**3.2 Arterial repair: end to side**

This technique is an important one to have in the armamentarium. It allows a "way out" for example when there is a paucity of recipient vessels or if the flap donor vessel is too short. It does however carry a risk of size mismatch in terms of diameter and wall thickness. While the former may be somewhat addressed by an oblique cut or narrowing the larger vessel, difference in thickness is more difficult to deal with. The risk of turbulent flow must be born in mind [7].

## *3.2.1 Preparing the vessel*

Ensure the donor vessel is of adequate length to reach the arteriotomy site without undue tension. It must be freed of adventitia at least up to 3 mm away and dilated to ease anastomosis. It is essential to ensure there are no kinks or twists in the donor vessel (artery or especially if it is a vein) because this may be disastrous once it is anastomosed!

#### **Figure 18.**

*Continuous suture technique. The vessel is locked by two stay sutures 180° apart. A continuous running suture is started from the distal side proximally.*
