PlasmaBlade versus Electrocautery for Deep Inferior Epigastric Perforator Flap Harvesting in Autologous Breast Reconstruction: A Comparative Clinical Outcome Study

Abstract

(1) Background: 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). (2) Methods: This retrospective cohort study included 128 patients with DIEP-based breast reconstruction. Patient characteristics and information on the postoperative course were collected and a comparative evaluation was conducted. (3) Results: 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). A 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. (4) Conclusions: 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.

Keywords: PEAK PlasmaBlade; autologous breast reconstruction; clinical outcome; electrosurgery; flap harvesting.

Figure 1

Intraoperative photo documentation of abdominal DIEP flap harvesting. (a) Preoperative markings of planned incisions. (b) Reconstructive result after skin-sparing mastectomy (resection weight: 650 g) on the left patient side and primary reconstruction (flap weight: 720 g). (c) Wound bed after mobilization, with the DIEP flap still in situ. (d) Defect after completion of DIEP flap harvesting (resection weight: 750 g).

Figure 2

Cumulative postoperative wound fluid quantity (mL). Comparative analysis through Student’s t-test indicates a significant increase (p* = 0.0324) in the MPE cohort (n = 72) compared to the PPB cohort (n = 56).

Figure 3

Evaluation of cumulative wound fluid quantity and risk factors. Mean and SEM of postoperative drainage volume (mL) are shown for both cohorts. Statistical significance was determined by Student’s t-test, revealing a significant reduction in postoperative wound fluid production after surgery with the PPB for those with a BMI exceeding 30 kg/m² (p* = 0.0284), those without prior neoadjuvant chemotherapy (p** = 0.0041) and for non-smokers (p** = 0.0046). The level for statistical significance was set at * p < 0.05, ** p < 0.02.

Figure 4

Relationship between BMI and wound fluid quantity (mL). In both groups, we compared the correlation of cumulative wound fluid quantity (mL) and BMI class by simple linear regression analysis. The analysis revealed a significant correlation between higher BMI class and increased postoperative wound fluid production in the MPE cohort. Slope significantly non-zero [PPB]: F(1.54) = 1.144, p ^ns = 0.2895, y= 35.19x + 223.4; [MPE]: F(1.70) = 8.104, p** = 0.0058, y = 81.06x + 221.6. The level for statistical significance was set at ^ns p ≥ 0.05, ** p < 0.02.

Figure 5

Comparative evaluation of postoperative pain. Mean and SEM for Numeric Analog Scale (NAS) assessment over a 10-day postoperative period. Statistical significance was determined by 2-way ANOVA: p**** < 0.0001, demonstrating a notable reduction in postoperative pain within the PEAK PlasmaBlade (PPB) group.