The Use of Harmonic Scalpel for Free Flap Dissection in Head and Neck Reconstructive Surgery

Surgeons conventionally use electrocautery dissection and surgical clip appliers to harvest free flaps. The ultrasonic Harmonic Scalpel is a new surgical instrument that provides high-quality dissection and hemostasis and minimizes tissue injury. The aim of this study was to evaluate the effectiveness and advantages of the ultrasonic Harmonic Scalpel compared to conventional surgical instruments in free flap surgery. This prospective study included 20 patients who underwent head and neck reconstructive surgery between March 2009 and May 2010. A forearm free flap was used for reconstruction in 12 patients, and a fibular flap was used in 8 patients. In half of the patients, electrocautery and surgical clips were used for free flap harvesting (the EC group), and in the other half of the patients, ultrasonic dissection was performed using the Harmonic Scalpel (the HS group). The following parameters were significantly lower in the HS group compared to the EC group: the operative time of flap dissection (35% lower in the HS group), blood loss, number of surgical clips and cost of surgical materials. This study demonstrated the effectiveness of the Harmonic Scalpel in forearm and fibular free flap dissections that may be extended to other free flaps

Influence of Canal Geometry and Dynamics on Controllability

This paper presents the results of the Task Committee on Canal Automation Algorithms with regard to the influence of canal properties on the controllability of irrigation canals. While the control provided by individual algorithms was not evaluated, studies were performed to illustrate inherent hydraulic limitations—the inability of canal pools to recover rapidly from disturbances or flow perturbations. Studies were performed in nondimensional form to develop a better understanding of how pool properties influence pool response. Three such studies were performed. First, nondimensional backwater curves were developed for a range of canal conditions. The second study involved the propagation of waves initiated at the upstream end of a canal pool, as this is influenced by downstream boundary conditions. Finally, the response of pools to downstream withdrawals was examined in terms of their sluggish recovery even when the correct flow change is applied upstream. These results will help in understanding how canal properties influence the ability of operators to effectively control a canal either manually or automatically, and should influence future design practices