Clinical application of ultrasonic scalpel in the preparation of fibular osteomyocutaneous free flap

doi:10.19438/j.cjoms.2023.02.009

Abstract

Abstract: PURPOSE: To explore the feasibility and practicability of ultrasonic scalpel in the preparation of fibular osteomyocutaneous free flap. METHODS: From September 2019 to March 2022, 62 patients who needed fibular osteomyocutaneous free flap to repair head and neck defects in the Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Qingdao University were collected. In the experimental group, fibular osteomyocutaneous free flaps were prepared by ultrasonic scalpel(n=30); while in the control group, fibular osteomyocutaneous free flaps were prepared by traditional monopolar electrotome(n=32). The preparation time of fibular osteomyocutaneous free flap, total intraoperative blood loss, blood loss of fibular donor site, drainage volume of fibular donor site, drainage days of fibular donor site and other surgery-related indexes were compared. The levels of tumor necrosis factor (TNF-α) and interleukin-6 (IL-6) in the postoperative drainage fluid were also compared. At the same time, postoperative complications (bleeding, edema, flap necrosis) and postoperative fibula donor site pain score were compared. SPSS 25.0 software package was used for statistical analysis. RESULTS: In the experimental group, the blood loss from fibular donor site was significantly decreased(P<0.01), and the preparation time of fibular osteomyocutaneous free flap, the total intraoperative blood loss, the drainage volume of fibular donor site, and the drainage days of fibular donor site were significantly decreased(P<0.05). The levels of TNF-α and IL-6 in the drainage fluid of the experimental group were significantly decreased(P<0.01). There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05). In addition, there was no significant difference in the pain score of the fibular donor site on the first day after operation between the two groups(P> 0.05), but the pain score of the fibular donor site in the experimental group was significantly decreased from the second day to the fifth day after operation(P<0.05). CONCLUSIONS: The preparation of fibular osteomyocutaneous free flap assisted by ultrasonic scalpel has less damage and better postoperative recovery for patients than traditional monopolar electrotome. Hemostasis with ultrasonic scalpel during operation has a good clinical application prospect in oral reconstructive surgery.

Key words: Ultrasonic scalpel, Fibular osteomyocutaneous free flap, Reconstruction

CLC Number:

R782.2

HU Xiao-dan, XU Hao-yue, LI Xiao, BU Ling-xue, JIA Mu-yun, YUAN Rong-tao, PANG Bao-xing. Clinical application of ultrasonic scalpel in the preparation of fibular osteomyocutaneous free flap[J]. China Journal of Oral and Maxillofacial Surgery, 2023, 21(2): 152-157.

References

[1] Hatchell AC, Schrag CH, Temple-Oberle CF, et al.Patient-reported outcomes after fibula free flap harvest: a pilot study[J]. Plast Reconstr Surg, 2021, 148(6): 1007e-1011e.
[2] Al Deek NF, Kao HK, Wei FC.The fibula osteoseptocutaneous flap: concise review, goal-oriented surgical technique, and tips and tricks[J]. Plast Reconstr Surg, 2018, 142(6): 913e-923e.
[3] Datarkar AN, Daware S, Kothe S, et al.Simultaneous placement of endosseous implants in free fibula flap for reconstruction of mandibular resection defects[J]. J Craniofac Surg, 2020, 31(5): e483-e485.
[4] 杨甦, 韩煦, 肖宜, 等. 超声刀在口腔癌颈淋巴结清扫术中的临床应用价值[J]. 中国临床医学, 2018, 25(6): 933-935.
Yang S,Han X,Xiao Y,et al.Application of harmonic scalpel in cervical lymph node dissection for oral carcinoma[J]. Chinese Journal of Clinical Medicine, 2018, 25(6): 933-935.
[5] Memon F, Ahmed A, Parveen S, et al.Outcomes of harmonic scalpel and electrocautery in patients who underwent modified radical mastectomy[J]. Cureus, 2020, 12(12): e12311.
[6] Kawabata R, Takiguchi S, Kimura Y, et al.A randomized phase II study of the clinical effects of ultrasonically activated coagulating shears (Harmonic scalpel) in open gastrectomy for gastric cancer[J]. Surg Today, 2016, 46(5): 561-568.
[7] Hu Y, Zheng C, Cao R, et al.Resection of benign tumours of the submandibular gland with harmonic scalpel-assisted minimally extracapsular dissection[J]. J Int Med Res, 2020, 48(1): 300060519892783.
[8] Targarona EM, Balague C, Marin J, et al.Energy sources for laparoscopic colectomy: a prospective randomized comparison of conventional electrosurgery, bipolar computer-controlled electrosurgery and ultrasonic dissection. Operative outcome and costs analysis[J]. Surg Innov, 2005, 12(4): 339-344.
[9] Liao G, Wen S, Xie X, et al. Harmonic scalpel versus monopolar electrocauterization in cholecystectomy[J]. JSLS, 2016, 20(3): e2016.00037.
[10] Yilmaz KB, Dogan L, Nalbant H, et al.Comparing scalpel, electrocautery and ultrasonic dissector effects: the impact on wound complications and pro-inflammatory cytokine levels in wound fluid from mastectomy patients[J]. J Breast Cancer, 2011, 14(1): 58-63.
[11] 胡建道, 曹澄, 孙红村, 等. 超声刀微创技术在颌下腺手术的临床应用研究[J]. 浙江创伤外科, 2018, 23(4): 675-677.
Hu JD, Cao C, Sun HC, et al.Clinical application of ultrasonic scalpel minimally invasive technique in submandibular gland surgery[J]. Zhejiang Journal of Traumatic Surgery, 2018, 23(4): 675-677.
[12] 屈振宇. 超声刀在腮腺手术中的应用[J]. 中国实用口腔科杂志, 2011, 4(5): 312-314.
Qu ZY.Application of ultrasonic scalpel in parotid surgery[J]. Chinese Journal of Practical Stomatology, 2011, 4(5): 312-314.
[13] Akazawa M, Saito T, Okadome M, et al.Comparison of electrosurgical devices for cervical conization: novel monopolar scalpel (VIO) versus ultrasonic scalpel[J]. J Low Genit Tract Dis, 2019, 23(1): 43-47.
[14] 邓廷超, 陈睿. 超声刀与单极电刀在腮腺浅叶切除术中的临床应用比较分析[J]. 重庆医科大学学报, 2019, 44(1): 119-122.
Deng TC, Chen R.Clinical application of harmonic scalpel versus monopolar electrocautery in superficial parotidectomy: a comparative analysis[J]. Journal of Chongqing Medical University, 2019, 44(1): 119-122.
[15] 王义洲, 蔡嫚, 孙立凡, 等. 腓骨肌皮瓣修复下颌骨节段性缺损术前有限元分析[J]. 中国口腔颌面外科杂志, 2021, 19(4): 325-331.
Wang YZ, Cai M, Sun LF, et al.Preoperative finite element analysis of fibula myocutaneous flap for segmental mandibular reconstruction[J]. China Journal of Oral and Maxillofacial Surgery, 2021, 19(4): 325-331.
[16] 毛驰, 竺涵光, 张志愿. 改良的游离腓骨瓣制备方法[J]. 口腔医学, 2000, 20(3): 131-132.
Mao C, Zhu HG, Zhang ZY.A modified technique for harvesting fibula free flap[J]. Stomatology, 2000, 20(3): 131-132.
[17] Rodríguez-Arias JP, Tapia B, Pampín MM, et al.Clinical outcomes and cost analysis of fibula free flaps: a retrospective comparison of CAD/CAM versus conventional technique[J]. J Pers Med, 2022, 12(6): 930-936.
[18] 周京安, 骆成玉, 李洋. 超声刀联合双极电凝镊在腔镜辅助甲状腺癌手术中的应用[J]. 中国微创外科杂志, 2022, 22(1): 26-30.
Zhou JA, Luo CY, Li Y.Application of ultrasonic scalpel combined with bipolar coagulation forceps in video-assisted thyroidectomy for thyroid carcinoma[J]. Chinese Journal of Minimally Invasive Surgery, 2022, 22(1): 26-30.
[19] McCarus SD, Parnell LKS. The origin and evolution of the HARMONIC^® scalpel[J]. Surg Technol Int, 2019, 35: 201-213.
[20] Tsimoyiannis EC, Jabarin M, Tsimoyiannis JC, et al.Ultrasonically activated shears in extended lymphadenectomy for gastric cancer[J]. World J Surg, 2002, 26(2): 158-161.
[21] 张彬, 安常明, 徐震纲, 等. 内镜辅助下腮腺切除术14例报道[J]. 中国口腔颌面外科杂志, 2008, 6(5): 339-342.
Zhang B, An CM, Xu ZG, et al.Endoscopic-assisted parotidectomy: Report of 14 consecutive cases[J].China Journal of Oral and Maxillofacial Surgery, 2008, 6(5):339-342.
[22] Huang Y, Mu GC, Qin XG, et al.The application of ultrasonic harmonic scalpel in the radical surgery of gastric cancer[J]. Clin Transl Oncol, 2013, 15(11): 932-937.
[23] Loo WT, Sasano H, Chow LW.Pro-inflammatory cytokine, matrix metalloproteinases and TIMP-1 are involved in wound healing after mastectomy in invasive breast cancer patients[J]. Biomed Pharmacother, 2007, 61(9): 548-552.