[Should we keep using the heating lamp in microsurgery?]

The "heating lamp" is one of the complementary measures used to improve the survival rate of replantations and flaps. No publication demonstrated its efficiency, but burn injuries have been reported. The purpose of this study was to estimate the efficiency of the "heating lamp". A questionnaire was sent to the members of the French society for surgery of the Hand, 16 % of who answered. The heat emitted by three electric bulbs (energy saving, strand, halogen) was measured at room temperature at 10, 15, 20 and 25cm distance from the bulb over 4h. The pressure of capillary drip PFC of the pulp of the index was measured in 10 healthy subjects by a laser Doppler. The PFC was measured without source of heat, then at 38, 40 and 42°C, during 30min. Among the answers to the questionnaire, 67 % never use the heating lamp. Among the 33 % who use it, the protocol was variable; 18 control the temperature without precision, 18 use it continuously, and 23 use it more than 24hours. Nine reported complications, including eight burns (five flaps, three replantations). Subjectively, the majority of the users believe in its efficacy. Objectively, the heat emitted by the "heating lamp" was unimportant; whatever the distance from the source. The PFC did not vary with the temperature. The "heating lamp" is used empirically in microsurgery. The physical and physiological measures at the lower threshold for burns (43°C) show that it is ineffective. Burns have been reported. In conclusion, the "heating lamp" should no longer be a part of the therapeutic arsenal of the hand surgeon.