Use of Ultrasonic Shears in the Harvest of the Free Osteocutaneous Fibula Flap

Abstract

Objective: Traditionally, the fibula free flap has been raised by electrocautery and sharp dissection with clipping and tying of vessels. Use of the ultrasonic scalpel has been proposed to be a faster, more hemostatic, and less traumatic method of harvest. Methods: We performed a retrospective chart review of 58 patients who underwent fibula free flap reconstruction between 2007 and 2010. The main outcome measures were blood loss, operative time, and flap harvest time. Results: Use of the ultrasonic shears was not associated with a statistically significant reduction in intraoperative blood loss, operative time, or flap harvest time. However, the flap harvest time did trend toward statistical significance (p = 0.073). Use of distribution-based effect sizes demonstrated a moderate clinically important difference in favor of the ultrasonic shears for both operative time and flap harvest time. Conclusions: The use of ultrasonic shears is comparable to traditional methods of fibula free flap harvest and can be considered an alternative method of harvest.