A comparison between scalpel and electrocautery in modified radical mastectomy

Objective - To compare the effects of a conventional cold scalpel and electrocautery in modified radical mastectomy. Design - A non-randomised controlled trial. Setting - Teaching hospital in Southern Taiwan. Subjects - 101 consecutive patients with primary breast cancer who underwent modified radical mastectomy between July 1987 and June 1989. Interventions - The 44 patients during the first year were allocated to have skin flaps fashioned conventionally with a cold scalpel and the 57 patients during the second year, by electrocautery. Main outcome measures - Morbidity and mortality among the 101 patients who underwent modified radical mastectomy. Results - The groups were comparable in regard to age, menopause, cancer stage, weight of specimen and histological type of cancer. The mean blood loss was 567 ml when scalpel was used and 150 ml when electrocautery was used (p < 0.001). The postoperative fall in packed cell volume was significantly greater in the scalpel group (0.75 [0.26] compared with 0.28 [0.15], p < 0.001) and more patients in this group required transfusion (9 compared with 0, p < 0.01). There were no deaths in either group. There were no significant differences in operation time, total postoperative Hemovac drainage, postoperative hospital stay, the number of lymph nodes removed, the number of metastatic lymph nodes, and postoperative complications between the groups. Conclusion - Electrocautery is a safe, convenient and rational method for constructing skin flaps in modified radical mastectomy, and patients do not need blood transfusions.