The use of cautery in “bloodless” radical mastectomy

Abstract

Several different forms of operative procedures for carcinoma of the breast have been advocated, but radical mastectomy remains the one most often recommended. Blood loss during this procedure is frequently high, often necessitating transfusion. Unfortunately, complications of the latter have been significant and justifiably have continued to receive attention in literature. In this study, blood loss and wound healing, with and without the use of electrocautery, in radical mastectomy were evaluated from both clinical and laboratory studies. Fifty patients who underwent radical mastectomy were studied for blood loss, transfusions received, and wound healing. Technique was identical except that one half of the patients had thin skin flap elevation via electrocautery rather than by sharp dissection. The average blood replacement was 160 ml per patient when cautery was used vs. 960 ml per patient when cautery was not used. The postoperative hemoglobin and hematocrit values were statistically similar for both groups. Wound healing was not affected. In addition, a laboratory study, utilizing skin incisions in dogs using scalpel and cautery, was performed. No appreciable difference in healing was noted either on gross or microscopic inspection. The use of electrocautery, therefore, for skin flap elevation during radical mastectomy is recommended.

Seroma Formation after Mastectomy: Pathogenesis and Prevention

“…As Kakos and James [11] in the 1970s suggested the use of electrocautery for breast dissection, it has been shown to decrease incision time, reduce blood loss and transfusion requirements but may be associated with increased wound complications. Ultrasonic dissection is well known in hepatic and cardiovascular surgeries and may create less thermal injuries than electrocautery.…”

Concepts of Seroma Formation and Prevention in Breast Cancer Surgery

“…Tissue dissection techniques in breast cancer surgery have been implicated as a major factor that influences the incidence and volume of seroma formation. Since Kakos and James 21 in the 1970s suggested the use of electrocautery for breast dissection, it has been shown to decrease incision time, reduce blood loss and transfusion requirements but may be associated with increased wound complications 21–27 . Studies comparing sharp dissection, electrocautery and ultrasonic dissection are shown in Table 1.…”

Sutureless Mastectomy Using Monopolar Electrocautery Only - A Report of 100 Consequent Cases

“…Tumescent anesthesia has been described as a successful alternative as well (10). Electrocautery is used world-wide for flap elevation and hemostasis since it was recommended by Karlos & James in 1970 (3,11).…”