Cold Steel Surgery Research Articles

Phonosurgery of Reinke’s edema with microdebrider

PurposeTo present our experience with a new microsurgical approach for treatment of the Reinke’s edema in suspension laryngoscopy–microdebridement. After a short review of existing literature we introduce speech therapy before and after the surgery into the protocol.Methods The authors compare the phonatory outcome, laryngostroboscopical results and subjective improvement of the voice of 30 patients with Reinke’s edema that were operated with either microdebridement or cold steel surgery techniques. “Sandwich” speech therapy strategy was applied for the vocal rehabilitation before and after surgery in both patient groups.ResultsAfter the microdebridement and the speech therapy the mucosal wave was regular, symmetric and periodic in all patients. No signs of abnormal scar tissue or anterior adhesions were observed. Significant improvement of vocal parameters was found after the surgery in both groups of patients: operated with the microdebridement technique and the cold steel technique. The subjective voice evaluated by Voice Handicap Index (VHI-10) was improved for both patient groups in a homogenous way.ConclusionsBased on the similarity of the vocal outcome in the two groups, microdebridement of the vocal folds is an excellent method for removing the edema of the Reinke’s space. Careful suction at a low voltage protects the lamina propria during the microdebridement. The authors discuss the indication to this innovating procedure in patients with difficult laryngeal exposure and small operating field.

Comparative Efficacy of the KTP Laser and Cold Steel in Office-Based Surgery for Oropharyngeal Papilloma.

Objective: This study aims to compare the efficacy of the potassium-titanyl-phosphate (KTP) laser and cold steel surgery in treating oropharyngeal papilloma. Methods: Between 2017 and 2020, we enrolled 242 patients with oropharyngeal papilloma who were treated with either the KTP laser (n = 160) or cold steel surgery (n = 82). Patient charts were reviewed for demographic data (age and gender), pathology, anatomical location of lesions, operative duration, pain rating, residual disease, and recurrence. Results: The oropharyngeal papillomas were successfully removed in all patients, except one with a significant pharyngeal reflex. There was no significant difference in the average time for lesion resection between KTP laser and cold steel group (18.11 ± 13.96s vs 19.43 ± 16.91s, P > .05). However, all patients who underwent cold steel surgery experienced bleeding during the operation and required postoperative observation (about 20min), making the total procedure time longer than that of the KTP laser procedure, which did not cause any intraoperative bleeding or require postoperative observation. After KTP laser treatment, the pain rating was .49 ± .98, whereas after cold steel surgery, it was .74 ± 1.12 (P = .058). Twenty-five samples were sent for human papillomavirus (HPV) testing, and one tested positive for both HPV 6 and 11 strains, while another tested positive for HPV 16. No residual disease or recurrence was observed at the treatment sites after a long period of follow-up (M = 15.35 ± 10.79mo; range = 6-39mo). Conclusion: The KTP laser provided a better hemostasis effect and a good surgical field of vision during the operation, allowing the surgeon to complete the procedure in less time. No significant difference in terms of pain rating, incision recovery, and postoperative recurrence between the KTP laser treatment and cold steel surgery.

Madelung's Disease - Case Series and Treatment by Tumescent Liposuction or Lipectomy.

Madelung disease is a disfiguring disorder belonging to the heterogeneous group of lipomatosis. The aetiology is not well understood, but alcohol consumption has been regarded as of importance. The reported incidence is about 1 in 25,000 inhabitants. We reviewed our files of the last ten years and identified eight adult patients with an equal gender distribution. Their age was between 60 and 85 years of life. Comorbidities are frequent. Clinical presentation may vary. Surgical treatment is reported and discussed. Both cold steel surgery and tumescent liposuction have their place in treatment.

Standard Guidelines of Care: Performing Procedures in Patients on or Recently Administered with Isotretinoin.

Background:Currently, the standard protocol regarding the performance of procedures on patients receiving or having recently received isotretinoin (13-cis-retinoic acid) states that the procedures should not be performed. The recommendations in standard books and drug insert require discontinuation of isotretinoin for 6 months before performing cosmetic procedures, including waxing, dermabrasion, chemical peels, laser procedures, or incisional and excisional cold-steel surgery. These recommendations have been followed for over two decades despite little evidence for the stated increased risk of scarring.Objective:The Association of Cutaneous Surgeons (I) constituted a task force to review the evidence and to recommend consensus guidelines regarding the safety of skin procedures, including resurfacing, energy-device treatments, and dermatosurgical procedures in patients with concurrent or recent isotretinoin administration.Materials and Methods:Data were extracted from the literature through a PubMed search using the keywords “isotretinoin,” “safety,” “scarring,” “keloids,” “hypertrophic scarring,” and “pigmentation.” The evidence was then labeled and circulated to all members of task force for review.Results:The task force is of the opinion that there is insufficient evidence to support the current protocol of avoiding and delaying treatments in the patient group under consideration and recommends that the current practice should be discontinued. The task force concludes that performing procedures such as laser hair removal, fractional lasers for aging and acne scarring, lasers for pigmented skin lesions, fractional radio-frequency microneedling, superficial and medium-depth peels, microdermabrasion, dermaroller, biopsies, radio-frequency ablation, and superficial excisions is safe in patients with concurrent or recent isotretinoin administration.

Retrospective analysis of earlobe keloids treated with the carbon dioxide laser ablation or cold steel debulking surgery

Background: Treatment of keloids is a therapeutic challenge. Objectives: To determine the outcome and the risk of recurrence after debulking cold steel surgery or carbon dioxide (CO2) laser ablation of earlobe keloids. Material and methods: The case records of 16 patients with earlobe keloids managed at Changi General Hospital, Singapore, from 2003 to 2009 were reviewed retrospectively. Results: Fourteen patients were females, and the mean age at presentation was 20 years. Eight patients underwent CO2 laser ablation, six patients underwent cold steel surgery, one patient underwent both surgery and CO2 laser ablation, and one patient received only 40 mg/ml of intralesional triamcinolone acetonide. Fourteen patients were followed up for 1–24 months post procedure, and two patients defaulted. Both modalities were equally effective in debulking the earlobe keloids. All 13 patients who had either CO2 laser ablation or cold steel surgery had recurrence of keloid growth at 2–18 weeks post procedure. The patient who received intralesional triamcinolone acetonide therapy alone had only partial response to the therapy. Conclusions: Both the CO2 laser ablation and cold steel surgery were equally useful in reducing the size of the earlobe keloids, but were not effective in preventing regrowth of the keloids, even with adjunctive intralesional steroids. Patients should be clearly counselled regarding this.

Reply to the letter to the editor by FG Dikkers: Laser-assisted microsurgery for intracordal cysts decreases cost-effectiveness, Eur Arch Otorhinolaryngol 2011, published online

First of all, we would like to thank Frederik Dikkers for his interest in our article: Matar N, Amoussa K, Verduyckt I, Nollevaux MC, Jamart J, Lawson G, Remacle M. CO2 laser-assisted microsurgery for intracordal cysts: technique and results of 49 patients. Eur Arch Otorhinolaryngol 267:1905–1909, as well as for his comments published recently [1]. Dr Dikkers is kind enough to recognize our expertise in laser technology and its application in microsurgery. We fully agree that the CO2 laser scanning technology is not the single best technique for treating intracordal cysts or any other benign vocal fold lesions. However, what we wanted to demonstrate is that lesions affecting the deep part of the lamina propria can be operated by CO2 laser without any injury the vocal ligament, provided that the parameters are strictly respected. That was considered impossible by many surgeons just some years ago. We have showed in a previous paper [2] that the coagulation along the incision line is 15 lm for ultra-pulse (median values) allowing sharp and precise section. Therefore, we agree that the functional results are similar for cold-steel or CO2-laser scanning, but we find presently the procedure easier to perform by CO2 laser. According to our biostatistician and co-author Jacques Jamart, calculation of medians is a popular technique in summary statistics and summarizing statistical data, because it is simple to understand and easy to calculate, while also giving a measure that is more robust in the presence of outlier values than is the mean [3]. With regard to the voice tone, we do not think that many readers of this journal are familiar with semitones and many instruments are calibrated in Hertz (Hz) [4]. Moreover, from what we know and contrary to what Dr Dikkers says, the frequency scale (Hz) by itself is not logarithmic, only the intensity scale is (in decibel or dB) [5]. This is true, however, that the pitch, a perceptual attribute of sound does not have a linear relationship with the fundamental frequency. The auditory system is more sensitive to some frequency changes than to others. In particular, the average listener is more sensitive to changes at lower frequencies. The semitone scale reflects actually this situation by an exponential growth function [6]. As we were dealing in our paper, not with the perception of the voice range, but with the improvement of the voice range itself, we found that expressing our results in hertz was more significant. We agree with Dr Dikkers that buying such an equipment only for phonosurgery would not be cost-efficient, but the versatility of this device is so extended: from cancer surgery to benign lesions of the vocal fold, from larynx and pharynx to middle ear and nose, from dermatology and gynecology to oto-rhino-laryngology.... With so many possible applications that cannot be performed by coldsteel surgery, spending money in laser technology makes a lot of sense for an institution or a group of practitioners.

Cold Steel Surgery for Blepharoplasty

Cold Steel Surgery for Blepharoplasty

Liposuction and surgical recontouring of the neck: a retrospective analysis.

With the advent of tumescent liposuction, many advances in cosmetic surgery have occurred. Liposuction of excess adipose tissue from the submental area, jowls, and neck, along with cold steel surgery, has become an attractive alternative to the facelift for cervicomental aesthetic surgery. To describe new techniques for tumescent neck liposuction, platysma repair, and subcutaneous musculoaponeurotic system plication, evaluate results, and assess complications with the procedures. We reviewed the results of the last 35 patients who underwent neck liposuction, simultaneous platysma plication, subdermal CO2 laser resurfacing, and/or subcutaneous musculoaponeurotic system plication at our institution. Three of 35 patients (9%) experienced mild complications from the procedure. Two of the three complications (66%) were in patients who underwent subdermal and/or platysma laser resurfacing at the time of liposuction. Good to excellent results were achieved in 91% of patients and fair to good results were achieved in 9%. No major complications such as nerve injury occurred. Neck liposuction can be a safe method for facial rejuvenation when performed properly. Platysma repair, and in some cases subcutaneous musculoaponeurotic system plication, can further improve results when combined with the liposuction procedure.

CO 2 laser surgery in veterinary dermatology

The carbon dioxide (CO 2) laser is an effective surgical tool in both human and veterinary cutaneous surgery. 1–6 The CO 2 laser can be used for incisional, excisional, or vaporizing procedures or can be an adjunct to conventional cold steel surgery.

Cold steel surgery

Cold steel surgery

CO2 laser blepharoplasty: A comparison to cold steel and electrocautery

Thirteen patients underwent blepharoplasty in a paired comparison study. A carbon dioxide laser was employed for one side while standard cold steel surgery and electrocautery was used on the contralateral side. In addition to reduced intraoperative time and bleeding, we found less postoperative ecchymosis and edema on the laser-treated side. Long-term follow-up showed no difference between the two sides when cosmetic end result and scars were compared.

Treatment of angiolymphoid hyperplasia of the external ear with carbon dioxide laser

Two women with long histories of angiolymphoid hyperplasia involving the left external ear were successfully treated with carbon dioxide laser vaporization. In one of these patients a previous treatment with argon laser photocoagulation had proved unsuccessful. Carbon dioxide laser vaporization can be advantageous in the treatment of angiolymphoid hyperplasia, especially when the patient is not a good candidate for cold steel surgery or when the disease process involves confined or convoluted structures such as those on the external ear.

Condyloma Acuminatum

Clinicians are confronting an epidemic of condyloma acuminatum. This disease classically has been recognized as flesh-colored, focal, verrucous tumors located on the genitalia and in the anorectal region; however, it has a much wider clinical spectrum and also may occur on any mucous membrane. A manifestation of the human papillomavirus (HPV), condylomata acuminata are defined by the presence of HPV rather than clinical appearance. Condyloma acuminatum may be a precancerous condition. Standard treatment has included podophyllum, cryosurgery, cold-steel surgery, laser surgery, and immunotherapy.

CO2 Laser Blepharoplasty: A Comparison to Cold Steel and Electrocautery

Thirteen patients underwent blepharoplasty in a paired comparison study. A carbon dioxide laser was employed for one side while standard cold steel surgery and electrocautery was used on the contralateral side. In addition to reduced intraoperative time and bleeding, we found less postoperative ecchymosis and edema on the laser-treated side. Long-term follow-up showed no difference between the two sides when cosmetic end result and scars were compared.

Phenol Alcohol Technique for Permanent Matricectomy

A simple technique for partial or complete destruction of the nail matrix with the use of phenol alcohol is outlined. A retrospective analysis of 30 random patients suggests that it has a low morbidity, is easy to perform, and has a high success rate. Therefore, it offers an excellent option to cold steel surgery, especially for the nonsurgically oriented dermatologist.

Skin Surgery

The recent proliferation of weapons designed to attack lesions of the skin has caused this formerly slim 228-page volume to balloon to a bulging 647 pages. This new edition fulfills the need for an updated text which creates order out of a confusing array of procedures (laser, cryoprobes, fluorouracil, immunological agents, electrosurgery, etc). Thirtytwo authors have contributed. <i>Skin Surgery</i>is divided into five sections: general considerations, cold steel surgery, electrosurgery, special procedures, and special locations of diseases. The section on special procedures is particularly rich in new contributions: Mohs, who has dedicated most of a distinguished career to his meticulous, controlled means of chemosurgery, gives a concise overview of this technique and results. Dillaha gives an excellent account of topical application of fluorouracil for keratoses. In a provocative study of immunotherapy, Klein relates how an induced hypersensitivity to topical triethyleneiminobenzoquinone causes the disappearance of extensive keratoses, multiple superficial basal cell