Experience with the continuous suture microvascular anastomosis in 200 consecutive free flaps

A variety of methods have been described for microvascular anastomosis. The continuous suture provides the same accuracy and versatility as the simple suture but can be significantly faster as well as much more hemostatic. The main argument against the use of the continuous suture is that it may narrow the caliber of the vessel lumen, and many surgeons have thus avoided its use. This technique has been used for arterial and venous anastomoses in 200 consecutive free flaps no matter what the size or the configuration of the vessels. One hundred ninety-four patients underwent 200 free tissue transfers and 410 anastomoses for a variety of oncologic-related reconstructions. A wide variety of different types of flaps, donor sites, and recipient sites were used. Of the 200 arteries (diameter, 0.5 to 5.0 mm), 90% were sutured end to end and 10% were sutured end to side. Of the 210 veins (diameter, 1.0 to 7.0 mm), 69.5% were anastomosed end to end and 30.5% end to side. There were 5 flap failures, yielding a success rate of 97.5%. Four of the failures were unrelated to the anastomosis. The reexploration rate for 200 flaps was 6.5%, with a 16.5% minor complication rate and 15.1% major complication rate. The continuous suture is a highly reliable rapid technique of microvascular anastomosis that can be used in vessels of all diameters. It is applicable for both the end-to-end and end-to-side anastomosis. It is particularly useful for vessels of disparate diameters. The success rate of reconstruction using this technique is comparable to that of most other large series using the simple suture and other methods.