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DOI: 10.1055/s-0037-1599099
End-to-End versus End-to-Side Microvascular Anastomosis: A Meta-analysis of Free Flap Outcomes
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.
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References
- 1 Khouri RK, Cooley BC, Kunselman AR. , et al. A prospective study of microvascular free-flap surgery and outcome. Plast Reconstr Surg 1998; 102 (03) 711-721
- 2 Bozikov K, Arnez ZM. Factors predicting free flap complications in head and neck reconstruction. J Plast Reconstr Aesthet Surg 2006; 59 (07) 737-742
- 3 Chalian AA, Anderson TD, Weinstein GS, Weber RS. Internal jugular vein versus external jugular vein anastamosis: implications for successful free tissue transfer. Head Neck 2001; 23 (06) 475-478
- 4 Clark JR, McCluskey SA, Hall F. , et al. Predictors of morbidity following free flap reconstruction for cancer of the head and neck. Head Neck 2007; 29 (12) 1090-1101
- 5 Ueda K, Harii K, Nakatsuka T, Asato H, Yamada A. Comparison of end-to-end and end-to-side venous anastomosis in free-tissue transfer following resection of head and neck tumors. Microsurgery 1996; 17 (03) 146-149
- 6 Godina M. Preferential use of end-to-side arterial anastomoses in free flap transfers. Plast Reconstr Surg 1979; 64 (05) 673-682
- 7 Samaha FJ, Oliva A, Buncke GM, Buncke HJ, Siko PP. A clinical study of end-to-end versus end-to-side techniques for microvascular anastomosis. Plast Reconstr Surg 1997; 99 (04) 1109-1111
- 8 Chia HL, Wong CH, Tan BK, Tan KC, Ong YS. An algorithm for recipient vessel selection in microsurgical head and neck reconstruction. J Reconstr Microsurg 2011; 27 (01) 47-56
- 9 Damen TH, Morritt AN, Zhong T, Ahmad J, Hofer SO. Improving outcomes in microsurgical breast reconstruction: lessons learnt from 406 consecutive DIEP/TRAM flaps performed by a single surgeon. J Plast Reconstr Aesthet Surg 2013; 66 (08) 1032-1038
- 10 Piazza C, Taglietti V, Paderno A, Nicolai P. End-to-end versus end-to-side venous microanastomoses in head and neck reconstruction. Eur Arch Otorhinolaryngol 2014; 271 (01) 157-162
- 11 Cho EH, Garcia RM, Blau J. , et al. Microvascular anastomoses using end-to-end versus end-to-side technique in lower extremity free tissue transfer. J Reconstr Microsurg 2016; 32 (02) 114-120
- 12 Kim H, Lim SY, Pyon JK. , et al. Rib-sparing and internal mammary artery-preserving microsurgical breast reconstruction with the free DIEP flap. Plast Reconstr Surg 2013; 131 (03) 327e-334e
- 13 Apostolides JG, Magarakis M, Rosson GD. Preserving the internal mammary artery: end-to-side microvascular arterial anastomosis for DIEP and SIEA flap breast reconstruction. Plast Reconstr Surg 2011; 128 (04) 225e-232e
- 14 Katou F, Echigo S, Ito M, Shirai N, Ohtani H, Motegi K. Reliability of internal jugular vein in oral microvascular reconstruction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 86 (05) 529-533
- 15 Halvorson EG, Cordeiro PG. Go for the jugular: a 10-year experience with end-to-side anastomosis to the internal jugular vein in 320 head and neck free flaps. Ann Plast Surg 2007; 59 (01) 31-35 , discussion 35
- 16 Bas L, May Jr JW, Handren J, Fallon J. End-to-end versus end-to-side microvascular anastomosis patency in experimental venous repairs. Plast Reconstr Surg 1986; 77 (03) 442-450
- 17 Graham BB, Varvares MA. End-to-side venous anastomosis with the internal jugular vein stump: a preliminary report. Head Neck 2004; 26 (06) 537-540
- 18 Vlastou C, Earle AS, Jordan R. Vein grafts in reconstructive microsurgery of the lower extremity. Microsurgery 1992; 13 (05) 234-235
- 19 Jandali S, Wu LC, Vega SJ, Kovach SJ, Serletti JM. 1000 consecutive venous anastomoses using the microvascular anastomotic coupler in breast reconstruction. Plast Reconstr Surg 2010; 125 (03) 792-798
- 20 Kelly JL, Eadie PA, Orr D, Al-Rawi M, O'Donnell M, Lawlor D. Prospective evaluation of outcome measures in free-flap surgery. J Reconstr Microsurg 2004; 20 (06) 435-438 , discussion 439
- 21 Akinci M, Ay S, Kamiloglu S, Erçetin O. Lateral arm free flaps in the defects of the upper extremity--a review of 72 cases. Hand Surg 2005; 10 (2-3): 177-185
- 22 Basheer MH, Wilson SM, Lewis H, Herbert K. Microvascular free tissue transfer in reconstruction of the lower limb. J Plast Reconstr Aesthet Surg 2008; 61 (05) 525-528
- 23 Nahabedian MY, Singh N, Deune EG, Silverman R, Tufaro AP. Recipient vessel analysis for microvascular reconstruction of the head and neck. Ann Plast Surg 2004; 52 (02) 148-155 , discussion 156–157
- 24 Okazaki M, Asato H, Sarukawa S, Takushima A, Nakatsuka T, Harii K. Availability of end-to-side arterial anastomosis to the external carotid artery using short-thread double-needle microsuture in free-flap transfer for head and neck reconstruction. Ann Plast Surg 2006; 56 (02) 171-175
- 25 Tsai YT, Lin TS. The suitability of end-to-side microvascular anastomosis in free flap transfer for limb reconstruction. Ann Plast Surg 2012; 68 (02) 171-174
- 26 Alan Turner MJ, Smith WP. Double venous anastomosis for the radial artery forearm flap. Improving success and minimising morbidity. J Craniomaxillofac Surg 2009; 37 (05) 253-257
- 27 Ashworth DR, Whear NM, Fan V. Radial free flaps using loupe magnification: audit of 97 cases of orofacial reconstruction. Br J Oral Maxillofac Surg 2004; 42 (01) 36-37
- 28 Fukuiwa T, Nishimoto K, Hayashi T, Kurono Y. Venous thrombosis after microvascular free-tissue transfer in head and neck cancer reconstruction. Auris Nasus Larynx 2008; 35 (03) 390-396
- 29 Kessler P, Poort L, Böckmann R, Lethaus B. Definition of quality indicators in microsurgery in head and neck reconstruction based on a 5-year follow-up without a loss. J Craniomaxillofac Surg 2013; 41 (01) 2-6
- 30 Yamashiro M, Hasegawa K, Uzawa N. , et al. Complications and outcome of free flap transfers for oral and maxillofacial reconstruction: analysis of 213 cases. Oral Sci Int 2009; 6 (01) 46-54
- 31 Chernichenko N, Ross DA, Shin J, Sasaki CT, Ariyan S. End-to-side venous anastomosis with an anastomotic coupling device for microvascular free-tissue transfer in head and neck reconstruction. Laryngoscope 2008; 118 (12) 2146-2150
- 32 Francis DO, Stern RE, Zeitler D, Izzard M, Futran ND. Analysis of free flap viability based on recipient vein selection. Head Neck 2009; 31 (10) 1354-1359
- 33 Maraka J, Hausien O, Abreo N, Patel NG, Durrani AJ. The microvascular coupler device for end-to-side venous anastomosis in free tissue transfer for head and neck reconstruction. J Plast Reconstr Aesthet Surg 2014; 67 (12) 1757-1758
- 34 Casey III WJ, Rebecca AM, Smith AA, Craft RO, Buchel EW. The cephalic and external jugular veins: important alternative recipient vessels in left-sided microvascular breast reconstruction. Microsurgery 2007; 27 (05) 465-469
- 35 Medina ND, Fischer JP, Fosnot J, Serletti JM, Wu LC, Kovach III SJ. Lower extremity free flap outcomes using an anastomotic venous coupler device. Ann Plast Surg 2014; 72 (02) 176-179
- 36 Rosenthal E, Carroll W, Dobbs M, Scott Magnuson J, Wax M, Peters G. Simplifying head and neck microvascular reconstruction. Head Neck 2004; 26 (11) 930-936
- 37 Ross GL, Ang ES, Golger A. , et al. Which venous system to choose for anastomosis in head and neck reconstructions?. Ann Plast Surg 2008; 61 (04) 396-398
- 38 Santamaria E, Granados M, Barrera-Franco JL. Radial forearm free tissue transfer for head and neck reconstruction: versatility and reliability of a single donor site. Microsurgery 2000; 20 (04) 195-201