Harmonic scalpels compared with electrocautery in reconstructive flap harvesting: A meta-analysis

Area of Science:

• Plastic Surgery
• Surgical Technology

Background:

• Electrical devices are crucial for flap surgery, but comparative efficacy data is inconsistent.
• Electrocautery and ultrasonic shears are commonly used, necessitating a clear understanding of their performance.
• This study addresses the need for evidence-based comparison of these surgical tools.

Purpose of the Study:

• To systematically evaluate and compare the efficacy of electrocautery versus ultrasonic shears (Harmonic scalpel) in flap surgery.
• To identify differences in flap harvest time, drain volume, bleeding, and postoperative complications.
• To provide evidence-based recommendations for surgical device selection.

Main Methods:

• A systematic literature review and meta-analysis of studies comparing electrocautery and Harmonic scalpel in flap surgery.
• Inclusion of 505 cases (209 electrocautery, 296 Harmonic scalpel) from eight studies.
• Statistical analysis using fixed-effects or random-effects models based on heterogeneity assessment (Q statistic, I² index).

Main Results:

• The Harmonic scalpel demonstrated a statistically significant reduction in flap harvest time (26.29 min shorter) and drain volume (58.76 ml smaller) compared to electrocautery.
• No significant differences were observed in bleeding volume between the two devices.
• Incidence rates of postoperative complications, including hematoma, infection, flap necrosis, and wound dehiscence, were similar for both methods.

Conclusions:

• The Harmonic scalpel offers superior outcomes regarding flap harvest time and drain volume in flap surgery.
• It is recommended as a preferred option for dissection and cauterization over conventional electrocautery.
• Further research may explore long-term outcomes and cost-effectiveness.