":"M L Shindo","year":"1996","journal-title":"Arch Otolaryngol Head Neck Surg"},{"issue":"02","key":"ref11","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.jcms.2023.10.002","article-title":"Safety and reliability of the internal jugular vein for venous anastomoses in head and neck oncological reconstruction: A retrospective study","volume":"52","author":"P 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Improving success and minimising morbidity","volume":"37","author":"M J Alan Turner","year":"2009","journal-title":"J Craniomaxillofac Surg"},{"issue":"10","key":"ref38","doi-asserted-by":"crossref","first-page":"1354","DOI":"10.1002\/hed.21105","article-title":"Analysis of free flap viability based on recipient vein selection","volume":"31","author":"D O Francis","year":"2009","journal-title":"Head Neck"},{"issue":"01","key":"ref39","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1055\/s-0030-1267829","article-title":"An algorithm for recipient vessel selection in microsurgical head and neck reconstruction","volume":"27","author":"H L Chia","year":"2011","journal-title":"J Reconstr Microsurg"},{"issue":"01","key":"ref40","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1007\/s00405-013-2496-y","article-title":"End-to-end versus end-to-side venous microanastomoses in head and neck reconstruction","volume":"271","author":"C Piazza","year":"2014","journal-title":"Eur Arch Otorhinolaryngol"},{"issue":"02","key":"ref41","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1097\/SAP.0000000000001905","article-title":"End-to-side venous anastomosis to a ligated vein stump for free flap transfer in head and neck reconstruction","volume":"83","author":"T Akazawa","year":"2019","journal-title":"Ann Plast Surg"},{"issue":"03","key":"ref42","doi-asserted-by":"crossref","first-page":"675e","DOI":"10.1097\/PRS.0000000000005358","article-title":"Usefulness of a longitudinal fixing method with two Bulldog vascular clamps for end-to-side anastomosis in head and neck reconstruction","volume":"143","author":"J Y Shin","year":"2019","journal-title":"Plast Reconstr Surg"},{"issue":"04","key":"ref43","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1080\/2000656X.2020.1755297","article-title":"Use of a biopsy punch for end-to-side anastomosis in free-tissue transfer","volume":"54","author":"J H Chung","year":"2020","journal-title":"J Plast Surg Hand 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