Use of the Venous Coupler in Breast Reconstruction by Means of a Deep Inferior Epigastric Perforator: Reduction of Surgery Length and Venous Thromboses ?
Condition: Mammary Reconstruction
MeSH terms: Thrombosis; Venous Thrombosis
Study type: Observational

Summary: 
      This is a retrospective study performed on medical records, in order to compare the number of
      venous thromboses, the surgery duration, the complications rate and the duration of
      anastomosis in breast reconstructive surgeries by the DIEP (Deep Inferior Epigastric
      Perforator Flap) technique, with or without the use of a venous coupler.
    

Detailed description: 
      Breast cancer is the most common and deadliest cancer among women in Belgium. Women with
      invasive cancer may be offered a total mastectomy with or without adjuvant/neoadjuvant
      therapy, and with or without breast reconstruction. It is obvious that the loss of a breast
      can impact the self-image, hence the importance of informing the patient about the
      possibilities of breast reconstruction. Between 14 and 20% of women choose to resort to
      reconstruction.

      Different types of breast reconstruction exist: prosthetic reconstruction, lipolifting and
      flap reconstruction (of large dorsal, gluteus maximus, rectus abdominis muscle and "DIEP").

      DIEP (Deep Inferior Epigastric Perforator Flap) presents numerous advantages. It consists in
      the use of a free cutaneo-greasy flap taken from the abdomen, without muscle removed. The
      abdominal skin has a similar appearance to the breast skin and, thanks to the presence of
      fat, the missing volume is replaced by a living tissue. Weakness of the abdominal wall is
      also avoided. However, it remains a surgical procedure with possible complications.

      There are several steps in this surgery. The first is to dissect the abdominal flap by
      talking the skin and subcutaneous fat and isolating one or two branches of the lower
      epigastric artery and one or two veins. The donor area is then closed. The second step is to
      prepare the recipient area, ie dissect the artery that will be anastomosed with the lower
      deep epigastric artery.This artery can be the intern mammary artery, the thoraco-dorsal
      artery or more rarely the axillary artery. The third step consists of performing arterial and
      venous anastomoses and checking the quality of these.

      Two microanastomoses must thus be performed: arterial and venous. The classic technique, the
      most used, is to suture the 2 veins. Alternatively, a coupler device can be used to perform
      the venous anastomosis.

      It is therefore interesting to compare the classical method and the venous coupler method in
      terms of surgery duration, venous thrombosis and complications. If the coupler is proved
      effective, it could replace the manual suture.

      Venous thrombosis is the main cause of flap failure. But surgery duration has also an impact
      on the complication rate, and the anastomosis duration corresponds to the time during which
      the flap is not perfused. It is thus necessary to keep it to a minimum in order to reduce the
      risk of flap loss.
    

Intervention name(s): Venous coupler
Intervention type(s): Device
Intervention description(s): A coupler can be used to perform a venous anastomosis. It is a double ring with pins on only one of its 2 faces. The technique consists in clamping the two veins, estimating the intima-to-intimal diameter of the vessels, choosing the coupler of the appropriate size, sliding the vein in the ring and evers the edges of the vessel to fix them on the pins, redo the same thing for the other vein and finally bring the two vessels together in order to clip them together.
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Women having had a total mastectomy and a mammary reconstruction by the DIEP technique with
        or without venous coupler utilisation, treated within the CHU Brugmann hospital between
        01/01/2017 and 01/09/2017.
      
Keywords: DIEP; Venous coupler