This study aims to evaluate the effects of end-to-end and end-to-side anastomosis techniques on arterial and venous thrombosis rates in free flap surgery and to examine their relationship with flap success rates. The study includes 472 free flap patients who underwent surgery between 2016 and 2024 at Ataturk University and Atlas University hospitals. A total of 86 patients with additional comorbidities or hypercoagulable conditions were excluded from the study. A total of 911 anastomoses were analyzed, of which 41% were end-to-side and 59% were end-to-end. Arterial and venous thrombosis rates were retrospectively analyzed, and the data were statistically evaluated using SPSS software. No significant difference was observed in thrombosis rates between end-to-end and end-to-side arterial anastomoses (p > 0.05). However, end-to-side venous anastomoses demonstrated significantly lower thrombosis rates compared to end-to-end venous anastomoses (p < 0.05). Flap success rates were higher in cases with end-to-side anastomoses, where venous thrombosis rates were notably lower. End-to-side anastomosis emerges as a more effective technique in reducing thrombosis rates, particularly in venous anastomoses. The absence of a significant difference between end-to-end and end-to-side techniques in arterial anastomoses suggests that both methods can be safely utilized based on the surgeon's preference and the vascular anatomy. This study highlights the impact of anastomosis technique selection on the success of free flap surgery. However, as vessel diameter and type could not be comprehensively analyzed for their effects on thrombosis, further studies are needed in this area. • This study provides a detailed comparison of end-to-end and end-to-side anastomosis techniques, highlighting their impact on arterial and venous thrombosis rates in free flap surgeries. • End-to-side anastomosis significantly reduces venous thrombosis rates, making it a preferred choice for flaps with high venous drainage requirements. • Both end-to-end and end-to-side techniques demonstrated comparable effectiveness in preventing arterial thrombosis, showing no statistically significant difference. • Revision surgeries for thrombosed flaps achieved a high success rate of 90%, emphasizing the importance of early detection and intervention.
Cengiz et al. (Wed,) studied this question.