Comparison of dissection with harmonic scalpel and conventional bipolar electrocautery in deep inferior epigastric perforator flap surgery: A consecutive cohort study
Comparison of dissection with harmonic scalpel and conventional bipolar electrocautery in deep inferior epigastric perforator flap surgery: A consecutive cohort study
复制标题
DOI：
10.1016/j.bjps.2016.11.005
复制
发表时间：
2017-02-01
影响因子：
2.7
通讯作者：
Oh, Deuk Young
中科院分区：
文献类型：
--
作者：
Lee, Yoon Jae;Kim, Hak Young;Oh, Deuk Young
减少组织损伤是使用超声刀的理论优势。我们假设，在腹壁下动脉穿支皮瓣手术中，Harmonic超声刀的性能优于电凝，可能缩短手术时间，减少术后引流和疼痛。2015年1月至8月期间，24例连续患者被分配接受腹壁下动脉穿支皮瓣即刻提升术（12例采用双极电凝术，12例采用Harmonic超声刀）。主要结果变量为总手术时间、皮瓣提升时间（从筋膜切口开始）和引流量。我们比较了分离出的穿支数量和椎弓根的Moon和Taylor分类。分析前，使用Kolmogorov-Smirnov检验对数据进行正态性检验。采用Wilcoxon秩和检验比较连续变量。使用统计软件SAS 9.3版（SAS Institute，卡里，NC，USA）分析数据。两组在临床特征（平均年龄、体重指数和皮瓣重量）方面具有可比性。使用Harmonic超声刀和电凝器进行切割的手术时间存在统计学显著差异（分别为305.2和380.3分钟，p=0.002）。皮瓣提升时间缩短，特别是使用Harmonic超声刀时，其使用似乎对于解剖上腹深下穿支至关重要（分别为59.8与145.9 min，p < 0.0001）。两组引流量和住院时间无统计学差异。我们得出结论，Harmonic超声刀作为电凝术的替代品可能更可靠和有效。(C)2016年英国整形、重建和美容外科医生协会。由爱思唯尔有限公司出版。保留所有权利。
Reduced tissue damage is a theoretical advantage of using an ultrasonic harmonic scalpel. We hypothesized that the harmonic scalpelwould outperformelectrocautery in deep inferior epigastric perforator flap surgery, possibly resulting in a shorter operative time and reduced postoperative drainage and pain. Between January and August 2015, 24 consecutive patients were assigned to immediate deep inferior epigastric perforator flap elevation (12 for bipolar electrocautery and 12 for harmonic scalpel). The main outcome variables were total operative time, flap elevation time (starting fromthe fascia incision), and drainage volume. We compared the number of perforators isolated and the Moon and Taylor classification of the pedicle. Data were tested for normality using the Kolmogorov-Smirnov test before analysis. Continuous variables were compared by Wilcoxon rank-sum test. Data were analyzed using the statistical software SAS, version 9.3 (SAS Institute, Cary, NC, USA). Both groups were comparable with respect to clinical characteristics (mean age, body mass index, and flapweights). There was a statistically significant difference in the operative time between dissection with the harmonic scalpel and electrocautery (305.2 vs. 380.3 min, respectively, p=0.002). The flap elevation time was reduced, particularly when using the harmonic scalpel where its usage seems crucial for dissecting deep inferior epigastric perforators (59.8 vs. 145.9 min, respectively, p < 0.0001). No statistical difference was observed in the drainage volume and length of hospital stay between the groups. We conclude that the harmonic scalpel may be more reliable and efficient as an alternative to electrocautery. (C) 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.