Although an end-to-side anastomosis (ETS) is an essential method for free flaps in severe extremity injuries, the ETS has not been established in orthoplastic surgeons compared to an end-to-end anastomosis. We have adopted a microscopic parachute end-to-side (MPETS) technique which is modified from the ETS technique commonly used by cardiovascular surgeons. The MPETS technique consists of the two simple steps with microscope. First, the flap vessel is cut and widened and a large slit window is made into the recipient vessel. Second, the heel of the vessel is sutured using the parachute technique, followed by suturing both posterior and anterior walls with a continuous suture. In addition to the conventional ETS procedure, the MPETS technique has many advantages for free flaps, including easy slit-shaped vesselotomy, making a large window to avoid anastomotic narrowing, and easy anastomosis using the parachute technique at the heel of vessel which is a high-risk site of blood leakage. This technique can be applied to various sizes of arteries and veins. We believe that the microscopic parachute end-to-side technique might make free flaps easier and improve their clinical outcomes in severe extremity injuries.
