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A question of dissection

A recent study in the Journal of Plastic, Reconstructive & Aesthetic Surgery dispels the perception that ultrasonic harmonic dissection increases operative time.

Compared to conventional bipolar electrocautery, dissection with a harmonic scalpel (Ethicon Endo-Surgery) was found in the study to dramatically reduce operative time and flap elevation time in cases of deep inferior epigastric perforator breast reconstruction surgery.

The study included 24 consecutive patients assigned to immediate flap surgery: 12 for electrocautery and 12 for harmonic scalpel.

Both groups of patients had comparable clinical characteristics of mean age, body mass index (BMI) and flap weights.

The study found a statistically significant difference in the operative time between the scalpel and electrocautery: 305.2 minutes vs. 380.3 minutes, respectively.

The flap elevation time was also reduced with the scalpel, particularly for dissecting deep inferior epigastric perforators: 59.8 minutes vs. 145.9 minutes with electrocautery.

However, study authors concluded that there was no statistical difference in postoperative drainage volume and length of hospital stay between the two techniques.

“Previous studies have demonstrated that dissection with harmonic scalpel decreases the drainage volume and blood loss, although in our trails, these parameters were not significantly different,” the authors write.

The authors, from the Republic of Korea, note that reduced tissue damage is a theoretical advantage of a harmonic scalpel, which could result in a shorter operative time and decreased drainage and pain.

Related: Big talk about breast reconstruction

“The harmonic scalpel functions by generating a high-power and high-frequency (55,000 cycles/s) ultrasonic system, which causes the breakdown of hydrogen bonds and leads to the formation of denatured protein coagulum that seals the blood vessels and lymphatics, thus decreasing intraoperative blood loss and postoperative drainage volume,” the authors write.

Particularly during muscle dissection, the harmonic scalpel does not induce the muscle fibers to contrast, as is the case with electrocautery.

Neither surgical method caused flap necrosis or hemotoma. Likewise, because the length of hospital stay was not statistically different between the two groups, the harmonic scalpel appeared to have no effect on the amount of pain incurred during surgery.

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