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

PURPOSE: Introducing 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. METHODS: Eighty-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-alpha) and interleukin-6 (IL-6) levels in drainage fluids were determined to confirm the inflammatory response and tissue damage. RESULTS: The 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-alpha and IL-6 levels were significantly higher in samples obtained from the drains of patients operated with electrocautery. CONCLUSION: Ultrasonic 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.

Computed tomography in detecting bone metastases of breast carcinoma. Is it better than plain X-ray?

To compare 5mm slice computerized tomography [CT] and conventional x-ray [XR] in the detection of bone metastases in breast carcinoma patients. Ninety-eight female breast cancer patients treated in Ankara Oncology Hospital, Ankara, Turkey between September 1997 and March 2002 were assigned into 3 groups with respect to their Tc bone scan [Sc] results. Group 1 included patients with overt bone metastases, group 2 included patients with suspicious of metastases and group 3 were those patients with normal Sc results with back pain complaint. All patients underwent XR, and 5mm contiguous slice CT imaging for the related metastatic sites. For the third group, lumbosacral region was examined. A total 33 bone metastases have been diagnosed out of 98 patients. The Sc result showed 26/33 metastatic cases, XR 19/33 and CT 22/33 cases. There were no false positive results for CT and XR. Results of CT have 11 and XR has 14 false negatives out of 33 metastases. For XR the calculated sensitivity was 65.6, specificity was 100, diagnostic accuracy was 88.7, whereas for CT, sensitivity was 71.8, specificity was 100 and diagnostic accuracy was 90.8. When CT and XR were compared to detect bone metastases, results were not statistically significant [p>0.05]. Our results suggest that 5mm slice CT is not superior than XR to detect metastatic bone lesions. Larger series comparing different slice thickness of CT are needed to clarify the issue