Continuous Through-the-lumen Microvascular Anastomosis: A Retrospective Review of a Modified Technique

The debate between continuous and interrupted sutures for microvascular anastomosis has long persisted, with broader acceptance of the interrupted technique. Although studies show comparable outcomes, continuous suturing remains underused due to concerns of technical complexity, anastomotic constriction, and patency loss. We present a simplified and effective continuous technique that addresses these concerns.

This 5-year retrospective study included all elective free tissue transfers performed using the described continuous suture technique. Trauma-related replantation and revascularization cases were excluded. Patient records were reviewed for demographics, flap types, anastomosis configuration and timing, reexplorations, complications, and outcomes.

The technique was performed in 785 patients, encompassing 2346 microvascular anastomoses (794 arterial and 1552 venous). End-to-end anastomoses were done in 633 arteries and 867 veins, and end-to-side anastomoses in 161 arteries and 685 veins. Flap types included anterolateral thigh (n = 384), radial forearm (n = 220), fibula (n = 145), latissimus dorsi (n = 29), deep inferior epigastric artery (n = 2), ulnar forearm (n = 3), and toe transfers (n = 2). Mean arterial and venous anastomosis times were 7.5 and 10 minutes, respectively. All anastomoses achieved 100% immediate patency. There were 41 reexplorations, mostly for venous issues, with 28 flap failures. The overall flap success rate was 96.43%.

This modified continuous technique enables posterior wall repair through the vessel lumen without flipping, minimizing manipulation and reducing operative time. It offers a reproducible, efficient approach for both arterial and venous anastomoses.