Abstract
BACKGROUND: The HARMONIC Shears is an ultrasonic surgical device enabling precise tissue dissection with simultaneous hemostasis. Its application in lower limb free flap reconstruction following trauma is underexplored. METHODS: A retrospective cohort study compared nine patients undergoing lower limb free flap reconstruction with HARMONIC FOCUS™+ Shears to nine patients using conventional dissection (diathermy and LIGACLIP clips). Patients were matched by flap type and concomitant orthopedic procedures. Primary outcome was total operative time. Secondary outcomes included flap survival, postoperative complications, length of hospital stay, and a comprehensive cost analysis encompassing theater time, consumables, and inpatient stay. RESULTS: HARMONIC Shears significantly reduced operative time in cases without concomitant orthopedic procedures (262.8 ± 46.3 vs 364.2 ± 53.9 min; p = 0.012). Across all cases, mean operative time was shorter in the HARMONIC Shears group (322.0 ± 81.1 vs 380.4 ± 53.5 min; p = 0.09). Flap survival was higher with HARMONIC Shears, with higher reoperation rates in the conventional group reflecting flap failures; however, this difference was not statistically significant. Specific postoperative complications rates, including infection, wound dehiscence, and donor site morbidity, were slightly higher in the HARMONIC Shears group, but all differences were not statistically significant. Mean hospital stay was 8.5 days shorter in the HARMONIC Shears group (p = 0.31). Cost analysis revealed theater and inpatient savings of up to £8699 per case with the HARMONIC Shears after accounting for device costs. CONCLUSIONS: HARMONIC Shears may enhance operative efficiency and reduce healthcare costs in lower limb free flap reconstruction without compromising clinical outcomes. However, findings should be interpreted cautiously given the small sample size and limited statistical power. Larger prospective studies are warranted to confirm these findings.