Loos, Lesquin, and Lille From the Department of Plastic Surgery, Handcenter of Lille Sud Clinic and Lille University Hospital; and INSERM, French National Institute of Health and Medical Research, Université Lille Nord de France, Lille University Hospital.
Plast Reconstr Surg. 2010 Apr;125(4):1167-1175. doi: 10.1097/PRS.0b013e3181d18173.
Microvascular surgery has become an important method for reconstructing surgical defects resulting from trauma, tumors, or burns. The most important factor for successful free flap transfer is a well-executed anastomosis. This study was performed to review the authors' experience with a 1.9-microm diode laser in microsurgery, with special attention to outcomes and performance of the technique.
Between January of 2005 and December of 2007, 27 patients underwent microsurgery with a 1.9-microm diode laser at the authors' institute. The patients had a mean age of 31 years (range, 2 to 59 years); 14 patients were women and 13 patients were men. This technique was used for digital replantations (n = 2) and for free flap transfer (n = 27). Causes of the defects were trauma (n = 14), tumor (n = 9), congenital (n = 2), burn (n = 1), infection (n = 1), arthritis (n = 1), and dog bite (n = 1). Laser-assisted microvascular anastomosis was performed with a 1.9-microm diode laser after placement of equidistant stitches. The following parameters were used: spot size, 400 microm; power, 125 mW; time depending on vessel size (0.8 to 1.8 mm); and fluence varying from 70 to 200 J/cm.
Three surgical revisions following hematoma and one rupture of the arterial anastomosis leading to a free deep inferior epigastric perforator flap necrosis resulting from high-dose radiotherapy before surgery occurred after laser-assisted microvascular anastomosis, accounting for an overall success rate of 96.6 percent.
This study reports the numerous benefits of the technique: easier performance of vascular anastomosis with difficult access, decrease of reperfusion bleeding and complications, and a short learning curve.
显微外科已成为重建创伤、肿瘤或烧伤导致的外科缺损的重要方法。游离皮瓣移植成功的最重要因素是吻合口的良好操作。本研究旨在回顾作者在显微外科中使用 1.9μm 二极管激光的经验，特别关注该技术的结果和表现。
2005 年 1 月至 2007 年 12 月，作者所在机构的 27 例患者接受了 1.9μm 二极管激光的显微外科手术。患者的平均年龄为 31 岁（范围：2 至 59 岁）；14 例为女性，13 例为男性。该技术用于数字再植术（n=2）和游离皮瓣移植术（n=27）。缺损的原因包括创伤（n=14）、肿瘤（n=9）、先天性（n=2）、烧伤（n=1）、感染（n=1）、关节炎（n=1）和狗咬伤（n=1）。激光辅助血管吻合术是在放置等距缝线后，使用 1.9μm 二极管激光进行的。使用的参数如下：光斑大小为 400μm；功率为 125mW；时间取决于血管大小（0.8 至 1.8mm）；和能量密度从 70 至 200J/cm 不等。
激光辅助显微血管吻合术后发生 3 例血肿手术修正，1 例动脉吻合口破裂导致游离腹壁下深动脉穿支皮瓣坏死，这是由于手术前接受了高剂量放疗。总的成功率为 96.6%。
本研究报告了该技术的诸多优点：更容易进行难以接近的血管吻合，减少再灌注出血和并发症，以及较短的学习曲线。
