Rajan Shiv, Akhtar Naseem, Arya Sugandha, Gupta Sameer, Prakash Puneet, Kumar Vijay, Misra Sanjeev, Chaturvedi Arun, Tripathi Abhilasha, Mishra Prabhakar
Department of Surgical Oncology, King George's Medical University, Lucknow, India.
Atal Bihari Vajpayee Medical University, Lucknow, India.
Indian J Surg Oncol. 2024 Dec;15(4):762-767. doi: 10.1007/s13193-024-01985-z. Epub 2024 Jun 19.
Inguinal skin flap necrosis (SFN) is a significant clinical problem associated with inguinal lymph node dissection (ILND). The aetiology of SFN is multifactorial, and its manifestations vary widely. Thermal damage caused by electrocautery during the elevation of the skin flap may contribute to this problem, which has not been studied previously. This prospective, observational study included patients undergoing ILND from January 2020 to July 2022. Based on the technique of raising the inguinal skin flaps, the patients were divided into two groups (cold knife or electrocautery). The remaining part of the procedure was the same. The inguinal wound was examined and photographed to assess the SFN. A total of 42 patients were included (21 in each group). Age, gender, body mass index (BMI), alcohol or tobacco consumption, immune compromised status, and serum albumin were comparable ( > 0.05). The average time required to elevate flaps was 13.14 vs. 11.47 min ( = 0.0231), and gauze soakage was 2.05 vs. 1.52 ( < 0.0001) with a cold knife compared to electrocautery. The incidence of SFN and surgical site infection (SSI) was significantly lower with the use of a cold knife [4.8% vs. 33.3% ( = 0.045) and 0% vs. 19% ( = 0.0378)]. Grade 3 necrosis was observed only with electrocautery use. Compared to conventional electrocautery, the cold knife technique lowers the incidence of SFN and SSI. Further research with a larger sample size and a standardized definition is needed to validate these results.
腹股沟皮瓣坏死（SFN）是与腹股沟淋巴结清扫术（ILND）相关的一个重大临床问题。SFN的病因是多因素的，其表现差异很大。皮瓣掀起过程中电灼造成的热损伤可能导致这一问题，此前尚未对此进行研究。这项前瞻性观察性研究纳入了2020年1月至2022年7月期间接受ILND的患者。根据腹股沟皮瓣掀起技术，将患者分为两组（冷刀组或电灼组）。手术的其余部分相同。检查并拍摄腹股沟伤口以评估SFN。共纳入42例患者（每组21例）。年龄、性别、体重指数（BMI）、饮酒或吸烟情况、免疫功能低下状态和血清白蛋白水平具有可比性（>0.05）。与电灼相比，冷刀掀起皮瓣所需的平均时间为13.14分钟对11.47分钟（=0.0231），纱布浸湿情况为2.05对1.52（<0.0001）。使用冷刀时，SFN和手术部位感染（SSI）的发生率显著更低[4.8%对33.3%（=0.045），0%对19%（=0.0378）]。仅在使用电灼时观察到3级坏死。与传统电灼相比，冷刀技术降低了SFN和SSI的发生率。需要进行更大样本量和标准化定义的进一步研究来验证这些结果。
