Wax M K, Winslow C, Desyatnikova S, Andersen P E, Cohen J I
Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon 97201, USA.
Laryngoscope. 2001 Apr;111(4 Pt 1):568-71. doi: 10.1097/00005537-200104000-00003.
OBJECTIVES/HYPOTHESIS: The radial forearm fasciocutaneous free flap has become the workhorse for reconstruction of head and neck ablative defects. A location distal to the head and neck allows this flap to be elevated concurrent with the ablation. Most commonly, the flap is elevated under tourniquet control. This involves a primary ischemic insult with a certain amount of hemorrhage after the tourniquet is released. Bipolar scissors are a new method of dissection. They may allow for a speedier dissection with a concomitant decrease in ischemic time. Their hemostatic properties may control hemorrhage after use of the tourniquet.
A prospective study of patients undergoing radial forearm free flaps over a 12-month period at a tertiary care referral center was undertaken.
Forty patients were entered into the study, flaps were elevated with scalpel (20) and with bipolar scissors (20). Mean time under tourniquet was 39 minutes (range, 30-56 min) with scalpel compared with 27 minutes (range, 21-31 min) with bipolar scissors (P <.001). Total mean time of elevation (including control of hemostasis and pedicle dissection) for scalpel elevation was 50 minutes (range, 35-61 min) compared with 32 minutes (range, 20-41 min) for bipolar scissors elevation (P <.001). Mean blood loss was 46 mL (range, 15-110 mL) in the scalpel elevation group compared with 14 mL (range, 0-50 mL) in the bipolar scissors elevation group (P <.001). Complications at the donor site were equal between groups.
Bipolar scissors are a safe, efficient method for elevating radial forearm free flaps.
目的/假设：桡侧前臂筋膜皮瓣已成为头颈部切除术后缺损重建的主要手段。该皮瓣位于头颈部远端，可在切除手术同时进行切取。最常见的是，皮瓣在止血带控制下切取。这会导致一次原发性缺血损伤，止血带松开后还会有一定量的出血。双极电剪是一种新的解剖方法。它可能使解剖速度更快，同时减少缺血时间。其止血特性可能在使用止血带后控制出血。
在一家三级医疗转诊中心，对12个月内接受桡侧前臂游离皮瓣手术的患者进行了一项前瞻性研究。
40例患者纳入研究，20例用手术刀切取皮瓣，20例用双极电剪切取皮瓣。用手术刀切取皮瓣时止血带平均使用时间为39分钟（范围30 - 56分钟），而用双极电剪时为27分钟（范围21 - 31分钟）（P <.001）。手术刀切取皮瓣的总平均切取时间（包括止血和蒂部解剖）为50分钟（范围35 - 61分钟），而双极电剪切取皮瓣为32分钟（范围20 - 41分钟）（P <.001）。手术刀切取皮瓣组平均失血量为46毫升（范围15 - 110毫升），双极电剪切取皮瓣组为14毫升（范围0 - 50毫升）（P <.001）。两组供区并发症相同。
双极电剪是切取桡侧前臂游离皮瓣的一种安全、有效的方法。
