Skin Flap Necrosis in Inguinal Lymph Node Dissection

Inguinal skin flap necrosis (SFN) is a significant clinical problem associated with inguinal lymph node dissection (ILND). The aetiology of SFN is multifactorial, and its manifestations vary widely. Thermal damage caused by electrocautery during the elevation of the skin flap may contribute to this problem, which has not been studied previously. This prospective, observational study included patients undergoing ILND from January 2020 to July 2022. Based on the technique of raising the inguinal skin flaps, the patients were divided into two groups (cold knife or electrocautery). The remaining part of the procedure was the same. The inguinal wound was examined and photographed to assess the SFN. A total of 42 patients were included (21 in each group). Age, gender, body mass index (BMI), alcohol or tobacco consumption, immune compromised status, and serum albumin were comparable (p > 0.05). The average time required to elevate flaps was 13.14 vs. 11.47 min (p = 0.0231), and gauze soakage was 2.05 vs. 1.52 (p < 0.0001) with a cold knife compared to electrocautery. The incidence of SFN and surgical site infection (SSI) was significantly lower with the use of a cold knife [4.8% vs. 33.3% (p = 0.045) and 0% vs. 19% (p = 0.0378)]. Grade 3 necrosis was observed only with electrocautery use. Compared to conventional electrocautery, the cold knife technique lowers the incidence of SFN and SSI. Further research with a larger sample size and a standardized definition is needed to validate these results.