The effect of harmonic scalpel, electrocautery, and scalpel use on early wound complications after modified radical mastectomy

Mastectomy when performed with scalpel and electrocautery is associated with some blood loss and morbidity in the form of prolonged drainage, seroma, wound infection, flap necrosis, and hematoma.

A total of 120 patients operated with mastectomy enrolled for the study. The groups were defined by the instruments used for flap preparation: 41 patients operated with electrocautery, 40 patients operated with scalpel, and 39 patients operated with harmonic scalpel formed three groups. The need for closed suction drains, the amount and duration of seroma, surgical site infection, hematoma, and flap ischemia and necrosis were evaluated.

The amounts of intraoperative blood loss in electrocautery and harmonic scalpel groups were 560 and 500 mL, respectively, and it was increased to 750 mL in scalpel group (p = 0.001). Total drainage amounts of scalpel and harmonic scalpel groups were 894 and 908 mL, respectively, and it was increased to 1,113 mL in electrocautery group (p = 0.0033). Seroma incidence rates in scalpel, electrocautery, and harmonic scalpel groups were 45, 65 and 28 %, respectively (p = 0.003). The differences between groups in relation to the duration of surgery, breast volume and weight, the areas of flap dissection, the duration of closed suction drainage, and the amount of early drainage were not statistically significant. There was also no difference between groups with regard to hematoma, flap necrosis, and ecchymosis and infection rates.

Although the use of harmonic scalpel reduces the risk of seroma formation and intraoperative blood loss, further studies are needed to verify the real impact of such technique.