LAUSR

Meticulous anastamotic technique and 'lie' of the vessels postanastomosis sets the stage for success in microvascular surgery. Positional issues of anastamosed vessels are a common cause for flap failure. Unlike end to end anastomosis, end to side poses a technical challenge. IJV is the commonest vein for end to side anastomosis in the head and neck region. Anatomic differences between arteries and veins dictate that the venous anastomosis should not be excessively lax or taut leading to dire consequences. Arbitrary predetermination of the point of anastomosis on the IJV provides the surgeon with a futuristic idea of the possible position of the vessel. Lack of techniques to mark this predetermined point of anastomosis could cause potential havoc in the post-anastomotic period. In our study, we used only one vein and one artery for anastomosis. All the flap veins were anastomosed end to side with the IJV (Fig. 1). Application of the vascular clamps changes the 3-dimensional spatial orientation of the internal jugular vein and obscures the predetermined point of anastomosis. Hence, we have devised a simple technique of marking the point of anastomosis (Fig. 2) with a tissue marker to aid in identification of the predetermined point of anastomosis. The vascular clamps are then applied and anastomosis proceeds in the usual manner (Figs. 3 and 4). Marked site is prepared for anastomosis. Anastomosis is done using prolene 9-0 and the clamps are released. At our centre, we do an average of 300 free flaps per year and we have utilized this technique in our last 75 cases of end to side anastomosis with the IJV for various free flaps.