Comparison of PEAK PlasmaBlade™ to conventional diathermy in abdominal-based free-flap breast reconstruction surgery—A single-centre double-blinded randomised controlled trial

Friebel, Thessa Rebecca; Narayan, Nitisha; Ramakrishnan, Venkat; Morgan, Mary S.; Cellek, Selim; Griffiths, Mat

doi:10.1016/j.bjps.2020.12.007

Cited by 6 publications

(11 citation statements)

References 34 publications

(48 reference statements)

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“…Our analysis yielded the significant (p* = 0.0324) finding of a higher cumulative wound fluid quantity in the monopolar electrocautery group (351.11 ± 185.96 ml) compared to the PEAK PlasmaBlade group (279.38 ± 183.38 ml). While previous research on this topic has provided inconclusive data, some studies support our finding by reporting lower total drain output following the use of the PEAK PlasmaBlade [11,[17][18][19][20]22], whereas other authors found no difference between the two dissection devices [21,25,26]. It's worth noting that, to the best of our knowledge, no prior study has reported an increase in seroma rates after utilizing the PEAK Plasma Blade.…”

Section: Discussionsupporting

confidence: 69%

“…Our data reveal a significant decrease in post-operative pain within the PEAK PlasmaBlade cohort. To our knowledge, only Friebel et al has previously compared postoperative pain levels between both dissection devices, reporting an increase in the PPB cohort [21]. This was attributed to the potential impact of tighter abdominal closure due to lower flap weights in this group.…”

Section: Discussionmentioning

confidence: 94%

“…Studies assessing outcomes in extensive wound areas, like those involved in autologous breast reconstruction using the abdominal donor site, have often been limited by small sample sizes [11,[17][18][19][20][21][22]25,26]. While more extensive investigations have been undertaken in distinct surgical contexts, such as tonsillectomy [27-29] and surgical implant replacement [30], these findings may not be directly applicable to the specific circumstances of autologous breast reconstruction.…”

Section: Discussionmentioning

confidence: 99%

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PlasmaBlade versus Electrocautery for DIEP Flap Harvesting in Autologous Breast Reconstruction: A Comparative Clinical Outcome Study.

Augustin,

Schoberleitner,

Unterhumer

et al. 2024

Preprint

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DIEP-based breast reconstruction necessitates wide undermining at the abdominal donor-site, creating large wound areas. Flap harvesting is usually conducted using electrosurgical dissection devices. This study sought to compare the clinical outcomes in patients after using the PEAK PlasmaBlade (PPB) versus monopolar electrocautery (MPE). This retrospective cohort study included 128 patients with DIEP-based breast reconstruction. Patient characteristics as well as information on the postoperative course were collected and a comparative evaluation was conducted. The MPE group exhibited significantly (p* = 0.0324) higher abdominal drainage volume (351.11 ± 185.96 ml) compared to the PPB group (279.38 ± 183.38 ml). Subgroup analysis demonstrated that PPB significantly reduced postoperative wound fluid in patients with BMI > 30 kg/m² (p* = 0.0284), without prior neoadjuvant chemotherapy (p** = 0.0041), and among non-smokers (p = 0.0046). Furthermore, postoperative pain was significantly (p**** < 0.0001) lower in the PPB cohort. This study confirms the non-inferiority of the PEAK PlasmaBlade to conventional electrocautery for abdominal flap harvesting. The PPB demonstrated advantages, notably reduced drainage volume and lower postoperative pain levels. Recognizing patient subsets that benefit more from the PPB highlights the importance of personalized device selection based on patient characteristics.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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PlasmaBlade versus Electrocautery for DIEP Flap Harvesting in Autologous Breast Reconstruction: A Comparative Clinical Outcome Study.

Augustin,

Schoberleitner,

Unterhumer

et al. 2024

Preprint

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“…A total of 29 duplicates were removed. After title and abstract screening, 645 studies moved on to full-text screening, with 553 studies excluded; 92 studies 13–104 were included for final analysis (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“Spin” in Plastic Surgery Randomized Controlled Trials with Statistically Nonsignificant Primary Outcomes: A Systematic Review

Yuan

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Randomized controlled trials (RCTs) are considered the standard when determining the effectiveness of therapeutic interventions. 1 When the goal of an RCT is to show that one intervention or treatment is better than another, it is called a superiority trial. 2 Significant findings would demonstrate that intervention A is better than intervention B and nonsignificant findings could only be interpreted as intervention A not being superior to intervention B. In comparison, a noninferiority trial refers to an RCT that assesses whether an intervention is "not worse" than another within an acceptable margin of risk or benefit. 2 Significant findings would be interpreted as intervention A not being worse Background: "Spin" refers to a manipulation of language that implies benefit for an intervention when none may exist. Randomized controlled trials (RCTs) in other fields have been demonstrated to employ spin, which can mislead clinicians to use ineffective or unsafe interventions. This study's objective was to determine the strategies, severity, and extent of spin in plastic surgery RCTs with nonsignificant primary outcomes. Methods: A literature search of the top 15 plastic surgery journals using MEDLINE was performed (2000 through 2020). Parallel 1:1 RCTs with a clearly identified primary outcome showing statistically nonsignificant results (P > 0.05) were included. Screening, data extraction, and spin analysis were performed by two independent reviewers. The spin analysis was then independently assessed in duplicate by two plastic surgery residents with graduate-level training in clinical epidemiology. Results: From 3497 studies identified, 92 RCTs were included in this study. Spin strategies were identified in 78 RCTs (85%), including 64 abstracts (70%) and 77 main texts (84%). Severity of spin was rated moderate or high in 43 abstract conclusions (47%) and 42 main text conclusions (46%). The most identified spin strategy in the abstract was claiming equivalence for statistically nonsignificant results (26%); in the main text, focusing on another objective (24%). Conclusions: This study suggests that 85% of statistically nonsignificant RCTs in plastic surgery employ spin. Readers of plastic surgery research should be aware of strategies, whether intentional or unintentional, used to manipulate language in reports of statistically nonsignificant RCTs when applying research findings to clinical practice.

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“…Based on a study with 80 patients undergoing breast-conserving surgery, it was suggested that the ABC may reduce the development of haematomas or seromas [ 93 ]. Furthermore, the PlasmaBlade was compared to conventional diathermy in a study with 108 abdominal-based free-flap breast reconstruction patients [ 94 ]. The PlasmaBlade resulted in less abdominal seromas at 2-week follow-up.…”

Section: Discussionmentioning

confidence: 99%

Plasma Device Functions and Tissue Effects in the Female Pelvis—A Systematic Review

Berg

Boer

Gao

et al. 2023

Cancers

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Medical use of (non-)thermal plasmas is an emerging field in gynaecology. However, data on plasma energy dispersion remain limited. This systematic review presents an overview of plasma devices, fields of effective application, and impact of use factors and device settings on tissues in the female pelvis, including the uterus, ovaries, cervix, vagina, vulva, colon, omentum, mesenterium, and peritoneum. A search of the literature was performed on 4 January 2023 in the Medline Ovid, Embase, Cochrane, Web of Science, and Google Scholar databases. Devices were classified as plasma-assisted electrosurgery (ES) using electrothermal energy, neutral argon plasma (NAP) using kinetic particle energy, or cold atmospheric plasma (CAP) using non-thermal biochemical reactions. In total, 8958 articles were identified, of which 310 were scanned, and 14 were included due to containing quantitative data on depths or volumes of tissues reached. Plasma-assisted ES devices produce a thermal effects depth of <2.4 mm. In turn, NAP effects remained superficial, <1.0 mm. So far, the depth and uniformity of CAP effects are insufficiently understood. These data are crucial to achieve complete treatment, reduce recurrence, and limit damage to healthy tissues (e.g., prevent perforations or preserve parenchyma). Upcoming and potentially high-gain applications are discussed, and deficits in current evidence are identified.

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Comparison of PEAK PlasmaBlade™ to conventional diathermy in abdominal-based free-flap breast reconstruction surgery—A single-centre double-blinded randomised controlled trial

Cited by 6 publications

References 34 publications

PlasmaBlade versus Electrocautery for DIEP Flap Harvesting in Autologous Breast Reconstruction: A Comparative Clinical Outcome Study.

PlasmaBlade versus Electrocautery for DIEP Flap Harvesting in Autologous Breast Reconstruction: A Comparative Clinical Outcome Study.

“Spin” in Plastic Surgery Randomized Controlled Trials with Statistically Nonsignificant Primary Outcomes: A Systematic Review

Plasma Device Functions and Tissue Effects in the Female Pelvis—A Systematic Review

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