Abstract
BACKGROUND: Microvascular anastomosis is the key for successful free flap transplantation. Ideally, the anastomosis should maintain the flow with minimal turbulence, disruption of endothelium, and minimizing the furrow to prevent thrombosis and failure of the flap. One of the main pitfalls of micro-anastomosis is vessels size mismatch. METHOD AND RESULT: There are many ways to overcome this issue, which includes forced mechanical dilation of the smaller vessel, oblique cuts, fish mouth cuts, interposition grafts, end-to-side anastomosis, coupling device, and others. Here, we report a simple technique with single customizable longitudinal arteriotomy of the smaller vessel to achieve an adequate size match to the larger vessel. It has been used for more than 10 years at our institution that allow us to achieve an end-to-end patent anastomosis. CONCLUSION: Vertical arteriotomy is a simple technique that in our experience achieved end-to-end anastomosis high patency rate.