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Outcomes after 1.9-μm Diode Laser-Assisted Anastomosis in Reconstructive Microsurgery: Results in 27 Patients

Leclère, Franck M. P. M.D., M.Sc.; Schoofs, Michel M.D.; Buys, Bruno Ing.; Mordon, Serge R. Ph.D.

Plastic and Reconstructive Surgery: April 2010 - Volume 125 - Issue 4 - p 1167-1175
doi: 10.1097/PRS.0b013e3181d18173
Hand/Peripheral Nerve: Original Articles

Background: Microvascular surgery has become an important method for reconstructing surgical defects resulting from trauma, tumors, or burns. The most important factor for successful free flap transfer is a well-executed anastomosis. This study was performed to review the authors' experience with a 1.9-μm diode laser in microsurgery, with special attention to outcomes and performance of the technique.

Methods: Between January of 2005 and December of 2007, 27 patients underwent microsurgery with a 1.9-μm diode laser at the authors' institute. The patients had a mean age of 31 years (range, 2 to 59 years); 14 patients were women and 13 patients were men. This technique was used for digital replantations (n = 2) and for free flap transfer (n = 27). Causes of the defects were trauma (n = 14), tumor (n = 9), congenital (n = 2), burn (n = 1), infection (n = 1), arthritis (n = 1), and dog bite (n = 1). Laser-assisted microvascular anastomosis was performed with a 1.9-μm diode laser after placement of equidistant stitches. The following parameters were used: spot size, 400 μm; power, 125 mW; time depending on vessel size (0.8 to 1.8 mm); and fluence varying from 70 to 200 J/cm2.

Results: Three surgical revisions following hematoma and one rupture of the arterial anastomosis leading to a free deep inferior epigastric perforator flap necrosis resulting from high-dose radiotherapy before surgery occurred after laser-assisted microvascular anastomosis, accounting for an overall success rate of 96.6 percent.

Conclusion: This study reports the numerous benefits of the technique: easier performance of vascular anastomosis with difficult access, decrease of reperfusion bleeding and complications, and a short learning curve.

Loos, Lesquin, and Lille

From the Department of Plastic Surgery, Handcenter of Lille Sud Clinic and Lille University Hospital; and INSERM, French National Institute of Health and Medical Research, Université Lille Nord de France, Lille University Hospital.

Received for publication September 4, 2009; accepted October 22, 2009.

Disclosure: The authors have no financial interest in any of the products, devices, or drugs mentioned in this article.

Serge R. Mordon, Ph.D., INSERM U 703, CHRU, 152, rue du Dr. Yersin, 59120 Loos, France,

©2010American Society of Plastic Surgeons