From the Research
Electrocautery dissection appears to increase rather than reduce seroma formation compared to knife dissection in surgical procedures. When using electrocautery, the heat generated damages lymphatic vessels and creates thermal injury to surrounding tissues, which can lead to increased fluid accumulation in the surgical site. This thermal damage causes inflammatory reactions and impairs the normal healing process, resulting in greater fluid exudation. In contrast, sharp dissection with a scalpel creates cleaner cuts with less collateral tissue damage, potentially allowing for better lymphatic preservation and reduced inflammatory response. However, electrocautery offers other benefits including reduced blood loss, faster dissection time, and better hemostasis, which explains its widespread use despite the seroma risk. To minimize seroma formation while using electrocautery, surgeons often employ additional techniques such as placement of surgical drains, compression dressings, quilting sutures, or tissue sealants. The choice between electrocautery and knife dissection should be based on the specific procedure, patient factors, and the surgeon's assessment of which risks (bleeding versus seroma) are more concerning in each individual case, as supported by studies such as 1 which found that seromas developed in 16 wounds in the electrocautery group compared with 5 in the scalpel group. Some studies, like 2, have investigated alternative dissection methods, such as plasmakinetic cautery, but found no significant differences in seroma formation compared to conventional electrocautery. Other studies, such as 3, have shown that the use of an ultrasound scalpel can reduce seroma formation after axillary dissection. Key factors to consider in minimizing seroma formation include:
- The use of quilting sutures and drains to reduce fluid accumulation
- Minimizing the use of electrocautery and instead using sharp dissection techniques
- Employing techniques to obliterate dead space and reduce fluid accumulation
- Considering patient factors, such as body mass index, that may increase the risk of seroma formation, as noted in studies like 4. Ultimately, the decision between electrocautery and knife dissection should prioritize minimizing morbidity, mortality, and improving quality of life for the patient.