THE EFFECT OF LASERS, ELECTROCAUTERY, AND SHARP DISSECTION ON CUTANEOUS FLAPS

This study evaluated the technical ease and wound-healing response of cutaneous flaps constructed on dogs using Nd:YAG laser, CO2 laser, ele ctrocautery, and sharp dissection. Four flaps were constructed on the dorsum of 16 dogs using each of the four modalities. Parameters examin ed included drainage after both 48 hours and 1 week, time of dissectio n, bursting strength, and semiquantitative assessments of fibroblast, polymorphonuclear leukocyte, monocyte, and collagen content. Significa ntly less time was required to construct flaps with electrocautery as compared with CO2 laser, Nd:YAG laser, and sharp dissection (15 versus 18, 20, and 26 minutes, respectively; p < 0.01). Significantly fewer suture ligatures were necessary to obtain hemostasis for electrocauter y, CO2 laser, and Nd:YAG laser as compared with sharp dissection (0, 2 , and 2 versus 15 sutures, respectively; p < 0.01). Drainage was signi ficantly less for flaps constructed using sharp dissection as compared with both CO2 and Nd:YAG lasers at 48 hours (12 versus 26 cc, p < 0.0 1, and 20 cc, p < 0.05, respectively). Significantly less drainage was observed after 48 hours for flaps created using electrocautery as com pared with CO2 laser (14 versus 26 cc; p < 0.05). Bursting strength of flaps constructed using sharp dissection was significantly greater th an that of those constructed using electrocautery, Nd:YAG laser, and C O2 laser (1086 versus 638 gm, p < 0.05, 714 gm, and 571 gm, p < 0.01, respectively). Semiquantitative histologic evaluation revealed a highe r collagen content and fibroblast infiltration and less polymorphonucl ear leukocyte infiltration in wounds created using sharp dissection as compared with CO2 laser, Nd:YAG laser, and electrocautery. Flaps crea ted using electrocautery had a higher collagen content than those crea ted using CO2 or Nd:YAG lasers. This study demonstrates that (1) cutan eous flaps constructed using standard sharp dissection had less draina ge and evidence of faster and stronger healing than those constructed using CO2 or Nd:YAG lasers, and (2) although flaps constructed using e lectrocautery required less time to complete, they had evidence of slo wer and less strong healing than those created using sharp dissection. This study suggests that using sharp dissection to create cutaneous f laps is the most advantageous method with respect to the parameters ex amined, with the exception of time required for completion. It is poss ible that sharp dissection, used in conjunction with electrocautery to aid in hemostasis, may be the method of choice for the creation of cu taneous flaps.