A comparison of suture versus laser-assisted microvascular anastomosis (LAMA) in the pig buttock flap model

Introduction of microvascular free-tissue transfer to head and neck surgery has completely altered the current approach to extirpation and reconstruction. The increased flexibility now available offers multiple options for reconstruction and has essentially removed the limitations of size and geometry which existed with other types of repair. Despite these advantages, increased surgical time and potential flap failure loom as limiting factors. Since the initial use of sutures to perform microvascular anastomoses, numerous experiments have been conducted in order to identify other options for vessel approximation. Laser-assisted microvascular anastomosis (LAMA) was first attempted with the neodymium-yttrium aluminum garnet (Nd:YAG) laser and, subsequently, other wavelengths were used in experimental models. Success with this technique has been repeatedly documented. Although a comparable animal model to study skin flaps was initially described in 1979, little is currently available in the literature that describes the actual use of a microvascular free flap model. Certainly, nothing exists regarding the role of LAMA and microvascular free-tissue transfer. This study was designed to establish a reliable and reproducible animal model to study free-tissue transfer. Through the use of laser Doppler flowmetry, values of blood perfusion of flaps can be determined. Anastomoses with standard suture and various laser-assisted techniques could then be done and compared, analyzing the parameters of time and blood flow. Histologic evaluation could be correlated with clinical observations. In so doing, LAMA could be objectively evaluated as a potentially viable method of vascular reconstruction in microsurgical free-tissue transfer.