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Augustin A, Schoberleitner I, Unterhumer SM, Krapf J, Bauer T, Wolfram D. PlasmaBlade versus Electrocautery for Deep Inferior Epigastric Perforator Flap Harvesting in Autologous Breast Reconstruction: A Comparative Clinical Outcome Study. J Clin Med 2024; 13:2388. [PMID: 38673669 PMCID: PMC11051315 DOI: 10.3390/jcm13082388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
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.
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Affiliation(s)
| | | | | | | | | | - Dolores Wolfram
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
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2
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Paterson A, Kumaria A, Sitaraman M, Sabbubeh T, Ingale H, Basu S. Dissection using pulsed radiofrequency energy device (PlasmaBlade) is safe and efficient in experimental revision neuromodulation implant surgery. Br J Neurosurg 2024; 38:439-446. [PMID: 33621158 DOI: 10.1080/02688697.2021.1885622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/22/2020] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The use of functional neurosurgical implants has increased over the past 10 years. PlasmaBlade is an innovative electrosurgical appliance harnessing pulsed radiofrequency (RF) energy. Our aim was to assess the risk of damage to neuromodulation hardware during PlasmaBlade dissection. MATERIALS AND METHODS A simulated setting with chicken breast threaded with different hardware and PlasmaBlade used in three configurations. . Post dissection, the wires were inspected naked eye and under an operating microscope. The induced current was assessed contemporaneously using an oscilloscope. RESULTS Five surgeons tested the PlasmaBlade at different generator settings. Sixty dissections were undertaken. No structural damage or induced current was identified at CUT 3/4, COAG 5. At CUT 6, COAG 5 and during dissection in a perpendicular orientation with prolonged hardware contact, opacification of insulation material occurred in 15/20 dissections. There was no dissolution of insulation even at this setting. On deviation from Medtronic advice, hardware damaged occurred if one was reckless with the PlasmaBlade. CONCLUSION When using the recommended settings and operational technique, PlasmaBlade dissection did not cause any damage to implant wiring/tubing in this simulated setting. This report seeks to add to clinical data suggesting PlasmaBlade is safe for dissection around deep brain stimulator (DBS), vagal nerve stimulator (VNS), and spinal cord stimulator (SCS) hardware.
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Affiliation(s)
- Alistair Paterson
- Department of Neurosurgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Ashwin Kumaria
- Department of Neurosurgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Murugan Sitaraman
- Department of Neurosurgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Thabit Sabbubeh
- Department of Neurosurgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Harshal Ingale
- Department of Neurosurgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Surajit Basu
- Department of Neurosurgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
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3
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Liao CD, Zhao K, Nikkhahmanesh N, Bui DT. Decreasing Seroma Incidence Following Abdominoplasty: A Systematic Review and Meta-Analysis of High-Quality Evidence. Aesthet Surg J Open Forum 2024; 6:ojae016. [PMID: 38585023 PMCID: PMC10995621 DOI: 10.1093/asjof/ojae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
Background Seroma formation is the most common complication of abdominoplasties. Many preventive interventions have been proposed, but none have been recognized as a definitive solution, partly due to varying levels of evidence (LOE) in the literature. Objectives We aimed to analyze seroma prevention methods supported by high-level evidence. Methods The PubMed database was queried through August 2023. Primary articles of interest included randomized controlled trials (RCTs), prospective comparative studies, and meta-analyses of these studies. The LOE for each article was determined according to the American Society of Plastic Surgeons Rating Scale. The "seroma occurrence ratio," or ratio of seroma events in the interventional group to respective control group, was calculated to compare incidence rates between techniques. Results Twenty articles and 9 categories of techniques were analyzed. Study designs included 10 RCTs, 2 prospective cohort studies, 7 prospective comparative studies, and 1 retrospective randomized study. The use of progressive-tension and quilting sutures had the most data supporting a statistically significant reduction in seroma (occurrence ratio 0.306, P < .001). Tissue adhesives and preservation of Scarpa's fascia were also well reinforced (0.375, P < .01 and 0.229, P < .011, respectively), while increasing the number of drains was not (P = .7576). Meta-analysis demonstrated that compared with 2 drains alone, alternative techniques were more effective at reducing seroma occurrence (pooled risk ratio 0.33, 95% CI, 0.11-0.99). Conclusions This review highlights multiple seroma prevention techniques for abdominoplasty investigated in recent high-quality literature. We suggest future randomized comparative studies of the various seroma prevention methods to fully ascertain their efficacy following abdominoplasty. Level of Evidence 1
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Affiliation(s)
- Christopher D Liao
- Corresponding Author: Dr Christopher D. Liao, 100 Nicolls Rd #271, Stony Brook, NY 11794-8191, USA. E-mail:
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4
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Dyrbuś M, Kurek A, Sokoła K, Niedziela JT, Ostręga M, Cieśla D, Gąsior M, Tajstra M. Low-temperature electrocautery for high-risk cardiac implantable electronic device procedures. Cardiol J 2023; 31:171-173. [PMID: 38149490 PMCID: PMC10919561 DOI: 10.5603/cj.94123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 09/05/2023] [Accepted: 09/22/2023] [Indexed: 12/28/2023] Open
Affiliation(s)
- Maciej Dyrbuś
- 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.
| | - Anna Kurek
- 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Sokoła
- 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Jacek T Niedziela
- 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Mateusz Ostręga
- 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Daniel Cieśla
- Department of Science and New Technologies, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Mariusz Gąsior
- 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Mateusz Tajstra
- 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
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5
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Sala L, Bonomi S, Fabbri A, Ciniselli CM, Bardelli A, Verderio P, Pruneri G, Cortinovis U. Use of PEAK PlasmaBlade in implant-based breast reconstruction and radiotherapy: new strategy to reduce complications. TUMORI JOURNAL 2023; 109:86-96. [PMID: 34719290 DOI: 10.1177/03008916211056072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Implant-based breast reconstruction in the setting of radiotherapy often leads to higher complications rates (mainly capsular contracture and wound dehiscence) and poor cosmetic outcomes. We hypothesized that the combination of pulsed-electron avalanche knife (PEAK) PlasmaBlade (a pulsed radiofrequency electrosurgery) and acellular dermal matrix Veritas® in postmastectomy radiotherapy implant-based breast reconstruction could result in lower complications rate, better reconstructive results, and patient satisfaction. METHODS A prospective observational study focused on the use of PEAK PlasmaBlade in implant-based breast reconstruction and radiotherapy was carried out in the Plastic Reconstructive Surgery Unit at Fondazione IRCCS Istituto Nazionale Tumori Milano between December 2017 and 2019 (2017-2018: enrollment; 2018-2019: follow-up). Patient demographics were queried and complication rates and patient and surgeon satisfaction were assessed. RESULTS A total of 88 patients were enrolled; 2 patients received bilateral reconstruction, leading to a total of 90 procedures. Sixty-two women received contralateral symmetrization. Seroma was the most frequent minor complication (8.8%); implant exposure was the most recorded among major complications (5.5%). Preoperative lipofilling was the most substantial protective factor for preventing complications (p < 0.001). A significant association between capsular thermal damage thickness and the type of electrosurgery used (traditional electrosurgery vs PEAK PlasmaBlade) was observed, with lower values with PEAK PlasmaBlade (p < 0.0001). CONCLUSIONS Our protocol results in low rates of surgical complications and a high level of patient and surgeon satisfaction although longer follow-up is needed.
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Affiliation(s)
- Laura Sala
- Plastic and Reconstructive Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Stefano Bonomi
- Plastic and Reconstructive Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alessandra Fabbri
- Department of Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milano University of Milan, School of Medicine, Milano, Italy
| | - Chiara Maura Ciniselli
- Unit of Bioinformatics and Biostatistics, Department of Applied Research and Technological Development Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Annalisa Bardelli
- Unit of Bioinformatics and Biostatistics, Department of Applied Research and Technological Development Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Paolo Verderio
- Unit of Bioinformatics and Biostatistics, Department of Applied Research and Technological Development Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Giancarlo Pruneri
- Department of Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milano University of Milan, School of Medicine, Milano, Italy
| | - Umberto Cortinovis
- Plastic and Reconstructive Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Post-Bariatric Plastic Surgery: Abdominoplasty, the State of the Art in Body Contouring. J Clin Med 2022; 11:jcm11154315. [PMID: 35893406 PMCID: PMC9330885 DOI: 10.3390/jcm11154315] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/13/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022] Open
Abstract
Due to the increased prevalence of obesity in the last decades, bariatric surgery has been on the rise in recent years. Bariatric surgery is a compelling option for weight loss in obese patients with severe obesity-related comorbidities or for whom lifestyle modifications have proven ineffective. Redundant skin following significant weight loss is a common occurrence affecting up to 96% of patients who undergo bariatric surgery, negatively impacting physical and psychosocial health and detracting from activities of daily living. Statistics of the American Society of Plastic Surgeons show that 46,577 body contouring procedures were performed after massive weight loss in the USA in a 2020 report. Abdominoplasty, a well-established cosmetic surgery procedure for improving body contour, is performed by removing excess skin and fat from the abdominal wall and thereby restoring musculofascial integrity and skin elasticity, resulting in a more ideal body shape and increasing quality of life. Although abdominoplasty is a safe procedure, it has been associated with a higher complication rate compared with other body-contouring procedures. Technologic advances over the past decade have been developed as non-invasive alternatives or adjunctive tools to surgery to enhance cosmetic results and minimize complications. New energy-based technologies may supplant invasive surgery for mild to moderate skin laxity and/or diminish the extent of surgery and resulting scars. Plastic surgeons play a significant role in improving the quality of life of patients who suffer from obesity and underwent bariatric surgery. We are deeply convinced, however, that the advancement of knowledge and research in this field will determine the introduction of new technologies and custom-made techniques. This advancement will reduce the complication rate with a rapid reintegration of the patient into the world of work and resumption of daily activities.
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7
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Lee E, Elzomor A, Boulos S, Silva O, Pasick LJ, Benito DA, Tong J, Zapanta P, Joshi AS, Goodman JF, Thakkar PG. Complications associated with PEAK PlasmaBlade from 2010 to 2020 from MAUDE. Proc AMIA Symp 2022; 35:615-620. [DOI: 10.1080/08998280.2022.2075686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Esther Lee
- Division of Otolaryngology–Head and Neck Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California
| | - Amir Elzomor
- Division of Otolaryngology–Head and Neck Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Sameh Boulos
- Division of Otolaryngology–Head and Neck Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Olivia Silva
- Division of Otolaryngology–Head and Neck Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Luke J. Pasick
- Department of Otolaryngology–Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Daniel A. Benito
- Division of Otolaryngology–Head and Neck Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Jane Tong
- Department of Otolaryngology–Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Philip Zapanta
- Division of Otolaryngology–Head and Neck Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Arjun S. Joshi
- Division of Otolaryngology–Head and Neck Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Joseph F. Goodman
- Division of Otolaryngology–Head and Neck Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Punam G. Thakkar
- Division of Otolaryngology–Head and Neck Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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8
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Salari N, Fatahi B, Bartina Y, Kazeminia M, Heydari M, Mohammadi M, Hemmati M, Shohaimi S. The Global Prevalence of Seroma After Abdominoplasty: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2021; 45:2821-2836. [PMID: 34080041 DOI: 10.1007/s00266-021-02365-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Abdominoplasty is one of the most common cosmetic surgeries performed worldwide. Seroma is also the most common local complication associated with abdominoplasty, which increases care costs, reduces patient satisfaction, and has serious complications for patients. Results of previous studies report different levels of seroma prevalence after abdominoplasty. The aim of this study is to standardize the statistics of the prevalence of seroma after abdominoplasty using meta-analysis. METHODS In this systematic review and meta-analysis study, data from studies conducted on the global prevalence of seroma after abdominoplasty was extracted using the keywords "Prevalence, Epidemiology, Complications, Abdominoplasty, Seroma, and Lipo abdominoplasty" in the databases of Science, Scientific Information Database, MagIran, Embase, Scopus, PubMed, Web of Science, and Google Scholar search engine without time limit until October 2020. The random-effects model was used to analyze the eligible studies, and the heterogeneity of the studies was investigated with the I2 index. Data analysis was performed using Comprehensive Meta-Analysis software (Version 2). RESULTS In reviewing 143 studies (five studies related to Asia, 55 studies related to Europe, three studies related to Africa, and 80 studies related to the Americas) with a total sample size of 27834 individuals, the global prevalence of seroma after abdominoplasty was obtained as 10.9% (95% CI: 9.3-3.6.6%) and the highest prevalence of seroma was related to the Europe continent with 12.8% (95% CI: 10.15-3.9%). The results from meta-regression showed a declining trend in the global prevalence of seroma after abdominoplasty with an increase in the sample size, age of study participants, and the year of study (p < 0.05). CONCLUSIONS This study shows that the prevalence of seroma after abdominoplasty is high globally. Therefore, physicians and specialists must consider its importance and take the controlling and treatment measures seriously. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behnaz Fatahi
- Student research committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yalda Bartina
- Department of Translation Studies, Faculty of Literature, Istanbul University, Istanbul, Turkey
| | - Mohsen Kazeminia
- Student research committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammadbagher Heydari
- Department of General Surgery, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Mahvan Hemmati
- Student research committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor, Malaysia
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Zhong Y, Wei Y, Min N, Guan Q, Zhao J, Zhu J, Hu H, Geng R, Hong C, Ji Y, Li J, Zheng Y, Zhang Y, Li X. Comparative healing of swine skin following incisions with different surgical devices. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1514. [PMID: 34790720 PMCID: PMC8576679 DOI: 10.21037/atm-21-3090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/05/2021] [Indexed: 11/06/2022]
Abstract
Background Electrosurgical technology is widely used in surgical dissection and hemostasis, but the generated heat creates thermal injury to adjacent tissues and delays wound healing. The plasma blade (PB) applies pulsed radiofrequency (RF) to generate electrical plasma along the edge of a thin, flat, insulated electrode, minimizing collateral tissue damage. This study aimed to evaluate wound healing in swine skin following incision with a new surgical system that applies low-temperature plasma (NTS-100), a foreign PB, conventional electrosurgery (ES), and a scalpel blade. Methods In vitro porcine skin and an in vivo porcine skin model were used in this study. Full-thickness skin incisions 3 cm in length were made on the dorsum of each animal for each of the 5 surgical procedures at 0, 21, 28, 35, and 42 days. The timing of the surgical procedures allowed for wound-healing data points at 1, 2, 3, and 6 weeks accordingly. Local operating temperature and blood loss were quantified. Wounds were harvested at designated time points, tested for wound tensile strength, and examined histologically for scar formation and tissue damage. Results Local operating temperature was reduced significantly with NTS-100 (cut mode 83.12±23.55 °C; coagulation mode 90.07±10.6 °C) compared with PB (cut mode 94.46±11.48 °C; coagulation mode 100.23±6.58 °C, P<0.05) and ES (cut mode 208.99±34.33 °C, P<0.01; coagulation mode 233.37±28.69 °C, P<0.01) in vitro. Acute thermal damage from NTS-100 was significantly less than ES incisions (cut mode: 247.345±42.274 versus 495.295±103.525 µm, P<0.01; coagulation mode: 351.419±127.948 versus 584.516±31.708 µm, P<0.05). Bleeding, histological scoring of injury, and wound strength were equivalent for the NTS-100 and PB incisions. Conclusions The local operating temperature of NTS-100 was lower than PB, and NTS-100 had similarly reliable safety and efficacy.
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Affiliation(s)
- Yuting Zhong
- Medical School of Chinese PLA, Beijing, China.,Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yufan Wei
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Ningning Min
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Qingyu Guan
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Jin Zhao
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Junyong Zhu
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Huayu Hu
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Rui Geng
- Medical School of Chinese PLA, Beijing, China.,Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Chenyan Hong
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Yashuang Ji
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Jie Li
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yiqiong Zheng
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yanjun Zhang
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xiru Li
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
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10
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Torres-Silva C, Pisco A, Valença-Filipe R, Rebelo M, Peres H, Vásconez L, Costa-Ferreira A. Dissection Technique for Abdominoplasty With Scarpa Fascia Preservation: Comparative Study on Avulsion Technique Versus Diathermocoagulation. Aesthet Surg J 2021; 41:NP804-NP819. [PMID: 33403390 DOI: 10.1093/asj/sjaa428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Many strategies have been developed to lower the high complication rate associated with a full abdominoplasty. The dissection technique may have a role to achieve this goal. OBJECTIVES The present study compared 2 different dissection techniques to perform a full abdominoplasty with Scarpa fascia preservation: avulsion technique and electrodissection. METHODS A retrospective observational cohort study was performed in 2 health institutions from January 2005 to January 2019. A total of 251 patients were involved: 122 patients submitted to abdominoplasty employing the avulsion technique (Group A) and 129 with diathermocoagulation (coagulation mode) (Group B). The latter was further divided into group B1 (57 patients with device settings according to surgeon's preferences) and B2 (72 patients with a specific regulation aiming at minimal tissue damage). Several variables were analyzed: population characteristics, time of hospital stay, time to drain removal, total and daily drain output, emergency department visits, readmission, reoperation, and local and systemic complications. RESULTS The general characteristics of both groups did not statistically significantly differ except for previous abdominal surgery. The diathermocoagulation group had a significantly lower length of hospital stay and time to drain removal. Moreover, these advantages were maximized when electrocautery was conducted with a specific low-voltage setting as significant differences were found. The other outcomes were identical. CONCLUSIONS Limiting the extension of electrodissection with the avulsion technique did not present any advantage. Utilizing diathermocoagulation (coagulation mode) during a full abdominoplasty with Scarpa fascia preservation, especially when it is aimed at minimal tissue damage, reduces patients' time with drains. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Catarina Torres-Silva
- Department of Surgery and Physiology, Faculty of Medicine, Porto University, Porto, Portugal
| | - Andreia Pisco
- Department of Surgery and Physiology, Faculty of Medicine, Porto University, Porto, Portugal
| | - Rita Valença-Filipe
- Department of Surgery and Physiology, Faculty of Medicine, Porto University, Porto, Portugal
| | - Marco Rebelo
- Plastic Surgery Department, Portuguese Institute of Oncology of Porto (IPO), Porto, Portugal
| | - Helena Peres
- Interdisciplinary Centre of Marine and Environmental Research (CIIMAR), Portugal
| | | | - António Costa-Ferreira
- Department of Surgery and Physiology, Faculty of Medicine, Porto University, Porto, Portugal
- Department of Plastic, Aesthetic and Reconstructive Surgery, São João University Hospital, Porto, Portugal
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11
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Uysal D, Ibrisim E. A Retrospective Study of Coronary Artery Bypass Grafting with Low-Thermal Plasma Dissection Device Compared to Conventional Monopolar Electrosurgery. Braz J Cardiovasc Surg 2021; 36:379-387. [PMID: 34236794 PMCID: PMC8357391 DOI: 10.21470/1678-9741-2020-0386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: The objective of this study is to compare the effects of conventional monopolar electrosurgery (CMES) and low-thermal plasma kinetic cautery (PKC) on complications such as bleeding, abnormal wound healing, pain, and drainage in patients who underwent on-pump coronary artery bypass grafting (CABG). Methods: This retrospective clinical study included 258 patients undergoing CABG; the patients were randomized to PKC (PEAK PlasmaBlade, n=153) and CMES (n=105) groups. The patients’ clinical data were examined retrospectively for biochemical variables, postoperative drainage, post-surgery erythrocyte suspension transfusion count, surgical site pain examined with visual analogue scale (VAS), and wound healing. Two-sided P-value > 0.05 was considered as statistically significant. Results: The median post-surgery erythrocyte suspension transfusion number was significantly lower with PKC compared to CMES (0 [0-1] vs. 1 [1-4], respectively, P<0.001). Mean postoperative drain output and time until removal of drain tubes were significantly lower with PKC compared to CMES (300±113 vs. 547±192 and 1.95±1.5 vs. 2.44±1.8; P<0.001 and P=0.025, respectively). Mean VAS score for spontaneous and cough-induced pain were significantly lower with PKC compared to CMES (1.98±1.51 vs. 3.94± 2.09 and 3.76±1.46 vs. 5.6±1.92; P<0.001 for both comparisons). Reoperation due to bleeding was significantly higher with CMES compared to PKC (0 vs. 11 [7.2%], P=0.001). Conclusion: Use of PKC during CABG considerably reduces postoperative drainage, need for blood transfusion, reoperation due to bleeding, and postoperative pain. PCK appears to be a good alternative to CMES for CABG.
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Affiliation(s)
- Dincer Uysal
- Department of Cardiovascular Surgery, Suleyman Demirel Universitesi Tip Fakultesi, Isparta, Turkey
| | - Erdogan Ibrisim
- Department of Cardiovascular Surgery, Suleyman Demirel Universitesi Tip Fakultesi, Isparta, Turkey
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Schlosshauer T, Kiehlmann M, Riener MO, Rothenberger J, Sader R, Rieger UM. Effect of low-thermal dissection device versus conventional electrocautery in mastectomy for female-to-male transgender patients. Int Wound J 2020; 17:1239-1245. [PMID: 32368860 DOI: 10.1111/iwj.13382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 11/28/2022] Open
Abstract
Subcutaneous mastectomy, the first step in sexual reassignment surgery of female-to-male transsexuals, is associated with high rates of complication and revision surgery. Also, conventional electrosurgery and the associated thermal tissue damage may compromise outcome. This retrospective randomised clinical study evaluated the effect of low-thermal plasma dissection device (PEAK PlasmaBlade, Medtronic, Minneapolis, Minnesota) in comparison with conventional electrosurgery. A total of 17 female-to-male transsexuals undergoing mastectomy were randomised to PEAK PlasmaBlade on one breast side and to monopolar electrosurgery on the other side of the same patient. Wounds of 17 patients were examined histologically for acute thermal injury. Significantly less total volume of drain output (58.8 ± 37.4 mL vs 98.5 ± 76.4 mL; P = .012) was found on the PEAK PlasmaBlade side compared with the electrosurgery side. Duration of drain was significantly shorter on the PEAK PlasmaBlade side (2.5 ± 0.7 days vs 3.2 ± 0.6 days; P = .010). Furthermore, the PEAK PlasmaBlade side showed fewer thermal damages (41.2% vs 82.4%; P = .039) and thermal injury depth from PEAK PlasmaBlade side was less (3170 vs 4060 μm). PEAK PlasmaBlade appears to be superior to monopolar electrosurgery for mastectomy in female-to-male transsexuals, because it demonstrated less thermal tissue damage, less total volume of drain output, and shorter duration of drain, resulting in faster wound healing.
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Affiliation(s)
- Torsten Schlosshauer
- Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, AGAPLESION Markus Hospital, Frankfurt, Germany.,Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, AGAPLESION Ev. Hospital, Giessen, Germany
| | - Marcus Kiehlmann
- Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, AGAPLESION Markus Hospital, Frankfurt, Germany
| | - Marc-Oliver Riener
- OptiPath, Institute of Pathology, Frankfurt, Germany.,Institute of Pathology, University Hospital Erlangen, Nuremberg, Germany
| | - Jens Rothenberger
- Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, AGAPLESION Markus Hospital, Frankfurt, Germany
| | - Robert Sader
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt, Germany
| | - Ulrich M Rieger
- Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, AGAPLESION Markus Hospital, Frankfurt, Germany
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Schlosshauer T, Kiehlmann M, Riener MO, Sader R, Rieger UM. Comparative analysis on the effect of low-thermal plasma dissection device (PEAK PlasmaBlade) vs conventional electrosurgery in post-bariatric abdominoplasty: A retrospective randomised clinical study. Int Wound J 2019; 16:1494-1502. [PMID: 31531963 DOI: 10.1111/iwj.13221] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 08/23/2019] [Indexed: 11/30/2022] Open
Abstract
Post-bariatric patients undergoing abdominoplasty have a relatively high risk of complications due to residual obesity and major comorbidities. Also, conventional electrosurgery and the associated thermal tissue damage may compromise outcomes. This retrospective randomised clinical study evaluated the effect of low-thermal plasma dissection device (PEAK [pulsed electron avalanche knife] PlasmaBlade) in comparison with conventional electrosurgery. A total of 52 post-bariatric patients undergoing abdominoplasty were randomised to PEAK PlasmaBlade (n = 26) and to monopolar electrosurgery (n = 26). Wounds of 20 patients per group were examined histologically for acute thermal injury depth. In PEAK PlasmaBlade incisions, acute thermal damage was significantly reduced compared with standard of care (40% vs 75%; P = .035). Also, acute thermal injury depth from PEAK PlasmaBlade was less than that from electrosurgery (2780 μm vs 4090 μm). Significantly less total complication rate (30.8% vs 69.2%; P = .012) was found by PEAK PlasmaBlade compared with electrosurgery. Moreover, the PEAK PlasmaBlade showed less than half as many wound healing problems (19.2% vs 46.2%; P = .075), far fewer secondary bleeding (7.7% vs 30.8%; P = .075), and no seroma compared with four seroma with the standard of care (0% vs 15.4%; P = .11). PEAK PlasmaBlade appears to be superior to traditional monopolar electrosurgery for post-bariatric abdominoplasty, because it demonstrated significantly less tissue damage, less total complication rate, and fewer postoperative seroma resulting in faster wound healing.
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Affiliation(s)
- Torsten Schlosshauer
- Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, AGAPLESION Markus Hospital, Frankfurt am Main, Germany
| | - Marcus Kiehlmann
- Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, AGAPLESION Markus Hospital, Frankfurt am Main, Germany
| | - Marc-Oliver Riener
- OptiPath, Institute of Pathology, Frankfurt am Main, Germany.,Institute of Pathology, University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Robert Sader
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt, Germany
| | - Ulrich M Rieger
- Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, AGAPLESION Markus Hospital, Frankfurt am Main, Germany
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