Artikel
The use of the ultrasound scalpel (Harmonic®) for the preparation of the pectoralis major or radialis flap
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Autoren
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Stefan Tesche
- Department of Oto-Rhino-Laryngology/Head and Neck-Surgery, University Hospital, Hamburg, Germany
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Frank Metternich
- Department of Oto-Rhino-Laryngology/Head and Neck-Surgery, University Hospital, Hamburg, Germany
| Veröffentlicht: | 8. August 2007 |
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Gliederung
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Introduction: The pectoralis- major (PM) and the radialis- (RL) or forearm- flap are useful tools in reconstructive surgery of the head and neck. The accuracy of the preparation strongly influences the results of both flaps. The use of the ultrasound scalpel (US), which allowes tissue dissection with simultaneous coagulation and no muscle contraction, seems to be an improvement.
Methods: We included 15 patients with Head- and Neck Sqamous Cell Carcimomas (T3 and T4) who received a PM- flap (n=10) or a RL- flap (n=5) for reconstruction after tumour resection. We investigated the parameters intra- and postoperative hemostasis, flap`s vitality and postoperative pain. We used ten comparable tumour patients as control group.
Results: In 87% (13/15) we needed no further bipolar coagulation or ligation; in all 5 RL- flaps the US achieved hemostasis alone. There was no postoperative bleeding. The long term results concerning flap`s vitality were in all cases excellent. The postoperative pain was comparable to the control group.
Conclusion: The US offers a very exact tissue dissection with simultaneous hemostasis. This results in an excellent control of the operation field. Because of the mechanical action of the US there are only little thermal effects on neighbouring tissues. This means a lower risk of inducing microthromboses when dissection of the perforating vessels of the radial artery and no muscle contraction when the preparation of pectoralis muscle is performed. Because of our experiences we can recommend the US for the preparation of the pectoralis major or radialis flap.
