The use of cautery in “bloodless” radical mastectomy

Several different forms of operative procedures for carcinoma of the breast have been advocated, but radical mastectomy remains the one most often recommended. Blood loss during this procedure is frequently high, often necessitating transfusion. Unfortunately, complications of the latter have been significant and justifiably have continued to receive attention in literature. In this study, blood loss and wound healing, with and without the use of electrocautery, in radical mastectomy were evaluated from both clinical and laboratory studies. Fifty patients who underwent radical mastectomy were studied for blood loss, transfusions received, and wound healing. Technique was identical except that one half of the patients had thin skin flap elevation via electrocautery rather than by sharp dissection. The average blood replacement was 160 ml per patient when cautery was used vs. 960 ml per patient when cautery was not used. The postoperative hemoglobin and hematocrit values were statistically similar for both groups. Wound healing was not affected. In addition, a laboratory study, utilizing skin incisions in dogs using scalpel and cautery, was performed. No appreciable difference in healing was noted either on gross or microscopic inspection. The use of electrocautery, therefore, for skin flap elevation during radical mastectomy is recommended.