original article 286 Te efect of harmonic scalpel, electrocautery, and scalpel use on early wound complications 1 3 Summary Background Mastectomy when performed with scal- pel and electrocautery is associated with some blood loss and morbidity in the form of prolonged drainage, seroma, wound infection, fap necrosis, and hematoma. Methods A total of 120 patients operated with mas- tectomy enrolled for the study. Te groups were defned by the instruments used for fap preparation: 41 patients operated with electrocautery, 40 patients operated with scalpel, and 39 patients operated with harmonic scalpel formed three groups. Te need for closed suction drains, the amount and duration of seroma, surgical site infec- tion, hematoma, and fap ischemia and necrosis were evaluated. Results Te amounts of intraoperative blood loss in electrocautery and harmonic scalpel groups were 560 and 500 mL, respectively, and it was increased to 750 mL in scalpel group (p = 0.001). Total drainage amounts of scalpel and harmonic scalpel groups were 894 and 908 mL, respectively, and it was increased to 1,113 mL in electrocautery group (p = 0.0033). Seroma incidence rates in scalpel, electrocautery, and harmonic scalpel groups were 45, 65 and 28 %, respectively (p = 0.003). Te diferences between groups in relation to the duration of surgery, breast volume and weight, the areas of fap dis- section, the duration of closed suction drainage, and the amount of early drainage were not statistically signif- cant. Tere was also no diference between groups with regard to hematoma, fap necrosis, and ecchymosis and infection rates. Conclusions Although the use of harmonic scalpel reduces the risk of seroma formation and intraoperative blood loss, further studies are needed to verify the real impact of such technique. Keywords Breast cancer · Mastectomy · Harmonic scal- pel · Electrocautery · Complications Introduction Although the use of breast-conserving surgical tech- niques are increasing, modifed radical mastectomy (MRM) is still the most frequently performed surgical procedure for breast cancer [1]. Mastectomy when per- formed with scalpel and electrocautery is associated with some blood loss [2] and morbidity in the form of pro- longed drainage, seroma, wound infection, fap necrosis, and hematoma [3–5]. Seroma formation is the most frequent complication after mastectomy. Te pathogenesis of seroma has not been clearly defned yet. Seroma fuid contains elements like IgG, granulocytes, and leukocytes, which are usually seen in acute infammatory exudate [6]. Tis occurrence shows that surgical technical factors might be important for the formation of seroma [7]. Ultrasonic energy [harmonic scalpel (HS)] uses high- frequency ultrasonic waves for dissection and hemo- stasis. HS is a multifunctional instrument capable of performing tissue dissection and hemostasis simultane- ously. Tere is no risk of electrical injury, and thermal injury with HS is less in comparison with electrocautery [8]. HS causes breakdown of hydrogen bonds and forms a protein coagulum to occlude the vascular and lymphatic channels. Tis study was conducted to assess the feasibility of ultrasonic dissector in MRM and compare its early post- N. Karaman, MD () · B. Anlar, MD · L. Dogan, MD · C. Ozaslan, MD · C. Atalay, MD · M. Altinok, MD Department of General Surgery, Ankara Oncology Education and Training Hospital, Mehmet Akif Ersoy Mahallesi, Yenimahalle, Ankara, Turkey e-mail: niyazikaraman@hotmail.com Received: 23 August 2012 / Accepted: 10 September 2013 / Published online: 22 October 2013 © Springer-Verlag Wien 2013 Eur Surg (2013) 45:286–290 DOI 10.1007/s10353-013-0231-y The effect of harmonic scalpel, electrocautery, and scalpel use on early wound complications after modified radical mastectomy B. Anlar · N. Karaman · L. Dogan · C. Ozaslan · C. Atalay · M. Altinok