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Purpose <p>To evaluate and compare intraoperative blood loss, surgical time, and postoperative outcomes of pectoralis major myocutaneous (PMMC) flap elevation using traditional scalpel dissection versus monopolar cutting diathermy in patients undergoing reconstruction for oral squamous cell carcinoma (OSCC).</p> Materials and methods <p>This prospective observational study included 20 patients diagnosed with OSCC of the lower gingivobuccal sulcus, treated at the Department of Oral and Maxillofacial Surgery, Dr. D.Y. Patil Dental College and Hospital, Pune. Patients were recruited using a convenience sampling approach based on availability, willingness, suitability for surgery, and equipment availability. All procedures were performed by the senior author, who has over 25 years of experience performing PMMC flap elevations, ensuring a standardized technique across all patients. Intraoperative blood loss was quantified by standardized absorbent mop counts and suction volume (excluding irrigation fluid), and surgical time was recorded from incision to flap insetting. Flap viability was assessed using standardized clinical criteria including colour, capillary refill, and bleeding at the flap margins, independently evaluated by two experienced surgeons. Postoperative outcomes and complications were monitored over a six-month follow-up period.</p> Results <p>Both groups had comparable average operative times (Scalpel: 30.2 ± 3.5&#xa0;min; Diathermy: 29.8 ± 3.2&#xa0;min; <i>p</i> = 0.65). The scalpel group showed significantly higher intraoperative blood loss (225 ± 20 mL, ~ 5 mops) compared to the diathermy group (105 ± 15 mL, ~ 2 mops; <i>p</i> &lt; 0.001). All flaps survived postoperatively, including those receiving adjuvant radiation, with minimal complications.</p> Conclusion <p>Monopolar cutting diathermy significantly reduces intraoperative blood loss without compromising PMMC flap viability or postoperative outcomes. This technique enhances surgical efficiency and patient safety, particularly in resource-limited settings.</p>

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Comparative Evaluation of Intraoperative Blood Loss, Surgical Time and Outcome of PMMC Flap When Raised Using Scalpel and Monopolar Cutting Diathermy – in Vivo Study

  • 期刊论文

  • 发表日期：

    2025年12月22日

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  • Damini Goel,
  • Pushkar P. Waknis,
  • Digvijay Shitole,
  • Shubham Raut,
  • Pragya Borghate

摘要

Purpose

To evaluate and compare intraoperative blood loss, surgical time, and postoperative outcomes of pectoralis major myocutaneous (PMMC) flap elevation using traditional scalpel dissection versus monopolar cutting diathermy in patients undergoing reconstruction for oral squamous cell carcinoma (OSCC).

Materials and methods

This prospective observational study included 20 patients diagnosed with OSCC of the lower gingivobuccal sulcus, treated at the Department of Oral and Maxillofacial Surgery, Dr. D.Y. Patil Dental College and Hospital, Pune. Patients were recruited using a convenience sampling approach based on availability, willingness, suitability for surgery, and equipment availability. All procedures were performed by the senior author, who has over 25 years of experience performing PMMC flap elevations, ensuring a standardized technique across all patients. Intraoperative blood loss was quantified by standardized absorbent mop counts and suction volume (excluding irrigation fluid), and surgical time was recorded from incision to flap insetting. Flap viability was assessed using standardized clinical criteria including colour, capillary refill, and bleeding at the flap margins, independently evaluated by two experienced surgeons. Postoperative outcomes and complications were monitored over a six-month follow-up period.

Results

Both groups had comparable average operative times (Scalpel: 30.2 ± 3.5 min; Diathermy: 29.8 ± 3.2 min; p = 0.65). The scalpel group showed significantly higher intraoperative blood loss (225 ± 20 mL, ~ 5 mops) compared to the diathermy group (105 ± 15 mL, ~ 2 mops; p < 0.001). All flaps survived postoperatively, including those receiving adjuvant radiation, with minimal complications.

Conclusion

Monopolar cutting diathermy significantly reduces intraoperative blood loss without compromising PMMC flap viability or postoperative outcomes. This technique enhances surgical efficiency and patient safety, particularly in resource-limited settings.