A prospective randomized trial comparing harmonic scalpel versus electrocautery for pectoralis major myocutaneous flap dissection

Background: Conventionally, the pectoralis major myocutaneous flap is raised using electrocautery and/or other sharp instruments. The reported morbidity rate using conventional techniques of flap dissection varies from 16 to 63 percent. The purpose of this study was to consider the feasibility of myocutaneous flap dissection using the harmonic scalpel and to compare operative time, blood loss, drainage volume, and morbidity between patients undergoing flap dissection with the harmonic scalpel and those being treated with electrocautery. Methods: Thirty patients with oral cancer, for whom resection and reconstruction using a pectoralis major myocutaneous flap was planned, were recruited in a prospective, randomized two-arm trial. Patients in arm I (n = 15) had flap dissection using electrocautery and patients in arm II (n = 15) had flap dissection using the harmonic scalpel. Results: The mean operative duration for flap dissection (84 versus 47 minutes), blood loss (129 versus 36 ml), and total drainage volume (551 versus 302 ml) were found to be significantly less in the harmonic scalpel group. Conclusion: The results of the study indicate that it is feasible to dissect pectoralis major myocutaneous flaps using the harmonic scalpel with less operative time, blood loss, drainage volume, and morbidity in comparison with electrocautery.