Objective: The key to successful microvascular anastomosis is consistently achieving intima-to-intima contact, which is not always easy. In this article, we propose the “Multiple U” technique, which is a novel microvascular anastomosis technique that characterizes easy and reliable intima-to-intima contact.

Material and Methods: We performed the “Multiple U” technique for microvascular anastomosis in patients who underwent free flap reconstruction for head and neck region defects at Kaohsiung Chang Gung Memorial Hospital from 2020/09/01 to 2020/11/30 with IRB approval, reference number 202000894B0A3. Both the arterial and venous anastomosis were done using the “Multiple U” technique unless a significant vessel size discrepancy (more than 1:2) was encountered.

Results: A series of ten patients were included in this study. Nine patients had head and neck cancer and one patient had osteoradionecrosis of the right mandible body. Nine anterolateral thigh flaps and one radial forearm flap were used. The recipient arteries included the superior thyroid artery, lingual artery, and facial artery, while the recipient veins included the external jugular vein, branch of the internal jugular vein, and facial vein. The immediate patency test results for all vessel anastomoses were positive. No vascular complication of the anastomosis sites was found after the free flap transfers.

Conclusions: The “Multiple U” technique for microvascular anastomosis is a widely available technique that guarantees everted anastomosis sites and solid intima-to-intima contact. This technique can be performed on both arterial and venous anastomoses regardless of vessel size and wall thickness.

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