When plastic surgeons move tissue from one area of the body to another using the “free flap” technique, the crucial stage is the hook-up of tiny arteries and veins, so that the moved tissue can receive blood and oxygen in its new location. Since the 1960’s, this has been done with micro-sutures, sewing the vessels together with the aid of an operating microscope. It’s quite difficult, and the success of the surgery really depends on the skill of the surgeon, using sutures smaller than a human hair.
In this month’s issue of Plastic and Reconstructive Surgery, a new report from France discusses laser welding of these tiny vessels. Once the tiny arteries and veins are lined up, a small low-power diode laser has been used successfully to join the vessels together, like a high-tech pipe fitter welding two pipes together.
In the French study, 27 patients had reconstructive microsurgery using the laser diode welding technique on 58 vessels, ranging between 0.8 to 1.8 millimeters in diameter. Patency of the laser-welded vessels was excellent, at 96.6%. And the new technique was quicker, reducing overall surgery time and “ischemic” time – the critical time between the separation and the reconnection of the blood vessels to the moved tissue.
Impression: This looks like it could be a winner for microsurgery. The next step will be some direct comparison studies between laser, traditional suture techniques and the mechanical vessel coupler device. In addition, the use of the low-power laser could potentially be adopted for use in laparoscopic surgery, for biliary or urinary tract surgery. Time will tell.