Traditional electrosurgery and a low thermal injury dissection device yield different outcomes following bilateral skin-sparing mastectomy: a case report

Abstract

IntroductionAlthough a skin- and nipple-sparing mastectomy technique offers distinct cosmetic and reconstructive advantages over traditional methods, partial skin flap and nipple necrosis remain a significant source of post-operative morbidity. Prior work has suggested that collateral thermal damage resulting from electrocautery use during skin flap development is a potential source of this complication. This report describes the case of a smoker with recurrent ductal carcinoma in situ (DCIS) who experienced significant unilateral skin necrosis following bilateral skin-sparing mastectomy while participating in a clinical trial examining mastectomy outcomes with two different surgical devices. This unexpected complication has implications for the choice of dissection devices in procedures requiring skin flap preservation.Case presentationThe patient was a 61-year-old Caucasian woman who was a smoker with recurrent DCIS of her right breast. As part of the clinical trial, each breast was randomized to either the standard of care treatment group (a scalpel and a traditional electrosurgical device) or treatment with a novel, low thermal injury dissection device, allowing for a direct, internally controlled comparison of surgical outcomes. Post-operative follow-up at six days was unremarkable for both operative sites. At 16 days post-surgery, the patient presented with a significant wound necrosis in the mastectomy site randomized to the control study group. Following debridement and closure, this site progressively healed over 10 weeks. The contralateral mastectomy, randomized to the alternative device, healed normally.ConclusionWe hypothesize that thermal damage to the subcutaneous microvasculature during flap dissection may have contributed to this complication and that the use of a low thermal injury dissection device may be advantageous in select patients undergoing skin- and nipple-sparing mastectomy.

Determinants of optimal mastectomy skin flap thickness

“…In a retrospective study of 151 SSMs there was no significant difference between diathermy and scalpel. Despite this, dissection devices with a low risk of low thermal injury are being proposed in an attempt to minimize skin flap necrosis.…”

Micro/nanostructured surface modification using femtosecond laser pulses on minimally invasive electrosurgical devices

“…Many studies have published information on the applications of electrosurgical instruments during clinical surgery. Thermal damage and the sticking problem are critical challenges that affect the use of minimally invasive electrosurgical devices . The thermal damage induced by minimally invasive electrosurgical instruments can damage surrounding important organs and tissues .…”

“…Thermal damage and the sticking problem are critical challenges that affect the use of minimally invasive electrosurgical devices. 3,4 The thermal damage induced by minimally invasive electrosurgical instruments can damage surrounding important organs and tissues. 5 A sticking problem generates physical injury by a pulling force on the tissue.…”

Research of electrosurgical unit with novel antiadhesion composite thin film for tumor ablation: Microstructural characteristics, thermal conduction properties, and biological behaviors

“…For decades, electrosurgery has been performed to treat tumors from the orofacial excision. However, electrosurgical units are also known to pose serious threats such as tissue adherence and thermal damage of the surrounding tissue . The treatment position of orbital surgery is very close to eyes during clinical electrosurgery as shown in Figure , so it needs to prevent excessive thermal damage.…”

“…However, electrosurgical units are also known to pose serious threats such as tissue adherence 1 and thermal damage of the surrounding tissue. 2,3 The treatment position of orbital surgery is very close to eyes during clinical electrosurgery as shown in Figure 1, so it needs to prevent excessive thermal damage. Studies have shown that electrosurgical procedures may damage adjacent arteries, intestine, nerves, and bile ducts.…”