Use of the slit arteriotomy for end-to-side arterial anastomosis in free-tissue transfers to the extremities

Abstract

The purpose of this study was to demonstrate the reliability and advantages of the slit arteriotomy for end-to-side arterial anastomosis. Sixty free flaps for reconstruction of the upper and lower extremities were re-vascularised using this technique. Flaps used were: gracilis (20), latissimus dorsi (18), rectus abdominis (6), lateral arm (6), fibula (3), radial forearm (4), scapular (1) and anterolateral thigh (2). A double microclamp is applied. Using a 30 degrees microknife, a longitudinal slit is made on the recipient vessel. The clamps are then approximated slightly. This slackens the segment bearing the slit and opens up the slit to facilitate placement of sutures. Beginning at the heel, interrupted sutures are placed in such a way as to feed the redundancy of the donor artery wall towards the toe of the anastomosis. A slightly oversized slit is used to stretch the donor vessel, which due to its inherent elastic recoil keeps the anastomosis patent. Once the tourniquet is released, blood flow resumes and the slit forms an elliptical opening. A video is available for viewing at our website: www.microflap.com. The arterial patency rate was 98%. The mechanical advantage of the slit arteriotomy construct was demonstrated through computer simulation on a finite-element analysis model. The slit arteriotomy is simple, reliable, and can be consistently used in the transfer of free flaps to the extremities. As no portion of the recipient vessel wall is excised, the anastomotic diameter is increased. This promotes blood flow through the anastomosis.