Microvascular end-to-side anastomosis. A, With microvascular scissors, small ellipse of vessel wall is excised between microvascular clips (upper left). Suitable fit of recipient vessel is achieved with oblique cut to match elliptical defect in vessel wall (upper right). Vessel also can be trimmed transversely to provide 90-degree anastomosis. B, Suture line begins with sutures placed at each end of openings. Suture ends are left long temporarily for traction. C, Suture line continues, placing interrupted stitches around anastomosis. D, Completed end-to-side microvascular anastomosis. SEE TECHNIQUE 63.2.