Adverse events associated with anastomotic coupling devices in microvascular reconstruction

Objective: In light of the recent US Food and Drug Administration (FDA) Class 2 safety recall notice for anastomotic coupling devices, it is important to understand related adverse events. The aim of this study was to characterize adverse events in anastomotic coupling devices for microvascular reconstruction. Methods: A retrospective cross-sectional analysis using the 2011 to 2021 US FDA Manufacturer and User Facility Device Experience (MAUDE) database. All reports of adverse events involving anastomotic coupling devices were retrieved from the MAUDE database. Descriptive statistics were used to analyze categorized events. Results: There were a total of 293 documented adverse events related to anastomotic coupling devices. These adverse events resulted in 91 (31.1 %) patient injuries and 239 (81.6 %) device malfunctions. The most frequent patient problems were thrombosis/hematoma ( n = 38; 41.8 %), unspecified injury ( n = 31; 34.1 %), and failure to anastomose ( n = 13; 14.3 %). Free flap necrosis was reported in 42 % of thrombosis/hematoma cases ( n = 16). The most common malfunctions were devices operating differently than expected ( n = 74; 31.0 %), connection problems ( n = 41; 17.2 %), and twisted/bent material ( n = 19; 7.9 %). There was no significant trend in the number of adverse events over the study period ( p > 0.05). Conclusions: Adverse events from anastomotic coupling devices represent an important and modifiable factor in free tissue failure. Adverse events are predominately related to devices operating differently than expected and may result in vascular compromise of the free flap. Reconstructive surgeons should be cognizant of defective anastomotic coupling devices and be prepared to utilize traditional hand -sewn anastomosis.