Introduction: The value of end-to-side arterial anastomoses for free flap transfers to the extremities is well established. However, it is still unclear whether a slit could be used in preference to the conventional elliptical arteriotomy. The slit arteriotomy is simpler to create and does not require excision of the vessel wall. The purpose of this clinical study is to demonstrate the reliability of the slit arteriotomy for end-to-side arterial anastomoses.

Methods: Between 1999 and 2002, 49 free flaps for resurfacing the upper and lower extremities were revascularized using this technique. Flaps used were: gracilis (n=18), latissimus dorsi (n=14), rectus abdominis (n=6), lateral arm (n=4), fibula/peroneal (n=3), radial forearm (n=3), and anterolateral thigh (n=1).

Technical aspects: An end-to-side anastomosis with a 45-degree incident angle is created using an interrupted suture technique. A longitudinal slit arteriotomy is made with a 30-degree microknife. The salient features of the technique are: 1) Use of a double microclamp to maintain slackness of the arterial segment bearing the slit. By approximating the clamps the longitudinal slit is converted into an elliptical opening for better visualization; 2) Beginning at the heel, sutures are placed in such a way as to feed the redundancy of the donor artery wall toward the toe end of the anastomosis. The slit can be progressively lengthened to match the diameter of the expanded donor vessel end; 3) A slightly oversized slit is used to maintain the donor vessel on a stretch. Elastic recoil of the donor vessel will keep the slit patent. Following tourniquet release, the slit becomes an elliptical opening as blood flow resumes.

Results: There was one arterial failure attributed to kinking of the end-to side anastomosis (98% arterial patency rate). Overall success rate was 94% (one arterial failure and 2 venous failures).

Conclusion: The slit arteriotomy is simple, reliable, and can be used consistently for free tissue transfers to the extremities. The anastomotic diameter is increased as no portion of the recipient vessel wall is excised.