A prospective comparison of scalpel versus bipolar scissors in the elevation of radial forearm fasciocutaneous free flaps

Objectices/Hypothesis: The radial forearm fasciocutaneous fi ee flap has be come the workhorse for reconstruction of head and neck ablative defects. A location distal to the head and neck allows this flap to be elevated concur rent with the ablation. Most commonly, the flap is elevated under tournique t control. This involves a primary ischemic insult with a certain amount of hemorrhage after the tourniquet is released. Bipolar scissors are a new me thod of dissection. They may allow for a speedier dissection with a concomi tant decrease in ischemic time. Their hemostatic properties may control hem orrhage after use of the tourniquet. Study Design A prospective study of pa tients undergoing radial forearm free flaps over a 12-month period at a ter tiary care referral center was undertaken. Results: Forty patients were ent ered 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 sci ssors (P <.001). Total mean time of elevation (including control of hemosta sis and pedicle dissection) for scalpel elevation was 50 minutes (range, 35 -61 min) compared with 32 minutes (range, 20-41 min) for bipolar scissors e levation (P <.001). Mean blood loss was 46 mL (range, 15-110 mL) in the sca lpel elevation group compared with 14 mL (range, 0-50 mt) in the bipolar sc issors elevation group (P <.001). Complications at the donor site were equa l between groups. Conclusions: Bipolar scissors are a safe, efficient metho d for elevating radial forearm free flaps.