Modified radical mastectomy: a pilot clinical trial comparing the use of conventional electric scalpel and harmonic scalpel
Gustavo Henrique Fabri Pereira Ribeiro, Ligia Maria Kerr, Raphael Luiz Haikel, Stela Verzinhasse Peres, Angelo Gustavo Zucca Matthes, Rodrigo Augusto Depieri Michelli, Antônio Bailão Jr, José Humberto Tavares Guerreiro Fregnani, René Aloísio da Costa Vieira, Gustavo Henrique Fabri Pereira Ribeiro, Ligia Maria Kerr, Raphael Luiz Haikel, Stela Verzinhasse Peres, Angelo Gustavo Zucca Matthes, Rodrigo Augusto Depieri Michelli, Antônio Bailão Jr, José Humberto Tavares Guerreiro Fregnani, René Aloísio da Costa Vieira
Abstract
Background: The aim of this study was to compare the rates of local postoperative complications among women undergoing modified radical mastectomy with an electric scalpel (ES) or a harmonic scalpel (HS). It is thought that HS use has less postoperative complications, mainly seroma formation.
Methods: This study was a prospective non-randomised clinical trial (NCT01391988) among consecutive patients, performed in parallel. Patients underwent modified radical mastectomy using an HS or ES. We analysed the following operative variables: time, blood loss and seroma volume drainage. Postoperative complications, including seroma, flap necrosis, haematoma and infection were evaluated on the 7th and 14th days.
Results: Forty-six patients underwent a MRM with ES and 49 with HS; no differences were observed between the groups. The rate of local complications was 29% in the HS group and 52% in the ES group (p = 0.024). The rates of seroma (16.3% versus 28.3%; p = 0.161), necrosis (4.1% vs. 21.7%; p = 0.013; OR = 0.15), haematoma (2.0% vs. 8.7%; p = 0.195) and infection (2.0% vs. 6.5%; p = 0.351) were lower in the HS group. Adding the findings of all comparative studies using HSs in MRM to the seroma rates in the current study, the seroma rate, expressed as a categorical variable, did not decrease with HS. Seroma was present in 60/219 cases using an HS and in 69/239 cases utilising an ES (p = 0.72). Based on a multivariate analysis, HS decreased the risk of skin necrosis (p = 0.015).
Conclusions: HSs do not decrease the seroma rate. However, this method may be useful in skin sparing mastectomy because it decreases skin flap necrosis.
Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
Source: PubMed