Venous end-to-side anastomosis for free-flap reconstruction in the extremities: A case series and meta-analysis

This case series aimed to investigate the result of venous end-to-side (ETS) anastomosis in the extremities to contribute to a meta-analysis to evaluate the postoperative complications of venous ETS anastomosis in the extremities. This was a single-center case series and meta-analysis of patients who underwent venous ETS anastomosis for free-flap reconstruction of the extremities. We reviewed the records of 41 free flaps in 40 patients and performed a comprehensive search of PubMed, Scopus, and Web of Science for studies published from inception to December 2022. Primary outcomes were venous thrombosis, takebacks, and total and partial flap failures. Complication rates and confidence intervals were calculated using a random-effects model. In our case series, four (12.2%) patients with five flaps were taken back to the operating room, three (7.3%) flaps were due to venous thrombosis, and three (7.3%) flaps ultimately resulted in total flap failure. Our meta-analysis demonstrated the following complication rates: 4.0% (95% confidence interval [CI], 0-18.1%; I² = 0%) for venous thrombosis, 8.5% (95% CI, 0-21.8%; I² = 0%) for takebacks, 5.8% (95% CI, 0-18.3%; I² = 0%) for total flap failure, and 8.8% (95% CI, 0-28.4%; I² = 0%) for partial flap failure. Our case series and meta-analysis showed that the result of venous ETS anastomosis in the extremities was positive, and this technique was effective for addressing venous size discrepancy; although, its superiority to end-to-end anastomosis could not be established.