Everter-Assisted Arterial Coupling in Abdominal-Based Breast Reconstruction: A Preclinical Study and Retrospective Feasibility Case Series
- 1Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- 2Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
Abstract
Background/Objectives: Arterial coupling in microsurgery remains technically challenging despite widespread venous coupler adoption. We developed a novel everter device to facilitate arterial anastomosis using mechanical couplers and evaluated its feasibility and potential efficiency in abdominal-based breast reconstruction. Methods: Five pigs underwent paired superior epigastric artery flap reconstruction with everter-assisted and hand-sewn arterial anastomoses, analyzed using a paired t-test. A retrospective clinical series included 12 patients, 22 reconstructed breasts, 14 coupling attempts, and 8 primary hand-sewn recipient arterial anastomoses. The primary clinical outcome was successful coupling without revision or conversion. Clinical timing comparisons were descriptive. Results: All five porcine arterial couplings were successful. Mean arterial time was 8.47 ± 2.83 min versus 20.26 ± 3.32 min for hand-sewn controls, a paired reduction of 11.79 min (95% CI, 5.86 to 17.72; p = 0.005). Clinical coupling succeeded in 9 of 14 attempts (64.3%). Five attempts required conversion (35.7%), including three thrombotic and two technical failures. All were converted intraoperatively, with no flap loss. Mean arterial times were 9.2 ± 4.2 min for successful coupling (n = 8) and 20.2 ± 8.0 min for primary hand-sewn anastomosis (n = 6), an approximately 55% difference. Conclusions: Everter-assisted arterial coupling demonstrated clinical feasibility and shorter mean arterial times when successfully completed. These findings support further refinement and evaluation of the technique to establish safety and overall procedural efficiency.
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BibTeX
@article{dehdashtian2026everterassisted,
title = {{Everter-Assisted Arterial Coupling in Abdominal-Based Breast Reconstruction: A Preclinical Study and Retrospective Feasibility Case Series}},
author = {Amir Dehdashtian and Michael Sorkin and Paul S. Cederna and Adeyiza O. Momoh},
journal = {Cancers},
year = {2026},
month = oct,
doi = {10.3390/cancers18203343},
url = {https://www.mdpi.com/2072-6694/18/20/3343},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Everter-Assisted Arterial Coupling in Abdominal-Based Breast Reconstruction: A Preclinical Study and Retrospective Feasibility Case Series
AU - Amir Dehdashtian
AU - Michael Sorkin
AU - Paul S. Cederna
AU - Adeyiza O. Momoh
PY - 2026
DA - 2026/10/01
JO - Cancers
DO - 10.3390/cancers18203343
UR - https://www.mdpi.com/2072-6694/18/20/3343
AB - Background/Objectives: Arterial coupling in microsurgery remains technically challenging despite widespread venous coupler adoption. We developed a novel everter device to facilitate arterial anastomosis using mechanical couplers and evaluated its feasibility and potential efficiency in abdominal-based breast reconstruction. Methods: Five pigs underwent paired superior epigastric artery flap reconstruction with everter-assisted and hand-sewn arterial anastomoses, analyzed using a paired t-test. A retrospective clinical series included 12 patients, 22 reconstructed breasts, 14 coupling attempts, and 8 primary hand-sewn recipient arterial anastomoses. The primary clinical outcome was successful coupling without revision or conversion. Clinical timing comparisons were descriptive. Results: All five porcine arterial couplings were successful. Mean arterial time was 8.47 ± 2.83 min versus 20.26 ± 3.32 min for hand-sewn controls, a paired reduction of 11.79 min (95% CI, 5.86 to 17.72; p = 0.005). Clinical coupling succeeded in 9 of 14 attempts (64.3%). Five attempts required conversion (35.7%), including three thrombotic and two technical failures. All were converted intraoperatively, with no flap loss. Mean arterial times were 9.2 ± 4.2 min for successful coupling (n = 8) and 20.2 ± 8.0 min for primary hand-sewn anastomosis (n = 6), an approximately 55% difference. Conclusions: Everter-assisted arterial coupling demonstrated clinical feasibility and shorter mean arterial times when successfully completed. These findings support further refinement and evaluation of the technique to establish safety and overall procedural efficiency.
SN - 2072-6694
ER -