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Initial Experience Using Harmonic Ultrasound Coagulation (Focus from Ethicon) Versus Bovie Electrocautery in Reducing Lymphatic Wound Complications for Femoral Artery Dissections
Objective
Lymphatic complications following femoral artery dissections can serve as a potential nidus for wound infections with other devastating sequelae. There is evidence to suggest that the use of harmonic ultrasound coagulation may decrease the wound complication rate when used for other anatomic dissections. The usefulness of this low-frequency ultrasound technology for femoral artery dissections was studied with the specific aim of reducing the incidence of lymphoceles and lymphocutaneous fistula formation.
Methods
This is a retrospective review of patients who underwent a femoral artery cutdown procedure in an eleven month time period. All inguinal dissections were completed with either harmonic ultrasound coagulation or bovie electrocautery based on surgeon preference and equipment availability. Pre-operative demographic information, type of surgery, and post-operative course were recorded. Post-operative complications, including lymphoceles or lymphocutaneous fistula formation, detected by clinical exam were recorded.
Results
During the study period, 124 patients receiving 150 femoral artery dissections were included. A total of 16 lymphatic complications occurred (10.67%); 10 lymphoceles and 6 lymphocutaneous fistulas. Three of the complications (all lymphoceles) occurred in the harmonic ultrasound coagulation group (4.2%) versus 13 in the bovie electrocautery group (16.5%).
Conclusion
In this retrospective review, there were fewer wound complications related to lymphatic leaks when harmonic ultrasound coagulation was used in femoral artery dissections. Larger, prospective studies are needed to further assess the significance of decreased wound complications using harmonic ultrasound coagulation.