Comparing Scalpel, Electrocautery and Ultrasonic Dissector Effects: The Impact on Wound Complications and Pro-Inflammatory Cytokine Levels in Wound Fluid from Mastectomy Patients

Abstract

PurposeIntroducing the relationship between the surgical instruments used in modified radical mastectomy and wound complications is important for preventing and decreasing complications. This prospective randomized trial was designed to assess the impact of scalpel, electrocautery, and ultrasonic dissector usage on wound complications and tissue damage.MethodsEighty-two consecutive patients operated with mastectomy were studied. The postoperative time period needed for hemovac drainage, the amount and duration of seroma, infection, flap ecchymosis and necrosis rates were compared. Tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) levels in drainage fluids were determined to confirm the inflammatory response and tissue damage.ResultsThe numbers of patients included in the scalpel, electrocautery and ultrasonic dissector groups were 27, 26, and 29, respectively. The groups were homogenous with respect to age, body mass index, stage, cormorbidities, breast volume and flap area. Operation time and the amount of bleeding were statistically higher in the scalpel group. The incidence of seroma was higher in the electrocautery group and arm mobilization had to be delayed in this group. There were no differences between groups with respect to hematoma, infection, ecchymosis, necrosis, hemovac drainage and the total and first 3 days of seroma volume. TNF-α and IL-6 levels were significantly higher in samples obtained from the drains of patients operated with electrocautery.ConclusionUltrasonic dissector decreases operation time by decreasing the amount of bleeding without increasing the seroma incidence. High cytokine levels in drainage fluids from patients operated with elecrocautery indicates that electrocautery induces more tissue damage and acute inflammatory response. Therefore, seroma, due to acute inflammatory response, was seen more frequently in the electrocautery group. Ultrasonic dissector coagulates protein by breaking hydrogen bonds which may close vascular and lymphatic channels more precisely. But, its actual preventive effect on seroma formation might be related to diminished inflammatory response.

Abdominoplasty and seroma: A prospective randomised study comparing scalpel and handheld electrocautery dissection

“…There are few other published studies comparing sharp dissection with electrocautery dissection and these tend to be in breast patients. Yilmaz et al 11 looked at seroma formation post mastectomy and suggest electrocautery use may lead to an increase in seroma formation although numbers are small and seroma rates high in both knife and electrocautery group (37% and 53.8% respectively). Others have found that in thyroidectomy patients use of electrocautery or scalpel for flap dissection does not significantly affect seroma formation 12 whereas Porter et al 13 suggested electrocautery leads to an increase in seroma formation post mastectomy (38% v 13% p Z 0.01) although the results were only significant at the 90% confidence interval.…”

Seroma Production After Breast Cancer Surgery has a Pro-Inflammatory Component

“…Here, levels of other pro-inflammatory cytokines such as monocyte chemotactic protein-1 (MCP-1) were elevated, as were levels of antiinflammatory cytokines TGF-1, TGF-2, and TGF-3 but not IL-10. Yilmaz et al compared the use of a scalpel, electrocautery and ultrasonic dissection during mastectomy [20]. Interesting, electrocautery induced significantly higher levels of cytokines than scalpel and ultrasonic dissection.…”

229. The effect of plasmakinetic cautery on wound healing and complications in mastectomy

“…The incidence of such oc curences varies widely according to the type of surgical treat ment and the operative techniques used, ranging from less than 10% to more than 50% [5]. Electrocautery is one named cause of seroma formation in the literature [6]. The seroma formation is the next step coming after prolonged drainage duration and increased drainage amount, however we couldn't establish the statistical difference between the groups because of the small sample size.…”