Laser-Assisted Microvascular Anastomosis of Free Flaps in Reconstruction of Orofacial Defects: A Comparative Study Among Conventional Methods and Diode Laser Anastomosis.

BACKGROUND: The key role played by anastomosis determines the outcome of any free flap surgery. Besides many methods, the application of LASERS for performing microvascular anastomosis gaining popularity in recent times. The ease of application, utilizing lesser time for performing anastomosis than the conventional methods and minimal injury to the vessel layers, are contributing factors to the success of free flap surgery. Laser-assisted vascular anastomosis (LAVA) fulfills the criteria of lesser vessel wall damage and faster anastomosis and thus resulting in reduced flap ischemic time and overall outcome of the surgery.
METHODS: A prospective randomized case-control trial comparing conventional suturing methods (group I) with Laser-assisted vascular anastomosis (group II) on free flaps were performed for the reconstruction of orofacial defects. The parameters assessed for evaluation were anastomotic time, ischemic time and vessel patency following anastomosis. Student's t test and Fisher's exact tests were implied for statistical analysis.
RESULTS: The mean time taken for anastomosis was 19.75 min in the conventional group and 3.86 min in LAVA anastomosis. This difference was found to be extremely statistically significant (p < 0.00001). The mean ischemic time of the free flap harvested was 384.87 min in group I and 138.7 min in group II. This difference was also found to be extremely statistically significant (p < 0.00001).
CONCLUSION: The average anastomosis time for LAVA group was considerably reduced and total ischemic time was considerably less with successful uptake of the flap. In LAVA group, the post-operative complication was less when compared to the conventional anastomosis technique. © The Association of Oral and Maxillofacial Surgeons of India 2020.