Abstract
Background End-to-side (ETS) anastomoses are useful when preservation of distal vascularity
is critical. The ideal ETS microanastomosis should maintain a wide aperture and have
a smooth take-off point to minimize turbulence, vessel spasm, and thrombogenicity
of the suture line. We have developed a unique, dependable, and reproducible geometric
technique for ETS anastomoses, and analyze its efficacy in our series of patients.
Methods The geometric ETS technique involves creating a three-dimensional (3D) diamond-shaped
defect on the recipient vessel wall, followed by a slit incision of the donor vessel
to create a “spatula” fitting this defect. This technique removes sutures from the
point of most turbulent blood flow while holding the recipient vessel open with a
patch vesselplasty effect. We perform a retrospective review of a single surgeon's
experience using this technique.
Results The geometric 3D ETS technique was used in 87 free flaps with a total of 102 ETS
anastomoses in a wide range of cases including head and neck, trunk and genitourinary,
and extremity reconstruction. Overall, free flap success rates were 98%.
Conclusions The geometric 3D ETS technique creates a wide anastomosis, minimizes turbulence-inducing
thrombogenicity, and mechanically holds the recipient vessel open. It is reliable
and reproducible, and when performed properly has been shown to have high rates of
success in a large group of free tissue transfer patients.
Keywords
microsurgery - end to side anastomosis - microsurgical technique
