Abstract
Most free flap failures result from technical problems in performing vascular anastomoses, such as endothelial intima lacerations, distortion of the vessels, and unequal intersuture distances. These incorrect practices can lead to thrombosis formation and, ultimately, flap failure. Solving this problem is a challenging issue for all micro-reconstructive surgeons. In the last decade, a vascular anastomotic coupler instrument was developed and reported on. We review our recent experiences of free tissue transfer using this vascular coupler device, and discuss how venous problems can be overcome with its aid. We believe the excellent patency rate of the coupler may minimize the well-described problems of venous thrombosis in the challenging field of free tissue reconstructions.