title: End-to-End versus End-to-Side Microvascular Anastomosis: A Meta-analysis of Free Flap Outcomes.
abstract: BackgroundOptimal outcomes in microsurgery have been attributed to a range of factors, with performing of end-to-end (ETE) versus end-to-side (ETS) influencing anastomotic complications and flap outcomes.MethodsA systematic review of the literature and meta-analysis was undertaken to evaluate the relative risks of anastomotic complications with ETE versus ETS approaches, for arterial and venous anastomoses looking at risk ratios (RRs) for thrombosis and overall flap failure.ResultsRRs of thrombosis and flap failure in ETS versus ETE venous anastomosis groups were 1.30 (95% confidence interval [CI]: 0.53-3.21) and 1.50 (95% CI: 0.85-2.67), respectively. The RRs of thrombosis and flap failure in ETS versus ETE arterial anastomosis groups were 1.04 (95% CI: 0.32-3.35) and 1.04 (95% CI: 0.72-1.48), respectively.ConclusionDifferences in rates of thrombosis and flap failure between ETE and ETS venous and arterial anastomoses are marginal and nonsignificant. As such, the type of anastomotic technique is best decided on a case-by-case basis, dependent on anatomical, surgical, and patient factors.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, Victoria, Australia.|Department of Surgery, School of Clinical Science at Monash Health, Monash University, Victoria, Australia.
authors.forename: Iraj
authors.initials: I
authors.lastname: Ahmadi
authors.affiliation: Department of Surgery, School of Clinical Science at Monash Health, Monash University, Victoria, Australia.
authors.forename: Pradyumna
authors.initials: P
authors.lastname: Herle
authors.affiliation: Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, Victoria, Australia.|Department of Surgery, School of Clinical Science at Monash Health, Monash University, Victoria, Australia.
authors.forename: George
authors.initials: G
authors.lastname: Miller
authors.affiliation: Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, Victoria, Australia.|Department of Surgery, School of Clinical Science at Monash Health, Monash University, Victoria, Australia.
authors.forename: David J
authors.initials: DJ
authors.lastname: Hunter-Smith
authors.affiliation: Department of Surgery, School of Clinical Science at Monash Health, Monash University, Victoria, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Leong
authors.affiliation: Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, Victoria, Australia.|Department of Surgery, School of Clinical Science at Monash Health, Monash University, Victoria, Australia.|Department of Surgery, School of Medicine and Dentistry, James Cook University Clinical School, Queensland, Australia.
authors.forename: Warren Matthew
authors.initials: WM
authors.lastname: Rozen
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D058752:Free Tissue Flaps / Q000098:blood supply*; D006085:Graft Survival; D006801:Humans; D008866:Microsurgery / Q000379:methods*; D016017:Odds Ratio; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000517:prevention & control*