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Facial Plastic and Reconstructive Surgery

(521) Ultrasonic Shears Decrease Hematomas in Head and Neck Microvascular Reconstruction

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • AD

    Arman Danielian, MD, MS

    Resident
    UCLA Head and Neck Surgery
    Los Angeles , California, United States

    • Author(s)

  • KB

    Keith E. Blackwell, MD

    Professor of head and neck surgery
    UCLA David Geffen School of Medicine
    Los Angeles, California, United States

    • Senior Author(s)

  • RK

    Rhorie P. Kerr, MD, FACS

    Assistant Professor of Facial Plastic and Reconstructive Surgery
    University of California: Los Angeles
    Los Angeles, California, United States

    • Author(s)

  • ML

    Manwel Labib, MS

    UCLA David Geffen School of Medicine, United States

  • Rahul Seth, MD

    Associate Professor
    University of California, San Francisco
    San Francisco, California, USA

  • VN

    Vishad Nabili, MD

    Professor & Vice Chair
    UCLA Head and Neck Surgery Dept., Division of Facial Plastic Surgery
    Los Angeles, California, United States

  • AR

    Ali Razfar, MD

    Private Practice, United States

Disclosure(s):
Arman Danielian, MD, MS: No relevant relationships to disclose.
Rhorie P. Kerr, MD, FACS: No relevant relationships to disclose.


Introduction: To evaluate post-operative hematoma and takeback rates in a large series of microvascular reconstructions. We sought to determine whether the use of ultrasonic shears reduced these rates.

Methods: 2288 patients undergoing free flap reconstruction for head and neck defects between 1995 and 2022 were reviewed. Patients undergoing dissection with and without ultrasonic shears were compared to determine post-operative hematoma and takeback rates.

Results: The overall hematoma rate was 1.3% (29/2288) for the entire cohort. The post-operative hematoma rates with and without ultrasonic shears were 0.63% (9/1418) and 2.3% (20/870), relative risk=0.28, p=0.0015. Of 870 patients undergoing surgery without ultrasonic shears, 14 (1.61%) were taken back to the operating room for control of bleeding compared to 8 of 1418 (0.56%) in the ultrasonic shears cohort.

Conclusions: Our large series of patients undergoing microvascular reconstruction shows a decrease in post-operative hematoma rate and takeback for bleeding with the adoption of ultrasonic shears. Ultrasonic shears are an effective tool that can help decrease perioperative morbidity secondary to hematoma after head and neck tumor resection and microvascular reconstruction.