A Comparative Study of Seroma Formation and Wound Complications in Electrocautery vs. Scalpel Dissection during Modified Radical Mastectomy

Objective: To compare the frequency of formation of seromas and postoperative wound complications in patients undergoing Modified Radical Mastectomy using electrocautery versus scalpel dissection.

Methodology: This study was a prospective comparative study and lasted for a year and comprised 120 patients who underwent modified radical mastectomy for operable breast cancer. Patients were recruited in two equal groups; 60 patients underwent flap dissection using electrocautery and 60 patients underwent scalpel dissection. Baseline data for demographic and tumor characteristics were recorded. Postoperative results such as seroma development, duration of drainage and total amount of drains, wound complication and hospital stay were compared between the group results. Data were analyzed with the help of statistical package (SPSS) version 25.0, and a p-value ≤0.05.was considered to be statistically significant.

Results: Overall, the rate of seroma formation was 31.6% rate. Seroma occurred significantly more often as in electrocautery group (40%) than as in scalpel group (23.3%) p=0.048. The electrocautery group also had an increase in mean drain output (680± 110 vs 540± 95 mL, p=0.001) and drainage duration (8.2± 1.9 days vs 6.9± 1.7 days, p=0.002). Operative time and the amount of intra-operative blood loss were significantly reduced in the electrocautery group (p = 0.001), but the overall postoperative wound complication rate was increased (36.7% compared with 18.3%, p = 0.03). The mean duration of hospitalization was also longer in the electrocautery treatment group (9.5 ± 2.3 vs 7.8 ±2.1 days, p= 0.001).

Conclusion: Electrocautery dissection during modified radical mastectomy was associated with a significantly higher rate of seroma development and a significantly higher rate of overall wound complications than scalpel dissection, despite the benefits of intraoperative use of the former, such as shorter operative time and less blood loss. Scalpel dissection may therefore result in improved postoperative outcome including morbidity and a shorter hospital stay. Further large type randomised trials are recommended to confirm these findings.