A CLINICAL-STUDY OF END-TO-END VERSUS END-TO-SIDE TECHNIQUES FOR MICROVASCULAR ANASTOMOSIS

The choice of microvascular anastomotic technique, end-to-end versus e nd-to-side, is still an item of debate. A review of the literature rev eals no difference in patency rates in animal models where there is no size discrepancy. The available clinical evidence stems from Godina's early experience, proclaiming a higher failure rate with end-to-end a nastomoses. Factors such as size mismatch and use of injured vessels, rather than anastomotic technique, may have been responsible. This cli nical study examines the fate of over 2000 microvascular anastomoses p erformed in more than 900 tissue transplants. Complications attributab le to the anastomosis were considered failures of the anastomosis, wer e tabulated, and were compared between the two techniques. The end-to- end and end-to-side microvascular techniques were found to be equally effective when properly applied. The choice of technique therefore sho uld be secondary to factors influencing the choice of recipient vessel , such as the condition of the vessel, its accessibility, and the pres ervation or augmentation of maximal distal flow to an extremity.