Background: Microvascular free tissue transfer is a vital tool in reconstruction of large head and neck defects. There is limited research regarding the impact vascular anastomosis techniques on free flap outcomes.
Learning/Study Objectives: This study aims to compare end-to-side (ETS) versus end-to-end (ETE) microvenous anastomoses to better understand the associated utility and surgical outcomes.
Design Type: Retrospective cohort study
Methods: We performed a retrospective analysis of 1,060 free tissue transfer surgeries performed at our academic tertiary care institution, on a total of 952 unique patients. Failure rates were defined by flap compromise requiring take-back to the operating room. Chi-squared and multivariate regression statistical analyses were employed.
Results: A total of 104 events requiring take-back to the operating room occurred (9.8%), 22 of which were a result of flap compromise (2.1% flap failure rate). Of these 22 flap failures, 19 were a result of venous compromise requiring revision. There was no difference in failure rate between ETE and ETS anastomoses (OR 1.08 [0.30-3.91], p=0.902). The same was true after controlling for age, sex, prior radiation, and prior surgery (p=0.933). The impact of radiation therapy on failure rate was trending towards significance (OR 2.33 [0.91-6.23], p=0.051). Coupler anastomoses were more commonly associated with venous compromise compared to suture (OR 6.82 [2.52-18.55], p<0.001).
Conclusion: Free tissue transfer surgery at our institution has a high level of success, and no significant difference in failure rates was found between ETE and ETS microvenous anastomoses. However, the use of venous coupler and a history of radiation were associated with increased failure rates.