Preventive Effect on Seroma of Use of PEAK PlasmaBlade after Latissimus Dorsi Breast Reconstruction

Abstract

Postoperative seroma is still the main complication after a latissimus dorsi (LD) flap procedure. The etiology of seroma is currently thought to comprise tissue fluids resulting from inflammatory reactions in affected tissue caused by the use of monopolar electrocautery (EC). It is possible that seroma formation can be reduced by using alternative devices such as the PEAK PlasmaBlade (PPB), which provides atraumatic scalpel-like cutting precision while the blade temperature remains close to body temperature. The subjects were 44 patients who underwent breast reconstruction with LD flaps from August 2015 to April 2017. They were retrospectively split into groups treated with a PPB (n = 21) and with conventional EC (n = 23). Outcomes such as rate of seroma formation, total drain discharge volume, indwelling period of drainage at the donor site, length of hospital stay, and operation time were compared between the 2 groups. The incidence of seroma was significantly lower in the PPB group (19.0%) than in the EC group (47.8%). The total drain discharge volume was significantly lower and the indwelling period of drainage and length of hospital stay were significantly shorter in the PPB group. In summary, use of PPB in an LD flap procedure can reduce seroma formation and the lengths of the drainage period and the hospital stay.

Fig. 1.

The electrosurgical device and intraoperative pictures. A, The PPB (Medtronic Inc., Minneapolis, Minn.). Precise pulses of RF energy and proprietary insulation material on both sides of the blade enable the devise to dissect like a scalpel and control bleeding, while causing minimal thermal damage to surrounding tissue. B, Intraoperative image of skin incision. C, The dissection surface of the LD muscle using the PPB. RF, radiofrequency.

Fig. 2.

Schematic illustration shows the speculation suggesting that seroma formation is a consequence of surgical disruption of lymph vessels, with ensuing leakage of fluid and inflammatory exudates into the dead space created by the surgical dissection. There is a possibility that seroma formation can be prevented or reduced by using alternative devices like PPB that can dissect the tissue with minimal thermal damage to surrounding tissue.