Abstract
Background In 1949, a French vascular surgeon, Jean Kunlin, first described a venous end-to-side
anastomotic technique to address large vessel size mismatches. It was later modified
by Dr. Robert Linton for end-to-end (ETE) anastomoses on the “macrovascular” scale.
While multiple procedures exist for addressing moderate caliber discrepancies, few
safely and reliably compensate for marked diameter differences at the microvascular
level. In this study, we present the first large series adapting a modified geometric
Kunlin's technique for arterial and venous ETE anastomoses in reconstructive microsurgery.
Methods We reviewed 100 consecutive cases of free flap reconstructions from 2006 to 2015
utilizing a modified geometric Kunlin's technique for arterial and venous ETE anastomoses.
Patient demographics and flap outcomes were analyzed. Overall flap survival rates
and postoperative complications were analyzed and compared with standard values in
the microsurgical literature.
Results A total of 146 ETE anastomoses from 100 free flaps were analyzed. The average patient
age was 51 ± 3.1 years (range: 10–84 years). Free flaps in this study were used for
gender confirmation phalloplasties (20%) and reconstructing defects of the head and
neck (63%), extremities (16%), and trunk (1%). There was a total of 17 takebacks including
5 for hematoma, 8 for anastomotic thromboses (6 venous), and 4 without any identifiable
complication. Of these takebacks, two partial and two complete flap losses occurred.
There was an 88% salvage rate for flaps requiring takebacks during the postoperative
period. Overall, flap survival rate was 98% including those with complications or
takebacks.
Conclusion The modified Kunlin's technique is a reliable, facile, and versatile method of performing
ETE anastomoses for arterial and venous vessels, especially with vessel diameter mismatches
of 3:1 or greater, as well as for challenging orientations. Notably, it provides equivalent
flap survival and complication rates as compared with other techniques in the microsurgical
literature.
Keywords
end-to-end anastomosis - free flap - microsurgery
