title: Ultrasonic shears in free-tissue transfer: increased efficiency and cost savings.
abstract: OBJECTIVE
  The harvest of some microvascular free flaps for head and neck reconstruction entails tedious and time-consuming dissection of multiple perforating vessels and/or muscular attachments. The objective of this study is to investigate the use of ultrasonic shears as a means to decrease operative time and increase surgical efficiency in the harvest of microvascular free flaps.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  A prospective study of all people undergoing fibula (FFF) or anterolateral thigh (ALT) free flap reconstruction of head and neck defects was conducted from October 1, 2005, through December 30, 2009.
  
  
  RESULTS
  There were 69 FFF and 39 ALT free flaps performed by a single surgeon during the study period. Ultrasonic shears were used in 53 (76.8%) FFF and 26 (80.6%) ALT free flaps, whereas traditional dissection techniques were used in 16 (23.2%) FFF and 13 (19.4%) ALT free flaps. The use of ultrasonic shears significantly decreased the harvest time of FFF and ALT free flaps an average of 14.5 and 16.3 minutes, respectively. The average cost savings associated with the use of ultrasonic shears was $492 for FFF and $543 for ALT free flaps compared to traditional dissections techniques. Similar rates of complications were observed when ultrasonic shears were used compared to traditional techniques.
  
  
  CONCLUSIONS
  The use of ultrasonic shears in the harvest of microvascular free flaps decreases operative time, leading to significantly decreased costs without an increased risk of complications compared to traditional dissection techniques.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
authors.forename: Cody A
authors.initials: CA
authors.lastname: Koch
authors.forename: Steven M
authors.initials: SM
authors.lastname: Olsen
authors.forename: Eliot J
authors.initials: EJ
authors.lastname: Martin
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Moore
mesh_terms: D000328:Adult; D000368:Aged; D017046:Cost Savings / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply*; D006257:Head / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply / Q000637:transplantation*; D009333:Neck / Q000601:surgery*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000295:instrumentation*