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Surgical Technique |

The Use of Ultrasonic Shears for the Harvest of Perforator Free Flaps

Sameer Ahmed, BS; Doug Sidell, MD; Keith E. Blackwell, MD; Joel A. Sercarz, MD; Elliot Abemayor, MD, PhD; Vishad Nabili, MD
Arch Facial Plast Surg. 2009;11(5):343-346. doi:10.1001/archfacial.2009.64.
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A retrospective chart review was performed at a university medical center to evaluate the use of ultrasonic shears for the harvest of perforator free flaps over an 18-month period. The anterolateral thigh (ALT) was the perforator free flap site selected for the study. The site of origin and the number of musculocutaneous perforator vessels that were dissected using ultrasonic shears were recorded, and ALT flap viability and wound-healing complications were evaluated to assess safety. Seventeen patients underwent harvest of ALT perforator free flaps. Successful dissection of musculocutaneous perforators was achieved in 96% (27 of 28) of the descending branch perforators and in 100% (9 of 9) of the transverse branch perforators. Flap viability was 100% (17 of 17). We found that ultrasonic shears were effective and safe to use for harvesting perforator free flaps. According to these preliminary findings, the use of ultrasonic shears appears promising, yet further prospective analysis is needed.

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Figure 1.

Dividing the vastus lateralis muscle with ultrasonic shears. The overlying vastus lateralis muscle is divided and small side branches of the musculocutaneous perforator are simultaneously sealed with the ultrasonic shears.

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Figure 2.

The course of the musculocutaneous perforator (MP) through the vastus lateralis muscle (VL). The ultrasonic shears are used to unroof the musculocutaneous perforator and trace it to its origin from the descending branch of the lateral circumflex femoral artery (dLCFA).

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Figure 3.

Analysis of perforator dissection outcome with the use of ultrasonic shears.

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