title: Abdominoplasty and seroma: a prospective randomised study comparing scalpel and handheld electrocautery dissection.
abstract: BACKGROUND
  Seroma formation remains a significant problem in abdominoplasty procedures--the cause of which remains to be elucidated. It has been suggested that one of the causative factors for seroma formation is the use of handheld electrocautery as opposed to scalpel for abdominal flap dissection.
  
  
  METHODS
  Prospective trial in 102 consecutive abdominoplasty patients randomised to have abdominal flap dissection with either handheld electrocautery device on 'coagulation setting' or sharp dissection with scalpel and monopolar electrocautery forceps for haemostasis. In all other aspects the surgical technique was identical between the two groups. All drains were removed at 48 h, irrespective of drain volume. Primary outcome measure is postoperative seroma formation on clinical examination, secondary outcome measures are drain volume, weight of tissue removed, effect of liposuction and patient BMI.
  
  
  RESULTS
  Both study groups were similar in demographics with no significant difference in weight of tissue excised, BMI, drain output or post operative complictions. There was no significant difference in seroma formation rates between the handheld electrocautery group (17.2%) and the sharp dissection group (20.1%). Overall, the seroma rate was 18.6%. Liposuction to the flanks at the time of abdominoplasty was found to significantly increase the incidence of seroma, compared to patients having abdominoplasty alone.
  
  
  CONCLUSIONS
  Use of handheld electrocautery rather than scalpel for tissue dissection does not lead to increased seroma formation in abdominoplasty patients. Concomitant liposuction at the time of abdominoplasty increases the risk of seroma formation compared to patients having abdominoplasty alone.
authors.affiliation: Dept of Plastic Surgery, Royal Free Hospital, London, UK. Electronic address: mrdjmarsh@yahoo.com.
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Marsh
authors.affiliation: Dept of Plastic Surgery, Royal Free Hospital, London, UK.
authors.forename: Andreas
authors.initials: A
authors.lastname: Fox
authors.affiliation: Dept of Plastic Surgery, Royal Free Hospital, London, UK.
authors.forename: Adriaan O
authors.initials: AO
authors.lastname: Grobbelaar
authors.affiliation: Dept of Plastic Surgery, Royal Free Hospital, London, UK.
authors.forename: Jagdeep S
authors.initials: JS
authors.lastname: Chana
mesh_terms: D061645:Abdominoplasty / Q000009:adverse effects / Q000295:instrumentation*; D004210:Dissection / Q000295:instrumentation*; D004311:Double-Blind Method; D004564:Electrocoagulation; D006801:Humans; D015187:Lipectomy / Q000009:adverse effects; D008875:Middle Aged; D011446:Prospective Studies; D049291:Seroma / Q000209:etiology / Q000517:prevention & control*
keywords: Abdominoplasty; Diathermy; Scalpel; Seroma; Trial