PurposeIntroducing 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.MethodsEighty-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-α) and interleukin-6 (IL-6) levels in drainage fluids were determined to confirm the inflammatory response and tissue damage.ResultsThe 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-α and IL-6 levels were significantly higher in samples obtained from the drains of patients operated with electrocautery.ConclusionUltrasonic 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.

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286 The effect of harmonic scalpel, electrocautery, and scalpel use on early wound complications 1 3 SummaryBackground 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.Methods 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.Results 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.Conclusions 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.

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The aim of this study was to present our experiences with patients operated on for the recurrence of papillary thyroid cancer with the combined use of preoperative ultrasonographic mapping and radioguided occult lesion localization (ROLL). Twenty patients who had already undergone total thyroidectomy and central/lateral neck dissection for papillary thyroid carcinoma were reoperated on due to locoregional metastasis. The patients with proven recurrences and high Tg wash-out levels in cytopathologic aspirates were operated on. For each patient, numbers of marked and non-marked lesions, and the metastatic and total numbers of marked/non-marked and non-mentioned lesions in the maps were recorded. Thirty-four of 40 (85%) lesions removed with ROLL were found to be malignant. In addition to the marked lesions during mapping, 60 additional lesions had been defined as suspicious. Fifty-six of these lesions were found at exact anatomic sites and localizations described and removed. Of 56 lesions, 36 (64%) were found to be metastatic. During postoperative follow-up, chylous leak with spontaneous regression in 7 days and seroma occurred in one patient. Radioguided occult lesion localization and preoperative mapping contribute to the safety and comfort of patients in planned reoperations on lateral and central neck regions.

Total thyroidectomy is the right surgical decision for MNG since it achieves complete remission of symptoms and eliminates malignancy, with low morbidity and mortality rates.

PurposeSentinel lymph node biopsy (SLNB) in breast cancer patients with clinically negative axilla will ensure axillary dissection only for cases with lymph node metastasis and provide information about pathologic staging as accurate as the axillary dissection. It was shown that SLNB could be successfully performed regardless of the type of biopsy. The aim of this study was to investigate the feasibility of SLNB after excisional biopsy.MethodsOne hundred patients diagnosed with excisional biopsy or guide wire-localization and operated on with SLNB between February 2007 and March 2009 were retrospectively analyzed. SLNB was performed with 10 cc of 1% methylene blue alone or both methylene blue and 1 mCi of Tc-99m nanocolloid combination. Age, tumor localization and size, length of the biopsy incision, size of the biopsy specimen, multifocality, lymphovascular invasion, tumor grade, staining with methylene blue, localization, number and metastatic status of the lymph nodes stained, and success rate with a gamma probe were evaluated.ResultsSentinel lymph node (SLN) could not be identified in 9 (16.9%) of patients in the methylene blue group (n=53). In the combination group (n=47), SLN could not be identified in one patient. Of 32 patients with negative SLNB, metastatic involvement was found to be present in 5 patients after axillary lymph node dissection (false negatives). The average numbers of SLNs found in the methylene blue group and combination group were 1.4 and 1.6, respectively. SLN detection and false negative rates in the methylene blue group were 83% and 15.7%, respectively. The rates for the combination group were 98% and 6.4%, respectively. None of the parameters related to patient, tumor or process were found to affect detection rates of SLN.ConclusionOnly SLNB using a combination method is a safe and reliable technique for breast cancer patients diagnosed with excisional biopsy.

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