title: Infrared evaluation of the heat-sink bipolar diathermy dissection technique.
abstract: BACKGROUND
  The use of the bipolar diathermy dissection technique is widespread amongst surgeons performing flap perforator dissection and microvascular surgery. The 'heat-sink' modification uses a DeBakey forcep as a heat sinking interposition between the bipolar tip and the main (vascular or flap) pedicle aiming to protect it from the thermal effects of the bipolar diathermy. This study examines the thermal effects of bipolar cautery upon the microvasculature and investigates the efficacy of heat sinking as a thermally protective technique in microsurgical dissection.
  
  
  METHODS
  A chicken thigh microsurgical training model was used to examine the effects of bipolar cautery. The effects of bipolar were examined using high definition, real-time infrared thermographic imaging (FLIR Systems) and temperature quantitatively assessed at various distances away from the point of bipolar cautery. Comparison was made using the heat sink technique to determine if it conferred a thermoprotective effect compared to the standard technique without heat sink.
  
  
  RESULTS
  Using paired t-test analysis (SPSS) the heat sink modification of the bipolar dissection technique was found to have a highly statistically significant effect (P < 0.000000001) in reducing the conductive temperature along the vascular pedicle. This protective effect kept temperatures comparable to controls.
  
  
  CONCLUSIONS
  Bipolar cautery is an extremely safe method of electrosurgery, however when its use is required within 3 mm of important vascular architecture, the heat-sink method is a viable and easy technique to prevent thermal spread and limit potential coagulopathic changes.
authors.affiliation: Plastic Surgery Department, Royal Prince Alfred Hospital, Sydney, Australia. Electronic address: jamesallan82@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Allan
authors.affiliation: Plastic Surgery Department, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Dusseldorp
authors.affiliation: Department of Plastic Surgery and Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: N G
authors.initials: NG
authors.lastname: Rabey
authors.affiliation: Department of Plastic Surgery and Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Postgraduate Medical Institute at Anglia Ruskin University, Cambridge & Chelmsford, UK.
authors.forename: C M
authors.initials: CM
authors.lastname: Malata
authors.affiliation: Plastic Surgery Department, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Goltsman
authors.affiliation: Plastic Surgery Department, Royal Prince Alfred Hospital, Sydney, Australia; Department of Plastic Surgery and Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: A F
authors.initials: AF
authors.lastname: Phoon
mesh_terms: D000818:Animals; D002645:Chickens; D004210:Dissection / Q000295:instrumentation / Q000379:methods*; D004564:Electrocoagulation / Q000379:methods*; D005263:Femoral Artery / Q000601:surgery; D058752:Free Tissue Flaps; D007259:Infrared Rays; D008866:Microsurgery; D023421:Models, Animal; D013817:Thermography / Q000379:methods
keywords: Bipolar; Free-flap; Microsurgery; Reconstruction; Technique