title: Traditional electrosurgery and a low thermal injury dissection device yield different outcomes following bilateral skin-sparing mastectomy: a case report.
abstract: BACKGROUND
  Although a skin- and nipple-sparing mastectomy technique offers distinct cosmetic and reconstructive advantages over traditional methods, partial skin flap and nipple necrosis remain a significant source of post-operative morbidity. Prior work has suggested that collateral thermal damage resulting from electrocautery use during skin flap development is a potential source of this complication. This report describes the case of a smoker with recurrent ductal carcinoma in situ (DCIS) who experienced significant unilateral skin necrosis following bilateral skin-sparing mastectomy while participating in a clinical trial examining mastectomy outcomes with two different surgical devices. This unexpected complication has implications for the choice of dissection devices in procedures requiring skin flap preservation.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors: PEAK Surgical, Inc,, 2464 Embarcadero Way, Palo Alto, CA 94303, USA. jvose@peaksurgical.com.
authors: Richard E
authors: RE
authors: Fine
authors: Joshua G
authors: JG
authors: Vose
references: Int J Periodontics Restorative Dent. 1996 Oct;16(5):479-91
references: 9084320
references: Am Surg. 2003 Dec;69(12):1054-60
references: 14700290
references: Br J Surg. 2010 Mar;97(3):305-16
references: 20101646
references: Plast Reconstr Surg. 2009 Dec;124(6):1849-1859
references: 19952641
references: J Surg Res. 2011 May 1;167(1):e47-54
references: 21324486
references: Br J Plast Surg. 1991 Oct;44(7):495-9
references: 1954512
references: World J Surg. 2006 Aug;30(8):1410-3
references: 16850148
references: Ann Plast Surg. 2002 Dec;49(6):635-45
references: 12461448
references: Am J Surg. 2011 Feb;201(2):160-5
references: 20409522
references: Plast Reconstr Surg. 2011 Jul;128(1):104-111
references: 21701326
references: Arch Surg. 2008 Jan;143(1):38-45; discussion 45
references: 18209151
references: J Am Coll Surg. 2008 Sep;207(3):326-35
references: 18722936
references: Kathmandu Univ Med J (KUMJ). 2006 Jan-Mar;4(1):14-7
references: 18603860
references: Breast. 2011 Feb;20(1):21-5
references: 20619645
references: IEEE Trans Biomed Eng. 2008 Feb;55(2 Pt 2):838-41
references: 18270030
references: J Am Coll Surg. 2006 Mar;202(3):520-30
references: 16500257