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

The latissimus dorsi (LD) flap is a common and useful tool for breast reconstruction that has many advantages, including safety and ease of use. However, seroma at the donor site is still the main complication after an LD flap procedure.1–3 A seroma is now thought to mainly comprise tissue fluids resulting from disruption of lymphatic vessels and inflammatory reactions in affected tissue caused by use of monopolar electrocautery (EC).1–5 We previously reported that use of Harmonic Focus shears (HFS) for LD flap elevation, instead of EC, reduced the lengths of the drainage period and hospital stay after surgery.3 However, we could not find evidence that HFS significantly reduced the incidence of seroma formation, and HFS also has a high cost. The PEAK PlasmaBlade (PPB) is a new electrosurgical device that has lower cost and provides more atraumatic, scalpel-like cutting precision on skin, while the blade temperature stays close to body temperature and provides electrosurgical-like hemostasis, resulting in minimal tissue injury (Fig. ​(Fig.11).6,7 Therefore, there is a possibility that seroma formation can be significantly reduced using the PPB. The aim of this study was to evaluate the benefits of the PPB relative to conventional EC for tissue dissection, in terms of operation time, length of hospital stay, and complications, and to investigate the efficacy of the PPB for reduction and prevention of seroma in an LD flap procedure. Open in a separate window 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.