1.9 µm diode laser assisted vascular microanastomoses: Experience in 40 clinical procedures.

Background: Since the initial work of Jacobson and Suarez in 1960, microsurgery has evolved greatly. In 2009, we reported our clinical experience with 1.9 µm diode laser-assisted vascular microanastomoses (LAMA) for free flap reconstruction. In this report, the ongoing study is now expanded to include 11 additional procedures which were analyzed prospectively with a focus on the duration of the LAMA technique.

Methods: In total, 40 clinical procedures with LAMA have been performed since 2005. Mean follow-up was 3.3 years (range 0.5-5.5 years). Among those, 11 procedures were performed and prospectively analyzed during the period 2008-2009. LAMA was performed with a 1.9 µm diode laser after placement of equidistant stitches. For vessels size <1.5 mm, the following laser parameters were used: spot size 400 µm, five spots for each wall, power 125 mW, arterial/venous fluence 100/90 J/cm(2) (spot duration 1/0.9 seconds).

Results: For the last observed 11 procedures, mean occlusion time of the flap arterial and venous anastomoses was 5.4 ± 0.4 and 6.8 ± 0.7 minutes respectively. One anastomosis required a secondary laser application. Arterial and venous patency rates were 100% at the time of surgery. The success rate for the 11 procedures was 100%. The global success rate of the series (97.5%) is discussed and compared with the literature.

Conclusion: The success rates for reconstructive free flap surgery realized with LAMA appear excellent. Technical innovation will most likely lead to widespread use of the handpiece laser in the operating room.