Surgeons conventionally use electrocautery dissection and surgical clip appliers to harvest free flaps. The ultrasonic Harmonic Scalpel is a new surgical instrument that provides high-quality dissection and hemostasis and minimizes tissue injury. The aim of this study was to evaluate the effectiveness and advantages of the ultrasonic Harmonic Scalpel compared to conventional surgical instruments in free flap surgery. This prospective study included 20 patients who underwent head and neck reconstructive surgery between March 2009 and May 2010. A forearm free flap was used for reconstruction in 12 patients, and a fibular flap was used in 8 patients. In half of the patients, electrocautery and surgical clips were used for free flap harvesting (the EC group), and in the other half of the patients, ultrasonic dissection was performed using the Harmonic Scalpel (the HS group). The following parameters were significantly lower in the HS group compared to the EC group: the operative time of flap dissection (35% lower in the HS group), blood loss, number of surgical clips and cost of surgical materials. This study demonstrated the effectiveness of the Harmonic Scalpel in forearm and fibular free flap dissections that may be extended to other free flaps. 1. Introduction Free tissue transfers are widely performed to reconstruct head and neck defects, often after the resection of head and neck cancer. Free tissue transfers allow the tissue volume to recover and improve functional and esthetic results. Radial forearm and composite fibular flaps are the two most frequent free flaps used in head and neck reconstructive surgery. To decrease the operative time, surgical procedures generally involve two teams: one team removes the tumor, and the other team performs the reconstruction. Surgeons commonly use electrocautery dissection and surgical clip appliers for free flap tissue dissection. New ultrasonic dissection surgical techniques have been developed that use instruments to convert high-frequency ultrasonic waves (55,000？Hz) into mechanical energy. With ultrasonic dissection, surgical dissection and hemostasis of small to medium sized vessels are performed using the same surgical instrument by disrupting hydrogen bonds and forming coagulum. Ultrasonic dissection was initially used in gastrointestinal surgery [1–3] and urology and is now widely used in many surgical specialties, including plastic and reconstructive surgery (i.e., in abdominal lipectomies [4], face lifts [5], and myocutaneous flaps [6, 7]). The aim of this study was to evaluate the effectiveness and
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