Traditional electrosurgery and a low thermal injury dissection device yield different outcomes following bilateral skin-sparing mastectomy: a case report

The patient was a 61-year-old Caucasian woman who was a smoker with recurrent DCIS of her right breast. As part of the clinical trial, each breast was randomized to either the standard of care treatment group (a scalpel and a traditional electrosurgical device) or treatment with a novel, low thermal injury dissection device, allowing for a direct, internally controlled comparison of surgical outcomes. Post-operative follow-up at six days was unremarkable for both operative sites. At 16 days post-surgery, the patient presented with a significant wound necrosis in the mastectomy site randomized to the control study group. Following debridement and closure, this site progressively healed over 10 weeks. The contralateral mastectomy, randomized to the alternative device, healed normally.We hypothesize that thermal damage to the subcutaneous microvasculature during flap dissection may have contributed to this complication and that the use of a low thermal injury dissection device may be advantageous in select patients undergoing skin- and nipple-sparing mastectomy.Primarily because of inherent cosmetic and reconstructive advantages, the use of a skin- and nipple-sparing surgical technique during mastectomy is increasingly prevalent, especially for prophylactic mastectomy [1,2]. However, partial necrosis of the skin flap and/or nipple-areola complex is relatively common, affecting approximately 10% to 20% of patients [1-7]. Evidence suggests that thermal injury to the subcutaneous microvascular supply caused during electrosurgical dissection of the skin flap may be a contributing factor [1]. This complication represents a significant source of post-operative morbidity and a barrier to nipple preservation and optimal cosmetic outcome.We are currently conducting the first prospective, randomized, controlled study to evaluate the use of the PEAK PlasmaBlade (PEAK Surgical, Inc., Palo Alto, CA, USA) in simple mastectomy without immediate reconstruction. The PlasmaBlade is a US