Abstract
Background Whether to perform an end-to-end (ETE) versus end-to-side (ETS) arterial anastomosis
is an integral part of preoperative planning and intraoperative decision making in
free flap-based reconstructions. This study evaluated the impact of microsurgical
anastomotic technique on outcomes of lower extremity reconstructions, with a focus
on patients with peripheral arterial disease (PAD).
Methods Over a 6-year period, 425 patients underwent 437 microvascular lower extremity free
flap reconstructions with fasciocutaneous anterolateral thigh- or gracilis muscle
flaps at a single surgical center. The cases were divided into an ETE (n = 297 patients) versus ETS (n = 128 patients) group according to the anastomotic technique. A retrospective analysis
of patients' demographics, perioperative details, surgical complications, free flap
types, recipient sites, flap survival, and the potential impact of PAD on outcomes
was performed. Patient groups were comparable regarding comorbidities, American Society
of Anesthesiologists scores, types of performed free flaps and recipient sites.
Results We found no significant differences between the ETE versus ETS groups regarding the
rate of major or minor complications (p > 0.05). Specifically, in patients suffering from PAD (n = 64) the type of arterial anastomosis had no effect on the outcome.
Conclusion Overall, no significant differences in outcomes were observed when comparing the
types of performed arterial anastomosis. This observation also held true for the subgroup
of patients with PAD. Given that an ETS anastomosis did not increase the risk to encounter
complications while preserving distal perfusion, we believe that this technique is
the method of choice, especially in patients with impaired vascular status.
Keywords
end-to-end anastomoses - end-to-side anastomoses - peripheral arterial disease
