Effect of low‐thermal dissection device versus conventional electrocautery in mastectomy for female‐to‐male transgender patients

Abstract

Subcutaneous mastectomy, the first step in sexual reassignment surgery of female‐to‐male transsexuals, is associated with high rates of complication and revision surgery. Also, conventional electrosurgery and the associated thermal tissue damage may compromise outcome. This retrospective randomised clinical study evaluated the effect of low‐thermal plasma dissection device (PEAK PlasmaBlade, Medtronic, Minneapolis, Minnesota) in comparison with conventional electrosurgery. A total of 17 female‐to‐male transsexuals undergoing mastectomy were randomised to PEAK PlasmaBlade on one breast side and to monopolar electrosurgery on the other side of the same patient. Wounds of 17 patients were examined histologically for acute thermal injury. Significantly less total volume of drain output (58.8 ± 37.4 mL vs 98.5 ± 76.4 mL; P = .012) was found on the PEAK PlasmaBlade side compared with the electrosurgery side. Duration of drain was significantly shorter on the PEAK PlasmaBlade side (2.5 ± 0.7 days vs 3.2 ± 0.6 days; P = .010). Furthermore, the PEAK PlasmaBlade side showed fewer thermal damages (41.2% vs 82.4%; P = .039) and thermal injury depth from PEAK PlasmaBlade side was less (3170 vs 4060 μm). PEAK PlasmaBlade appears to be superior to monopolar electrosurgery for mastectomy in female‐to‐male transsexuals, because it demonstrated less thermal tissue damage, less total volume of drain output, and shorter duration of drain, resulting in faster wound healing.

PlasmaBlade versus Electrocautery for DIEP Flap Harvesting in Autologous Breast Reconstruction: A Comparative Clinical Outcome Study.

“…Our analysis yielded the significant (p* = 0.0324) finding of a higher cumulative wound fluid quantity in the monopolar electrocautery group (351.11 ± 185.96 ml) compared to the PEAK PlasmaBlade group (279.38 ± 183.38 ml). While previous research on this topic has provided inconclusive data, some studies support our finding by reporting lower total drain output following the use of the PEAK PlasmaBlade [11,[17][18][19][20]22], whereas other authors found no difference between the two dissection devices [21,25,26]. It's worth noting that, to the best of our knowledge, no prior study has reported an increase in seroma rates after utilizing the PEAK Plasma Blade.…”

“…Studies assessing outcomes in extensive wound areas, like those involved in autologous breast reconstruction using the abdominal donor site, have often been limited by small sample sizes [11,[17][18][19][20][21][22]25,26]. While more extensive investigations have been undertaken in distinct surgical contexts, such as tonsillectomy [27-29] and surgical implant replacement [30], these findings may not be directly applicable to the specific circumstances of autologous breast reconstruction.…”

“…In contrast, the PEAK PlasmaBlade (PPB) employs short (40 µs) high-frequency pulses of radiofrequency energy to generate electrical plasma along an insulated electrode's edge and it maintains a lower operating temperature around 45 °C [8,9]. Previous investigations suggest that the PlasmaBlade may offer advantages over electrocautery, demonstrating reduced thermal injury depth and inflammatory responses [8,10,11] processes and trauma to the lymphatic network during surgical dissection are known factors contributing to postoperative seroma formation, a common complication after DIEP flap harvesting, with reported incidences ranging from 1.4% to 16.2% [12][13][14][15][16]. Prolonged drainage duration to prevent seroma formation poses disadvantages such as extended hospitalization and the risk of ascending infections through the drain tube.…”

PlasmaBlade versus Electrocautery for Deep Inferior Epigastric Perforator Flap Harvesting in Autologous Breast Reconstruction: A Comparative Clinical Outcome Study

“…In contrast, the PEAK PlasmaBlade (PPB) employs short (40 µs) high-frequency pulses of radiofrequency energy to generate electrical plasma along an insulated electrode's edge and it maintains a lower operating temperature around 45 • C [8,9]. Previous investigations suggest that the PlasmaBlade may offer advantages over electrocautery, demonstrating reduced thermal injury depth and inflammatory responses [8,10,11]. Inflammatory processes and trauma to the lymphatic network during surgical dissection are known factors contributing to postoperative seroma formation, a common complication after DIEP flap harvesting, with reported incidences ranging from 1.4% to 16.2% [12][13][14][15][16].…”

“…Previous research has generated conflicting and inconclusive findings regarding whether the choice of the surgical dissection device significantly impacts clinical outcomes. While some studies suggest benefits associated with using the PPB, such as reduced seroma rates and shorter drain dwelling times, these studies have limitations, notably small sample sizes and none have evaluated patient-specific risk factors in this context [11,[17][18][19][20][21][22].…”