Journal of Plastic, Reconstructive & Aesthetic Surgery (2010) 63, e495ee496

CORRESPONDENCE AND COMMUNICATION

Piezoelectric osteotomies during

fibula free flap harvesting

Piezosurgery is useful in a variety of oral cranio-maxillofacial

and otologic surgical procedures. This new technique of
osteotomy carries out precise and selective cut. Hard and
soft tissues are cut at different frequencies. These are
presented here the piezosurgical used during osteotomies
of the useful fibula free flap.
Disadvantages encountered with the fibula free flap
have occurred when dissecting the pedicle as Collins
described recently1: risks of damage to the peroneal
vessels during dissection and osteotomies. The good
osteotomies placing are very difficult when contouring
Figure 2 Example of piezoelectric osteotomy performed
the fibula in mandibular reconstruction. Proximal and
without protection of the vessels on the deep surface.
distal osteotomies are performed using ultrasonic bone
cutting (Mectron, Piezosurgery). The ultrasonic device is
composed of 16 W generator attached by a flexible cord
(Figure 1a). An automatic irrigation system is connected oscillating saw with elevator on the postero-medial surface
for cooling during osteotomies. One insert is used for of the fibula to protect the pedicle. Subperiosteal dissec-
cutting: OT7 (Figure 1b). tion, necessary to put the elevator protecting the vessels,
All osteotomies are realised without protection of the can cause pedicle lesions.
pedicle on the deep surface of the fibula (Figure 2). Clas- Piezosurgery can be used for osteotomies without
siquely, osteotomies are performed using a sagittal protections of the pedicle during flap harvesting or after

Figure 1 (a) ultrasonic device composed of 16 W generator attached by a flexible cord. An automatic irrigation system is
connected for cooling during osteotomies. (b) One insert is used for cutting: OT7.

1748-6815/$ - see front matter ª 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjps.2009.09.010
e496
when contouring the fibula for mandibular reconstruction.
This technique decreases the risk of pedicle damages
during manipulations. Moreover, the piezoelectric bone
surgery ensure a precise micrometric bone cutting action
witch facilitate ideal placement of osteotomies.2
Extra osteotomies when contouring fibula could be
realised during harvesting while it is still attached to the
leg.1 With piezosurgery, cutting a fixed bone is easier and
faster than cutting a mobil bone. Moreover, this technique
maintains a blood-free operative area secondary to the
cavitation effect from the irrigation solution.2
The cost of a good ultrasonic device is about 8000 V.
Piezoelectric osteotomies have also been described in
cranio-maxillo-facial surgery for sectioning bone without
damaging soft tissues.2
Conflict of interest
None.
Correspondence and communication
References
1. Collin T, Sugden P, Ahmed O, et al. Technical considerations of
fibular osteocutaneous flap dissection. J. Plast, Reconstr Aesth
Surg; 2008:1503e6.
2. Gleizal A, Bera JC, Lavandier B, et al. Piezoelectric osteotomy:
a new technique for bone surgery e advantages in cranio-facial
surgery. Childs Nerv Syst 2007;23:509e13.
M. Laurentjoye
P.Y. Jeanniot
J.L. Beziat
A. Gleizal
Groupement hospitalier Lyon Nord, Maxillo-facial
surgery unit, 103 grand rue de la Croix-Rousse
69317, Lyon cedex 04, France
E-mail address: mathieu.laurentjoye@yahoo.fr