Turk J Med Sci 2008; 38 (2): 111-116 © TÜB‹TAK E-mail: medsci@tubitak.gov.tr 111 ORIGINAL ARTICLE Scalpel Versus Electrocautery Dissections: The Effect on Wound Complications and Pro-Inflammatory Cytokine Levels in Wound Fluid Aim: Electrocautery has been postulated as a risk factor for wound complications. This study was conducted to evaluate the effects of electrocautery and scalpel dissections on wound complications and local cytokine levels. Materials and Methods: Patients undergoing modified radical mastectomy were assigned to flap dissection with either electrocautery (n = 18) or scalpel (n = 20). Blood loss, drain volume and duration, seroma formation and wound complications were recorded. Tumor necrosis factor-alpha (TNF-α) and interleukin (IL)- 6 levels were measured in drain fluids at postoperative 24 hours. Results: The electrocautery group had significantly reduced blood loss and total drain volume, but increased seroma formation rate. Significantly elevated levels of TNF-α were measured in drain fluids of patients with electrocautery dissection. Conclusions: The use of electrocautery causes less bleeding and total drain output with an increased rate of seroma formation. Electrocautery dissection increases pro-inflammatory cytokine response in wound fluid, which may reflect an aggravated inflammation and increased potential for tissue damage. Key Words: Electrocautery, sharp dissection, seroma, wound complication, tumor necrosis factor-alpha, interleukin-6 Mastektomide Keskin Diseksiyon ve Koter Diseksiyonu Tekniklerinin Postoperatif Yara Komplikasyonlar› ve Yara S›v›s›ndaki Sitokin Düzeyleri Üzerine Etkileri Amaç: Elektrokoter kullan›m›n yara iyileflmesi aç›s›ndan bir risk faktörü oldu¤u bildirilmifltir. Bu çal›flma elektrokoter ve keskin diseksiyon kullan›m›n yara komplikasyonlar› ve lokal sitokin düzeyleri üzerine etkilerini karfl›laflt›rmak amac›yla düzenlenmifltir. Yöntem ve Gereç: Modifiye radikal mastektomi yap›lan hastalar flep disseksiyonu için elektroketer (n = 18) ve bistüri (n = 20) kullan›lanlar fleklinde iki gruba ayr›ld›. Tüm hastalar›n peroperatif kan kay›plar›, drenaj süreleri ve miktarlar›, seroma oluflumu ve di¤er komplikasyonlar› kaydedildi. Tüm hastalar›n postoperatif 24. saatte dren s›v›lar›ndan al›nan örneklerde. Tumor necrosis factor-alpha ve interleukin-6 düzeyleri ölçüldü. Bulgular: Elektrokoter kulln›lan grupta kan kayb› ve toplam drenaj miktarlar› aç›s›ndan anlaml› düflüklük saptan›rken sreoma oluflumu ve dren s›v›lar›nda ölçülen Tumor necrosis factor-alpha aç›s›ndan anlaml› art›fl tespit edildi. Sonuç: Flep diseksiyonunda elektrokoter kullan›m› kanama ve toplam drenaj miktar›nda azalmaya neden olurken seroma oluflumunu artt›rmaktad›r. Bununla birlikte yara s›v›s›ndaki proinflamatuvar sitokin cevab›n›n da artm›fl olmas› elektrokoter kullan›m›n inflamasyonda art›fla neden oldu¤unu ve doku hasar›nda art›fl yaratt›¤›n› düflündürmektedir. Anahtar Sözcükler: Elektrokoter, keskin diseksiyon, seroma, yara komplikasyonu, tumor necrosis factor- alpha, interleukin–6 Mehmet ÖZDO∕AN 1 Kerim Bora YILMAZ 2 Cihangir ÖZASLAN 2 Ahmet GÜRER 1 Özlem GÜLBAHAR 3 Eren ERSOY 1 1 Department of General Surgery, Atatürk Training and Research Hospital, Ankara - TURKEY 2 Department of General Surgery, Ankara Oncology Training and Research Hospital, Ankara - TURKEY 3 Department of Biochemistry, Faculty of Medicine, Gazi University, Ankara - TURKEY Received: August 13, 2007 Accepted: February 28, 2008 Correspondence Ahmet GÜRER Baflkent Sitesi A-1 Blok No: 5 06550 Y›ld›z, Çankaya, Ankara - TURKEY ahmetgurer@hotmail.com