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Comparative Analysis of Electrocautery Versus LigaSure Energy-based Device for Anterolateral Thigh Free Flap
Jiajun Feng1, Surya Subramanian1, Marcus Jia Ming Ng1
1From the Department of Plastic Surgery, Sengkang General Hospital, Singapore.
Background:
The anterolateral thigh (ALT) free flap is widely used in reconstructive surgery, but intramuscular perforator dissection remains technically demanding and time-consuming. Electrocautery may cause collateral thermal injury and slower dissection rates. Advanced bipolar energy devices, such as LigaSure, offer precise vessel sealing with reduced thermal spread, potentially enabling faster and more controlled dissection. This study aimed to directly compare electrocautery with LigaSure during ALT flap harvest, evaluating dissection efficiency and operative duration.
Methods:
A combined retrospective-prospective study was conducted. Group A retrospectively analyzed 20 ALT flaps by a single surgeon (10 with electrocautery, 10 with LigaSure), comparing flap harvest time. Group B prospectively analyzed 10 ALT flaps, where 2 surgeons each alternately dissected a perforator within the same flap using either electrocautery or LigaSure, facilitating direct comparison. Primary outcomes were flap harvest time and perforator dissection speed (time per centimeter of perforator length).
Results:
LigaSure significantly reduced flap harvest time. In group A, flap harvest time was shorter with LigaSure versus electrocautery. In group B, perforator dissection was significantly faster with LigaSure, averaging 11.5 versus 39.4 minutes with electrocautery. Normalized to perforator length, LigaSure achieved 1.61 minutes per centimeter compared with 6.29 minutes per centimeter with electrocautery, approximately 3.9 times faster (P < 0.05).
Conclusions:
LigaSure significantly enhances ALT flap dissection efficiency, especially along the intramuscular perforator course, thereby reducing flap harvest time. Its adoption can streamline workflow and improve procedural consistency in ALT flap harvest.
