Microvascular Anastomoses Using End-to-End versus End-to-Side Technique in Lower Extremity Free Tissue Transfer

Abstract

No advantage was noted for ETE or ETS arterial anastomoses based on reconstructive outcomes. The choice of anastomotic technique in lower extremity free tissue transfer should be based on patient factors and the clinical circumstances encountered.

Extending the limits of the anterior tibial artery as the recipient vessel for around the knee and proximal lower extremity defect reconstruction using the free anterolateral thigh and gracilis flap

“…By dissecting the artery up to its origin, an adequate vessel length and diameter can be achieved with a wide arc of rotation, which enables us to cover more distant defects around the knee and proximal/middle third of the lower extremity despite short‐pedicled free flaps. Moreover, dissection is straightforward and has a relatively low morbidity comparable to other reports in the literature (Cho et al, , Kang, Chung, Chang, & Kim, ). A difficult popliteal dissection can be avoided using our approach, as that area is an alternate recipient site around the knee.…”

“…Nevertheless, it has been reported that thrombus formation occurred more often in ETS anastomosis than in ETE anastomosis (Threlfall, ). Conversely, other studies have shown that there is no difference for ETE or ETS arterial anastomoses based on reconstructive outcomes (Cho et al, ). A recent study by Cho et al compared the reconstructive outcomes of lower extremity free flaps with ETE and ETS arterial anastomoses.…”

“…This study analyzed 413 lower extremity free flaps with ETE (66%) or ETS (34%) arterial anastomoses. No difference was observed in the foot ischemia and flap failure rates for ETE versus ETS arterial anastomoses (Cho et al, ). Furthermore, the incidence of foot ischemia did not differ for either technique in the context of impaired vascular run‐off or recipient vessel selection.…”

“…Options in a 3-vessel lower extremity microsurgical reconstruction are ETE or end-to-side (ETS) anastomosis. However, if fewer than 3 vessels are available, options for a disrupted artery might be ETS or ETE (Cho et al, 2016). Further options might be an arteriovenous loupe, (Cavadas, 2008) a T-shaped pedicle in a flow-through flap, (Song, Li, & Yu, 2016, Nemoto, Ishikawa, Kounoike, Sugimoto, & Takeda, 2015 or a perforator-to-perforator flap (Koshima, Nanba, Tsutsui, Takahashi, & Itoh, 2002).…”

Reconstruction of the Lower Extremity with Cross-Leg Free Flaps

“…If a defect in the lower extremity cannot be reconstructed with a skin graft, the choice of defect reconstruction will favor local flaps and free tissue transfers. [1][2][3][4][5] In appropriate cases, skin graft and local flaps can be well tolerated by both patients and surgeons. However, lower limb defects need to be reconstructed using free flaps, and suitable vessels need to be present in the same extremity.…”