J Reconstr Microsurg 2017; 33(06): 402-411
DOI: 10.1055/s-0037-1599099
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

End-to-End versus End-to-Side Microvascular Anastomosis: A Meta-analysis of Free Flap Outcomes

Iraj Ahmadi
1   Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, Victoria, Australia
2   Department of Surgery, School of Clinical Science at Monash Health, Monash University, Victoria, Australia
,
Pradyumna Herle
2   Department of Surgery, School of Clinical Science at Monash Health, Monash University, Victoria, Australia
,
George Miller
1   Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, Victoria, Australia
2   Department of Surgery, School of Clinical Science at Monash Health, Monash University, Victoria, Australia
,
David J. Hunter-Smith
1   Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, Victoria, Australia
2   Department of Surgery, School of Clinical Science at Monash Health, Monash University, Victoria, Australia
,
James Leong
2   Department of Surgery, School of Clinical Science at Monash Health, Monash University, Victoria, Australia
,
Warren Matthew Rozen
1   Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, Victoria, Australia
2   Department of Surgery, School of Clinical Science at Monash Health, Monash University, Victoria, Australia
3   Department of Surgery, School of Medicine and Dentistry, James Cook University Clinical School, Queensland, Australia
› Author Affiliations
Further Information

Publication History

29 September 2016

07 January 2017

Publication Date:
04 March 2017 (online)

Abstract

Background Optimal outcomes in microsurgery have been attributed to a range of factors, with performing of end-to-end (ETE) versus end-to-side (ETS) influencing anastomotic complications and flap outcomes.

Methods A systematic review of the literature and meta-analysis was undertaken to evaluate the relative risks of anastomotic complications with ETE versus ETS approaches, for arterial and venous anastomoses looking at risk ratios (RRs) for thrombosis and overall flap failure.

Results RRs of thrombosis and flap failure in ETS versus ETE venous anastomosis groups were 1.30 (95% confidence interval [CI]: 0.53–3.21) and 1.50 (95% CI: 0.85–2.67), respectively. The RRs of thrombosis and flap failure in ETS versus ETE arterial anastomosis groups were 1.04 (95% CI: 0.32–3.35) and 1.04 (95% CI: 0.72–1.48), respectively.

Conclusion Differences in rates of thrombosis and flap failure between ETE and ETS venous and arterial anastomoses are marginal and nonsignificant. As such, the type of anastomotic technique is best decided on a case-by-case basis, dependent on anatomical, surgical, and patient factors.