Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Techniques for microvascular reconstruction in free tissue transfer (FTT) vary between institutions, as do usage criteria and outcomes of these differing techniques. This retrospective review compares outcomes between end-to-end (ETE) vs end-to-side (ETS) microvascular anastomosis to determine best practice, if one exists, with regards to application. Data was extracted from electronic medical records of adult patients who underwent microvascular free tissue transfer reconstruction at a single institution over a 15-year period. A total of 1069 FTT were identified as having undergone ETE (n = 453) or ETS (n = 616). Flap failure rate was low for both techniques (ETE: 3.9%; ETS: 2.4%), and did not differ significantly (P = 0.15). Similar findings were recorded for flap takeback (ETE: 6.6%; ETS: 7.5%; P = 0.59) and reconstruction site complications (ETE: 19.8%; ETS: 20.9%; P = 0.67), specifically with regards to venous thrombosis (ETE: 2.4%; ETS: 0.9%; P = 0.06) and need for revision venous anastomosis (ETE: 2.6%; ETS: 1.9%; P = 0.44). Quantity of venous anastomoses (VA) did not significantly alter these findings, although number of VA considered separately was significantly associated with recon site complication (P = 0.02), flap failure (P = 0.05), and venous thrombosis (P < 0.01). The use of ETE vs ETS did not differ significantly based on prior head and neck surgery (ETE: 46.1%; ETS: 50.9%; P = 0.12) or prior free flap (ETE: 16.9%; ETS: 19.6%; P = 0.27); however, ETS was used significantly more often in cases of prior radiation (ETE: 39.7%; ETS: 49.5%; P < 0.01). The use of a coupler was employed significantly more often in ETE (ETE: 31.7%; ETS: 0.9%; P <0.01), but did not affect flap failure, takeback, or complication rate when utilized in either technique (P > 0.05). ETS is performed frequently during FTT at our institution in vessel-depleted, irradiated and otherwise uncomplicated microvascular reconstruction patients without any signficant effect on flap failure, takeback, and reconstruction site complication. Thus, ETS should be utilized when deemed appropriate based on flap inset geometry and configuration and should not be relegated to a secondary method of venous anastomosis.