{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T20:44:37Z","timestamp":1792183477057,"version":"4.4.0"},"reference-count":15,"publisher":"Georg Thieme Verlag KG","issue":"07","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Microsurgical breast reconstruction offers superior outcomes after mastectomy, but vascular microanastomosis remains technically demanding. Venous couplers are widely adopted, whereas the use of arterial couplers remains controversial. This study aimed to establish an algorithmic approach for arterial coupler use and compare outcomes with hand-sewn sutures.<\/jats:p>\n                  <jats:p>A retrospective review was performed on 105 patients undergoing deep inferior epigastric perforator flap breast reconstruction by a single surgeon. Patients were divided into an arterial coupler group (n\u2009=\u200962) and a hand-sewn suture group (n\u2009=\u200943). An intraoperative algorithm guided coupler use, requiring the absence of atherosclerosis, intact intima, and adequate vessel laxity. Demographics, operative details, microanastomosis time, and postoperative outcomes were analyzed.<\/jats:p>\n                  <jats:p>Patients in the coupler group were younger (47.6\u2009\u00b1\u20098.6 vs. 53.0\u2009\u00b1\u20097.9 years, p\u2009=\u20090.001) and underwent more robot-assisted procedures (16.1% vs. 2.3%, p\u2009=\u20090.025). Microanastomosis time was significantly shorter with couplers (19.6\u2009\u00b1\u20098.9 vs. 26.1\u2009\u00b1\u20096.5\u2009minutes, p\u2009&lt;\u20090.01). Flap survival was comparable between groups (96.8% vs. 100%, p\u2009=\u20090.512). Complication rates, including arterial\/venous insufficiency, hematoma, and infection, showed no significant differences. Two coupler failures occurred: One venous congestion and one late thrombosis, both attributed to multifactorial causes rather than device failure.<\/jats:p>\n                  <jats:p>Arterial couplers, when used under strict algorithmic selection criteria, provide reliable outcomes comparable to hand-sewn sutures while significantly reducing operative time. This approach enhances efficiency in microsurgical breast reconstruction and may guide future standardized practice.<\/jats:p>","DOI":"10.1055\/a-2751-8780","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T00:14:54Z","timestamp":1764029694000},"page":"541-547","source":"Crossref","is-referenced-by-count":1,"title":["An Algorithmic Approach to Arterial Coupler Use in Microsurgical Breast Reconstruction: Comparison with Hand-Sewn Sutures"],"prefix":"10.1055","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0096-7401","authenticated-orcid":false,"given":"Hyung Bae","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7072-9882","authenticated-orcid":false,"given":"Hyun Il","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun Ho","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin Sup","family":"Eom","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,12,12]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.5999\/aps.2012.39.1.3","article-title":"Breast reconstruction with microvascular MS-TRAM and DIEP flaps","volume":"39","author":"D W Chang","year":"2012","journal-title":"Arch Plast Surg"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"7S","DOI":"10.1097\/PRS.0000000000003941","article-title":"Current trends in postmastectomy breast reconstruction","volume":"140","author":"H Panchal","year":"2017","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1097\/00006534-200208000-00015","article-title":"Breast Reconstruction with the free TRAM or DIEP flap: Patient selection, choice of flap, and outcome","volume":"110","author":"M Y Nahabedian","year":"2002","journal-title":"Plast Reconstr Surg"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"e282","DOI":"10.1097\/PRS.0b013e3181bf825e","article-title":"History of microsurgery","volume":"124","author":"S Tamai","year":"2009","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1097\/00000637-199401000-00007","article-title":"Deep inferior epigastric perforator flap for breast reconstruction","volume":"32","author":"R J Allen","year":"1994","journal-title":"Ann Plast Surg"},{"issue":"06","key":"ref6","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1016\/j.bjps.2020.12.090","article-title":"Microvascular anastomotic arterial coupling: A systematic review","volume":"74","author":"G Pafitanis","year":"2021","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1097\/01.sap.0000202614.45743.34","article-title":"Routine use of microvascular coupling device for 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Sando","year":"2018","journal-title":"J Reconstr Microsurg"},{"issue":"07","key":"ref11","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1002\/micr.22169","article-title":"Venous coupler size in autologous breast reconstruction\u2013does it matter?","volume":"33","author":"P N Broer","year":"2013","journal-title":"Microsurgery"},{"issue":"06","key":"ref12","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1002\/micr.31078","article-title":"The use of arterial coupler for small size perforator-to-perforator microvascular anastomosis","volume":"43","author":"M F Scaglioni","year":"2023","journal-title":"Microsurgery"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1055\/s-0037-1606540","article-title":"Economic comparison of hand-sutured and coupler-assisted microvascular anastomoses","volume":"34","author":"L K Head","year":"2018","journal-title":"J Reconstr Microsurg"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"3S","DOI":"10.1097\/PRS.0000000000011205","article-title":"Conventional versus robot-assisted immediate breast reconstruction: Reconstructive outcome and patient-reported outcome measures","volume":"154","author":"H B Kim","year":"2024","journal-title":"Plast Reconstr Surg"},{"issue":"06","key":"ref15","doi-asserted-by":"crossref","first-page":"e31214","DOI":"10.1002\/micr.31214","article-title":"A clinical application for arterial coupling and histomorphometric comparison of internal mammary and thoracodorsal arteries for safe use","volume":"44","author":"S Lohasammakul","year":"2024","journal-title":"Microsurgery"}],"container-title":["Journal of Reconstructive 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