Work

Outcome of HARMONIC Shears for lower limb free flap reconstruction in trauma: A retrospective cohort study

Year: 2026

Type: article

Abstract: Background The HARMONIC Shears is an ultrasonic surgical device enabling precise tissue dissection with simultaneous haemostasis. 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 orthopaedic procedures. Primary outcome was total operative time. Secondary outcomes included flap survival, postoperative complications, length of hospital stay, and a comprehensive cost analysis encompassing theatre time, consumables, and inpatient stay. Results HARMONIC Shears significantly reduced operative time in cases without concomitant orthopaedic procedures (262.8 ± 46.3 vs 364.2 ± 53.9 minutes; 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 minutes; 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 theatre and inpatient savings of up to £8,699 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.

Source: JPRAS Open

DOI: 10.1016/j.jpra.2025.12.024

Authors: Mai Nishijo, Rawan Jaibaji, Calver Pang, Charles Yuen Yung Loh

Institutions: University of Cambridge, Addenbrooke's Hospital, University College London

Language: English

Topic: Reconstructive Surgery and Microvascular Techniques

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,920