Novel technique: piezoelectric BoneScalpel™ osteotomies ...€¦ · orthognathic surgery....
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Poster Design & Printing by Genigraphics ® - 800.790.4001 Novel technique: piezoelectric BoneScalpel™ osteotomies for harvesting osteocutaneous free flaps Cameron C. Wick, MD 1 ; Rod P. Rezaee, MD 1 ; Chad A. Zender, MD 1 1 University Hospitals Case Medical Center, Department of Otolaryngology – Head and Neck Surgery INTRODUCTION RESULTS Table 1. Operative Results ABSTRACT All osteotomies were successfully created with the BoneScalpel™ Ultrasonic Osteotome. The lead surgeons (R.P.R and C.A.Z.) report improved tactile control, minimal learning curve, and similar operative time compared to traditional oscillating and reciprocating saws. Vascular pedicles and adjacent soft tissue were not damaged. Bony unions appeared intact at 7- month follow-up. Nonrandomized case series of five patients undergoing mandibular resection related to oncologic disease of the head and neck and reconstruction with an osteocutaneous free flap. The Misonix BoneScalpel™ Ultrasonic Osteotome was used for all harvesting and reconstructive osteotomies. Osteocutaneous free flaps included thee fibular, one radial forearm, and one scapular. Surgeries were performed between July and October 2011 at University Hospitals Case Medical Center in Cleveland, OH. All patients were managed per our institutional protocol for head and neck free flap procedures. The two lead surgeons recorded subjective operative feedback. Retrospective chart analysis was performed after 7 – 9 months of follow-up. The piezoelectric BoneScalpel™ Ultrasonic Osteotome offers a safe and efficient method to create osteotomies during the harvest of osteocutaneous free flaps. Primary advantages include better tactile control, precise osteotomies, minimal learning curve, and theoretic protection of vital soft tissue structures such as a vascular pedicle. Future studies with objective data are needed to further support this novel technique in head and neck reconstruction. Ultrasound is a cyclic sound pressure with a frequency greater than 20,000 Hz. Ultrasonic technology was first used by dentistry in the1950’s for its ability to selectively cut dento- osseous structures. 1 This process is termed piezoelectric effect, with piezo- originating from Greek meaning to squeeze or press. Since then it has been advocated for many surgical procedures. 2-8 Low-frequency ultrasound devices selectivity displace dense, mineralized tissue while higher- frequency devices (i.e. Harmonic Scalpel TM ) have a propensity for separating soft-tissue. 5,6 The Misonix BoneScalpel™ Ultrasonic Osteotome is a low-frequency device that selectively cuts mineralized tissue like bone while theoretically sparing trauma to soft tissues. The harvesting of osteocutaneous free flaps presents unique challenges to the reconstructive surgeon, specifically the creation of an osteotomy adjacent to a flap’s vital vascular pedicle. Traditional osteotomy instruments are the oscillating saw and rotational burr, which produced considerable vibration and torque. Reports exist of flap complications secondary to soft tissue damage while creating the osteotomy. 9 Low-frequency piezoelectric osteotomies have been advocated for their improved tactile control, minimal learning curve, and preservation of adjacent soft tissue. 2-5 Surgical reports also suggest reduced osteotomy blood loss and less bone necrosis compared to traditional osteotomy methods. 2,4,6,10 Working at 22.5 kHz (22,500 strokes per second) the BoneScalpel™ Ultrasonic Osteotome has disposable blades that can produce a precise linear osteotomy as thin as 0.5 mm and with an insertion depth up to 20 mm. With these factors in mind, we sought to characterize how the Bonescalpel TM may benefit the harvesting of different osteocutaneous free flaps used to reconstruct mandibular defects. The goal of this preliminary report is to describe a future role of piezoelectric technology in the setting of osteocutaneous free flap osteotomies. METHODS AND MATERIALS 1. Richman MJ. The use of ultrasonics in root canal therapy and root resection. J Dent Med. 1957;12:12. 2. Salami A, Dellepiane M, Proto E, Mora R. Piezosurgery in otologic surgery: four years of experience. Otolaryngol Head Neck Surg. 2009;140:412-418. 3. Salami A, Mora R, Mora F, et al. Learning curve for Piezosurgery in well-trained otological surgeons. Otolaryngol Head Neck Surg. 2010;142:120-125. 4. Salami A, Dellepiane M, Crippa B, Mora R. A new method for osteotomies in oncologic nasal surgery: Piezosurgery. Am J Otolaryngol. 2010;31:150-153. 5. Salami A, Dellepiane M, Salzano FA, et al. Piezosurgery in the excision of middle-ear tumors: effects on mineralized and non- mineralized tissues. Med Sci Monit. 2007;13:PI25-129. 6. Nordera P, Spanio di Spilimbergo S, Stenico A, et al. The cutting edge technique for safe osteotomies in craniofacial surgery: the Piezosurgery bone scalpel. Plast Reconstr Surg 2007;120:1989-1995. 7. Dammous S, Darche V, Gilles R. Use of ultrasonic bone scalpel in orthognathic surgery. Congress of the European Association of Cranio-Maxillo-Facial Surgery. 2010;113-120. 8. Parker S, Kretzer R, Recinos P, et al. Use of novel ultrasonic bone scalpel for osteoplastic laminoplasty in the resection of intradural spinal cord pathology. Poster presentation at 27 th annual AANS/CNS Section. March 9-11,2011. 9. Collin T, Sugden P, Ahmed O, Ragbir M. Technical considerations of fibular osteocutaneous flap dissection. J Plast Reconstr Aesth Surg. 2008;61:1503-1506. 10. Tete S, Vinci R, Zizzari V, et al. Evaluation of effects on bone tissue of different osteotomy techniques. J Craniofac Surg 2009;20:1424-1429. 11. Laurentjoye M, Jeanniot P, Beziat J, Gleizal A. Piezoelectric osteotomies during fibula free flap harvesting. J Plast Reconstr Aesth Surg. 2010;63:e495-496. CONCLUSIONS REFERENCES Cameron Wick, MD University Hospitals ENT Institute LKS 5045 11100 Euclid Ave. Cleveland, OH 44106 Email: [email protected] Phone: (216) 201-0792 Website: casemed.case.edu/otolaryngology CONTACT Figure 1. BoneScalpel™ Ultrasonic Osteotome hand device. Figure 2. BoneScalpel™ Ultrasonic Osteotome unit. Figure 3. Intraoperative photographs of the BoneScalpel™ Ultrasonic Osteotome. Harvesting of a radial forearm osteocutaneous flap (a – c). Reconstructive osteotomies (d – e). (a) (b) (c) (d) (e) DISCUSSION Low-frequency piezoelectric technology has been widely accepted by many surgical specialties but there remains a paucity of data on its use in osteocutaneous free flap reconstructions 11 . We present the first case series for its use in this setting and note the ease of introducing this technology into our free flap regimen. The device offers improved tactile control and versatility via different cutting blades. Our data suggests appropriate union of the osseous grafts, with the only graft complication occurring in the setting of radionecrosis. More objective data, including a cost analysis, are required to verify these preliminary findings and further support the utility of low-frequency piezoelectric osteotomies in osteocutaneous free flaps. Objectives: To present a novel utilization for a piezoelectric device in the harvesting of osteocutaneous free flaps. Method Nonrandomized case series assessing a new osteotomy device, the Misonix BoneScalpel™ Ultrasonic Osteotome. Five patients underwent mandibular resections related to oncologic disease of the head and neck at University Hospitals Case Medical Center. The mandibular defects were reconstructed with osteocutaneous free flaps: three fibular, one radial forearm, and one scapular. Patients were managed per institutional protocol for head and neck free flaps. The BoneScalpel™ was used for all harvesting and reconstructive osteotomies. The two lead surgeons recorded subjective operative feedback. Results: All osteotomies were successfully created the BoneScalpel™. The lead surgeons (R.P.R and C.A.Z.) report improved tactile control, precise osteotomies, minimal learning curve, and similar operative time compared to traditional oscillating and reciprocating saws. Vascular pedicles and adjacent soft tissue were not damaged. Bony unions appeared intact at 7-month follow-up. Conclusion: The BoneScalpel™ Ultrasonic Osteotome offers a safe and efficient method to create osteotomies during the harvest of osteocutaneous free flaps. Primary advantages include better tactile control, minimal learning curve, and theoretic protection of vital soft tissue structures. Future studies with objective data are needed to further support this novel technique in head and neck reconstruction.
Transcript of Novel technique: piezoelectric BoneScalpel™ osteotomies ...€¦ · orthognathic surgery....
Poster Design & Printing by Genigraphics® - 800.790.4001
Novel technique: piezoelectric BoneScalpel™ osteotomies for harvesting osteocutaneous free flaps
Cameron C. Wick, MD1; Rod P. Rezaee, MD1; Chad A. Zender, MD1
1University Hospitals Case Medical Center, Department of Otolaryngology – Head and Neck Surgery
INTRODUCTION
RESULTS
Table 1. Operative Results
ABSTRACT
All osteotomies were successfully created with the BoneScalpel™ Ultrasonic Osteotome. The lead surgeons (R.P.R and C.A.Z.) report improved tactile control, minimal learning curve, and similar operative time compared to traditional oscillating and reciprocating saws. Vascular pedicles and adjacent soft tissue were not damaged. Bony unions appeared intact at 7-month follow-up.
Nonrandomized case series of five patients undergoing mandibular resection related to oncologic disease of the head and neck and reconstruction with an osteocutaneous free flap. The Misonix BoneScalpel™ Ultrasonic Osteotome was used for all harvesting and reconstructive osteotomies. Osteocutaneous free flaps included thee fibular, one radial forearm, and one scapular.
Surgeries were performed between July and October 2011 at University Hospitals Case Medical Center in Cleveland, OH. All patients were managed per our institutional protocol for head and neck free flap procedures. The two lead surgeons recorded subjective operative feedback. Retrospective chart analysis was performed after 7 – 9 months of follow-up.
The piezoelectric BoneScalpel™ Ultrasonic Osteotome offers a safe and efficient method to create osteotomies during the harvest of osteocutaneous free flaps. Primary advantages include better tactile control, precise osteotomies, minimal learning curve, and theoretic protection of vital soft tissue structures such as a vascular pedicle. Future studies with objective data are needed to further support this novel technique in head and neck reconstruction.
Ultrasound is a cyclic sound pressure with a frequency greater than 20,000 Hz. Ultrasonic technology was first used by dentistry in the1950’s for its ability to selectively cut dento-osseous structures.1 This process is termed piezoelectric effect, with piezo- originating from Greek meaning to squeeze or press. Since then it has been advocated for many surgical procedures.2-8
Low-frequency ultrasound devices selectivity displace dense, mineralized tissue while higher-frequency devices (i.e. Harmonic ScalpelTM) have a propensity for separating soft-tissue.5,6 The Misonix BoneScalpel™ Ultrasonic Osteotome is a low-frequency device that selectively cuts mineralized tissue like bone while theoretically sparing trauma to soft tissues.
The harvesting of osteocutaneous free flaps presents unique challenges to the reconstructive surgeon, specifically the creation of an osteotomy adjacent to a flap’s vital vascular pedicle. Traditional osteotomy instruments are the oscillating saw and rotational burr, which produced considerable vibration and torque. Reports exist of flap complications secondary to soft tissue damage while creating the osteotomy.9
Low-frequency piezoelectric osteotomies have been advocated for their improved tactile control, minimal learning curve, and preservation of adjacent soft tissue.2-5 Surgical reports also suggest reduced osteotomy blood loss and less bone necrosis compared to traditional osteotomy methods.2,4,6,10 Working at 22.5 kHz (22,500 strokes per second) the BoneScalpel™ Ultrasonic Osteotome has disposable blades that can produce a precise linear osteotomy as thin as 0.5 mm and with an insertion depth up to 20 mm. With these factors in mind, we sought to characterize how the BonescalpelTM may benefit the harvesting of different osteocutaneous free flaps used to reconstruct mandibular defects. The goal of this preliminary report is to describe a future role of piezoelectric technology in the setting of osteocutaneous free flap osteotomies.
METHODS AND MATERIALS
1. Richman MJ. The use of ultrasonics in root canal therapy and root resection. J Dent Med. 1957;12:12.
2. Salami A, Dellepiane M, Proto E, Mora R. Piezosurgery in otologicsurgery: four years of experience. Otolaryngol Head Neck Surg.2009;140:412-418.
3. Salami A, Mora R, Mora F, et al. Learning curve for Piezosurgeryin well-trained otological surgeons. Otolaryngol Head Neck Surg.
2010;142:120-125.4. Salami A, Dellepiane M, Crippa B, Mora R. A new method for
osteotomies in oncologic nasal surgery: Piezosurgery. Am J Otolaryngol. 2010;31:150-153.
5. Salami A, Dellepiane M, Salzano FA, et al. Piezosurgery in the excision of middle-ear tumors: effects on mineralized and non-mineralized tissues. Med Sci Monit. 2007;13:PI25-129.
6. Nordera P, Spanio di Spilimbergo S, Stenico A, et al. The cutting edge technique for safe osteotomies in craniofacial surgery: thePiezosurgery bone scalpel. Plast Reconstr Surg2007;120:1989-1995.
7. Dammous S, Darche V, Gilles R. Use of ultrasonic bone scalpel in orthognathic surgery. Congress of the European Association of Cranio-Maxillo-Facial Surgery. 2010;113-120.
8. Parker S, Kretzer R, Recinos P, et al. Use of novel ultrasonic bone scalpel for osteoplastic laminoplasty in the resection of intradural spinal cord pathology. Poster presentation at 27th
annual AANS/CNS Section. March 9-11,2011.9. Collin T, Sugden P, Ahmed O, Ragbir M. Technical considerations
of fibular osteocutaneous flap dissection. J Plast ReconstrAesth Surg. 2008;61:1503-1506.
10. Tete S, Vinci R, Zizzari V, et al. Evaluation of effects on bone tissue of different osteotomy techniques. J Craniofac Surg
2009;20:1424-1429.11. Laurentjoye M, Jeanniot P, Beziat J, Gleizal A. Piezoelectric
osteotomies during fibula free flap harvesting. J Plast ReconstrAesth Surg. 2010;63:e495-496.
CONCLUSIONS
REFERENCES
Cameron Wick, MDUniversity Hospitals ENT InstituteLKS 504511100 Euclid Ave.Cleveland, OH 44106Email: [email protected]: (216) 201-0792Website: casemed.case.edu/otolaryngology
CONTACT
Figure 1. BoneScalpel™ Ultrasonic Osteotome hand device.
Figure 2. BoneScalpel™ Ultrasonic Osteotome unit.
Figure 3. Intraoperative photographs of the BoneScalpel™Ultrasonic Osteotome. Harvesting of a radial forearm
osteocutaneous flap (a – c). Reconstructive osteotomies (d – e).
(a) (b)
(c)
(d) (e)
DISCUSSION
Low-frequency piezoelectric technology has been widely accepted by many surgical specialties but there remains a paucity of data on its use in osteocutaneous free flap reconstructions11. We present the first case series for its use in this setting and note the ease of introducing this technology into our free flap regimen. The device offers improved tactile control and versatility via different cutting blades.
Our data suggests appropriate union of the osseous grafts, with the only graft complication occurring in the setting of radionecrosis. More objective data, including a cost analysis, are required to verify these preliminary findings and further support the utility of low-frequency piezoelectric osteotomies in osteocutaneous free flaps.
Objectives:To present a novel utilization for a
piezoelectric device in the harvesting of osteocutaneous free flaps.
MethodNonrandomized case series
assessing a new osteotomy device, the Misonix BoneScalpel™ Ultrasonic Osteotome. Five patients underwent mandibular resections related to oncologic disease of the head and neck at University Hospitals Case Medical Center. The mandibular defects were reconstructed with osteocutaneous free flaps: three fibular, one radial forearm, and one scapular. Patients were managed per institutional protocol for head and neck free flaps. The BoneScalpel™ was used for all harvesting and reconstructive osteotomies. The two lead surgeons recorded subjective operative feedback.
Results: All osteotomies were successfully
created the BoneScalpel™. The lead surgeons (R.P.R and C.A.Z.) report improved tactile control, precise osteotomies, minimal learning curve, and similar operative time compared to traditional oscillating and reciprocating saws. Vascular pedicles and adjacent soft tissue were not damaged. Bony unions appeared intact at 7-month follow-up.
Conclusion: The BoneScalpel™ Ultrasonic
Osteotome offers a safe and efficient method to create osteotomies during the harvest of osteocutaneous free flaps. Primary advantages include better tactile control, minimal learning curve, and theoretic protection of vital soft tissue structures. Future studies with objective data are needed to further support this novel technique in head and neck reconstruction.
