End to Side Microvascular Anastomosis in External Carotid Artery in Vessel Depleted Neck: A Case Series.

[INTRODUCTION] Overtime, there have been significant changes in reconstructive techniques. The effectiveness of free flap reconstruction has increased with improved surgical technique as well as technological refinement in vessel selection and flap monitoring.

[MATERIAL AND METHOD] Twenty-five patients were included into this study, and surgeries were performed during the period of 3 months from January to March 2025 at our tertiary care center.

[RESULTS] Only 8% of total n = 25 patient had complication in microvascular surgery and needed re-exploration but no flap failure was noted.

[DISCUSSION] End-to-side anastomosis to the ECA is particularly beneficial in challenging clinical scenarios such as previously irradiated necks, infected or contaminated surgical fields, or when the distal branches of the ECA are atherosclerotic and unsuitable for end-to-end anastomosis.

[CONCLUSION] This technique ensures more stable and laminar arterial flow, which, in turn, reduces the risk of arterial thrombosis and improves overall flap survival.