The effect of diathermy setting on post-operative seroma following abdominoplasty

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Abdominoplasty is one of the most common plastic surgery procedures performed in Australia. A common complication of abdominoplasty is the formation of post operative seroma, which is thought to be influenced by dissection technique utilised by the surgeon. We propose to conduct a study of patients undergoing abdominoplasty, comparing seroma rates with three different diathermy settings. The proposal will be a prospective, randomised, study of consecutive patients undergoing abdominoplasty, with no exclusion criteria. Only patients consenting to involvement will be included. For excision of tissue and dissection of flaps, a monopolar coagulation diathermy with power setting of 20W will be used for one group, a monopolar coagulation diathermy with power setting of 35W will be used in the second group, and a monopolar cutting diathermy with power setting of 35W will be used for the third group. All three diathermy settings are well within usual range of setting used for diathermy and pose negligible additional risk to patients in either group. We hypothesize that the lower diathermy and cutting settings will result in lower seroma rates, due to less soft tissue damage during dissection. The general surgical technique involves scalpel skin incision, monopolar dissection, liposuction, rectus divarification repair where indicated, and layered soft tissue closure. Compression garment’s will be placed at the conclusion of surgery and continued fulltime for 6 weeks. Patient demographic factors and surgical technique baseline characteristics will be compared. Drains will be emptied at midnight daily by ward nurses who are blinded to the study, with outputs documented at 24-hour intervals. Postoperative mobilisation commences on day 1, with a physiotherapist. Drains will be removed when they were <30ml/d for 2 consecutive days. Data collected will include: baseline demographics, surgical technique, daily drain outputs, time to removal of drains, development of postoperative complications. If complications include seroma or haematoma, the size, location and subsequent management will be noted. Follow up period for the purpose of this study will be 6 weeks post operatively.

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