Outcomes after 1.9-microm diode laser-assisted anastomosis in reconstructive microsurgery: results in 27 patients.

Abstract

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-microm diode laser in microsurgery, with special attention to outcomes and performance of the technique. Between January of 2005 and December of 2007, 27 patients underwent microsurgery with a 1.9-microm 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-microm diode laser after placement of equidistant stitches. The following parameters were used: spot size, 400 microm; power, 125 mW; time depending on vessel size (0.8 to 1.8 mm); and fluence varying from 70 to 200 J/cm. 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. 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.