End-to-end and end-to-side microvascular anastomoses: a comparative study

The decision to use an end-to-end versus end-to-side anastomosis remains a controversial issue in microvascular surgery, although it is generally accepted that certain clinical situations require skills in both techniques (eg, vessel size discrepancy or the need to preserve donor vessel distal flow). Using rats, this investigation presents a unique free flap model comparing not only arterial end-to-end and end-to-side anastomoses, but venous anastomoses as well. There were 15 animals in each anastomosis group with a greater than 80% flap survival rate in each group. This supports findings of earlier studies that suggested no difference in survival when these two anastomosis types were compared. Equally important was the assessment of dermofluorometry as an immediate postoperative perfusion monitoring device. In this model, fluorometry was not found to be useful for predicting flap viability in an early period after completion of the anastomoses.