Preserving the Recipient Artery and Vein: End-to-Side Microvascular Vessel Anastomosis for Perforator Flap in Hand Soft Tissue Reconstruction

Introduction: End to end vessel anastomosis was priority for revascularization in most conventional free flaps. And we paid less attention to the recipient vessel’s preservation. However, for perforator flaps which were popular now with small vessel caliber, an end-to-side technique to the recipient artery and vein will fulfill both the need to spare the recipient vessel and provide a better technique for unmatched vessel anastomosis. The aim of this study is to discuss the feasibility and reliability of the end-to-side arterial and vein anastomosis by comparing it with the end-to-end anastomosis in terms of anastomosis time, spasm occurrence, incidence of thrombosis, and overall flap survival.

Methodology and Material: We reviewed the medical records since June, 2010 to June, 2013, 152 consecutive patients who underwent free perforator flaps were involved in our study, including SIEP 23 cases, lateral arm 36 cases, peroneal perorator flap 25 cases, ALT 78 cases. The end to side anastomosis were performed in 72 cases while end to end anastomosis in 80 cases; all patients were followed up for 6-24 months, early circulation, vascular spasm, anastomotic thrombosis were observed. Overall survival rate were analyzed statistically.

Results: The average anastomosis time for end to side anastomosis was 21.3 minutes, which was a little bit longer than end to end anastomosis with 14.4 minutes in average. The incidence of anastomotic vasospasm after end to side anastomosis was significantly lower than the end to end anastomosis (p < 0.05), postoperative anastomotic thrombosis rate had no statistically significant (P > 0.05), all flaps survived in end to side anastomosis group without crisis, 1 flap failed and partial necrosis occurred in another case in end to end anastomosis group.

Conclusions: Although anastomosis times were increased in the end-to-side group, this technique showed lower spasm rate and similar flap survival rate. Therefore, this technique is a reliable and technically feasible method and should be considered first as a choice when facing vessel discrepancy and for preserving the recipient artery and vein system