Kim Ki Jae, Chung Jae Ho, Lee Hyung Chul, Lee Byung Il, Park Seung Ha, Yoon Eul Sik
Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Korea.
Arch Plast Surg. 2020 Mar;47(2):140-145. doi: 10.5999/aps.2019.01130. Epub 2020 Feb 27.
Capsular contracture is a common complication of two-stage expander/implant breast reconstruction. To minimize the risk of this complication, capsulectomy is performed using monopolar cautery or ultrasonic surgical instrumentation, the latter of which can be conducted with a Harmonic scalpel. To date, there is disagreement regarding which of the two methods is superior. The purpose of this study was to compare postoperative outcomes between a group of patients who underwent surgery using a Harmonic scalpel and another group treated with monopolar cautery.
A retrospective chart review was conducted of patients who underwent capsulectomy as part of two-stage breast reconstruction between January 2018 and February 2019 and who received at least 1 month of follow-up after surgery. Operative time and postoperative outcomes, including drainage duration, were analyzed.
In total, 36 female patients underwent capsulectomy. The monopolar group consisted of 18 patients and 22 breasts, while the Harmonic scalpel group consisted of 18 patients and 21 breasts. There was no statistically significant difference in demographics between the two groups. The Harmonic scalpel group had a significantly shorter mean drainage duration (6.65 days vs. 7.36 days) and a smaller mean total drainage volume (334.69 mL vs. 433.54 mL) than the monopolar cautery group (P<0.05). No statistically significant difference was observed with regard to seroma or hematoma formation.
The Harmonic scalpel approach for capsulectomy reduced the total drainage volume and drainage duration compared to the monopolar cautery approach. Therefore, this approach could serve as a good alternative to electrocautery.
包膜挛缩是两阶段扩张器/植入物乳房重建的常见并发症。为了将这种并发症的风险降至最低，可使用单极电灼或超声手术器械进行包膜切除术，后者可使用超声刀进行。迄今为止，关于这两种方法哪种更优存在分歧。本研究的目的是比较一组使用超声刀进行手术的患者与另一组接受单极电灼治疗的患者的术后结果。
对2018年1月至2019年2月期间接受包膜切除术作为两阶段乳房重建一部分且术后至少随访1个月的患者进行回顾性病历审查。分析手术时间和术后结果，包括引流持续时间。
共有36名女性患者接受了包膜切除术。单极组由18名患者和22个乳房组成，而超声刀组由18名患者和21个乳房组成。两组之间的人口统计学特征无统计学显著差异。与单极电灼组相比，超声刀组的平均引流持续时间明显更短（6.65天对7.36天），平均总引流量更小（334.69 mL对433.54 mL）（P<0.05）。在血清肿或血肿形成方面未观察到统计学显著差异。
与单极电灼方法相比，超声刀用于包膜切除术的方法减少了总引流量和引流持续时间。因此，这种方法可作为电灼的良好替代方法。
