The effectiveness of different flap-raising techniques for mastectomy in reducing the rate of complications: a network meta-analysis

Abstract

Background: Seroma has been associated with some energy devices used in raising flaps during modified radical mastectomy. Perhaps, its occurrence might be reduced by determining the most effective technique for raising the flap. Hence, the wide array of energy devices available for mastectomy warrants a network meta-analysis for comparison to determine the most suitable for rseducing complications.

Methods: Searches were conducted on Google Scholar and PubMed for randomized controlled trials that compared the various energy devices (argon-cautery, diathermy, plasma blade, LigaSure, and harmonic scalpel) to traditional scalpel/scissors in mastectomy procedures. This review was registered with a PROSPERO number: CRD42023456510. The primary outcome was seroma formation, while the secondary outcomes included flap necrosis, drain effluent, and blood loss.

Results: Thirty-three studies were used for this network meta-analysis. Using sharp dissections (scissors or scalpel) for raising flaps in mastectomy reduced seroma formation [Odds ratio (OR): 0.375 (Credible interval (CrI): 0.244, 0.575)], Argon cautery decreased blood loss [Mean difference (MD): -304 (CrI: -698, 90.5)] but harmonic scalpel reduced the rate of flap necrosis [OR: 0.379 (CrI: 0.177, 0.791)] and the volume of drain effluent [MD: -383 (CrI: -704, -62.9)].

Conclusion: Using scissors or scalpels for mastectomy was associated with a reduction in the rate of seroma. In addition, the volume of drain effluent was reduced using a Harmonic scalpel compared to other energy devices. Aside from a reduction in flap necrosis rate, blood loss, and the volume of drain effluent; energy devices for raising flaps in mastectomy were not entirely superior to scalpels or scissors.

Keywords: Blood loss; Flap-raising; Mastectomy; Seroma.

Fig. 1

Shows the PRISMA flow diagram

Fig. 2A

shows the traffic plot for the studies incorporated in the network meta-analysis

Fig. 2B

Shows the summary plot for the studies incorporated in the network meta-analysis

Fig. 3A

Shows the network of comparison of seroma

Fig. 3B

Shows the SUCRA (Surface under the cumulative ranking curve) for seroma. Sharp dissection had the highest P-score at 83.9%

Fig. 3C

Shows the SUCRA for the volume of blood loss. Argon cautery had the highest P-score at 90.9%

Fig. 3D

shows the SUCRA for the occurrence of flap necrosis. Harmonic scalpel had the highest P-score at 84.4%

Fig. 3E

Shows the SUCRA for the volume of the drain effluent after mastectomy. Harmonic scalpel had the highest P-score at 86.3%