Making Skin Incision Research Articles

Needle-tip electrocautery versus steel scalpel incision in neurosurgery: study protocol for a prospective single-centre randomised controlled double-blind trial

IntroductionElectrocautery is used widely in surgical procedures, but making skin incision has routinely been performed with scalpel rather than electrocautery, for fear that electrocautery may cause poor incision healing, excessive...

Effect of making skin incision with electrocautery on positive Cutibacterium acnes culture rates in shoulder arthroplasty: a prospective randomized clinical trial

Cutibacterium acnes remains the most commonly detected organism in shoulder arthroplasty. C. acnes infection is thought to occur during shoulder arthroplasty through contamination of the surgical field with C. acnes from the incised dermis. The purpose of this study was to examine whether using electrocautery for making skin incisions would decrease C. acnes culture rates at the incised dermis compared to using scalpels during shoulder arthroplasty. Patients undergoing primary shoulder arthroplasty were randomized into 2 groups, Electrocautery vs. Scalpel incision group. All patients received a standard preoperative antiseptic preparation including chlorhexidine gluconate showers, intravenous antibiotic administration, and topical application of hydrogen peroxide, povidone iodine, isopropyl alcohol, and DuraPrep. Cultures were obtained from the incised dermal edge immediately after skin incision and later from surgeon's gloves and forceps immediately prior to humeral component implantation. The primary outcome was positive C. acnes culture rates compared between the groups. A total of 64 patients (32 in each group) were enrolled. There were 24 males in each group. Regarding dermis cultures, 10 patients (31%) in the Scalpel group were positive with 8 of them positive for C. acnes, whereas no patients in the Electrocautery group were positive (p < 0.001). Regarding glove cultures, the Electrocautery group had 8 patients positive C. acnes, while the Scalpel group had 8 (p = 0.777). Regarding forceps cultures, the Electrocautery group had 4 patients positive for C. acnes, and the Scalpel group had 6 (p = 0.491). All positive cultures were exclusively from male patients. There were no wound complications or infection in the Electrocautery group while the Scalpel group had one acute postoperative infection. Making skin incisions using electrocautery resulted in zero C. acnes culture at the incised dermis, suggesting its potential effect against C. acnes. However, despite this initial antibacterial effect, C. acnes still appeared on surgeon's gloves and forceps during surgery of male patients. All positive cultures were from male patients, suggesting that the source of C. acnes was specifically related to the male body. While the study hypothesis was supported by the results, the present study also raises new questions and calls for further research.

40. Understanding Periprosthetic Capsule Pathology in Pre-pectoral Versus Sub-pectoral Implant-based Breast Reconstruction: Development of a Rat Model

PURPOSE: Clinical practices in implant-based breast reconstruction continue to evolve with ongoing innovation in both the surgical approach and implant design. Development of standardized models is increasingly important to evaluate the effect of these changes in the outcomes of implant-based reconstruction. In this study, we designed a physiological rat breast implant model to assess the effects of pre-pectoral and sub-pectoral implant placement on breast implant capsule formation. METHODS: Miniature silicone implants measuring 2cc in diameter were optimized for placement in the pre-pectoral and sub-pectoral planes bilaterally in Lewis rats for an internally controlled model. A submammary approach was simulated in rats by making skin incisions at the inferior aspect of the pectoralis muscle bilaterally. For sub-pectoral implant placement the lateral edge of the pectoralis muscle was elevated, a sub-pectoral plane was established with blunt dissection, and a sterile implant was secured in the sub-pectoral plane with complete pectoralis coverage. For pre-pectoral implant placement, blunt dissection was used on the contralateral side to establish a subcutaneous plane. A sterile implant was secured in this subcutaneous pocket. Samples were harvested at 12 weeks and histological analysis of capsule formation was performed with H&E and Trichrome staining. RESULTS: The rats showed immediate signs of bilateral forelimb use with walking and grasp following recovery from anesthesia. The surgical sites healed well over two-week follow-up with no signs of wound-site mutilation, discomfort, or dehiscence. Histological analysis demonstrated both pre-pectoral and sub-pectoral capsule formation compared to sham surgery samples. Prepectoral implant capsules showed lamellar collagen architecture whereas subpectoral implant capsules demonstrated increased thickness, hypercellularity and synovial metaplasia. CONCLUSIONS: This model demonstrates that a physiological approach with pre-pectoral and sub-pectoral implant placement to model breast implant reconstruction is feasible in rats and thus improves upon previous models that utilize dorsal subcutaneous pockets instead of pectoral planes. These earlier approaches do not replicate the anatomy and mechanics of the clinical prepectoral and subpectoral space. Additionally, this model demonstrates differences in the periprosthetic fibrotic processes in pre-pectoral and sub-pectoral approaches for implant placement. This model facilitates further mechanistic understanding of the physiology and pathology associated with breast implant reconstruction including outcomes such as capsular contracture and BIA-ALCL and will provide a valuable platform to test treatments and strategies that may mitigate them.

Contralateral Inside-out Biportal Endoscopic Posterior Cervical Foraminotomy: Surgical Techniques and Preliminary Clinical Outcomes

Objective: The aim of this study was to describe the surgical techniques and preliminary results of inside-out biportal endoscopic posterior cervical foraminotomy (BEPCF) for unilateral cervical radiculopathy.Methods: This study involved 36 consecutive patients (38 segments) who underwent BEPCF for unilateral cervical radiculopathy between November 2020 and June 2022. Foraminotomy was performed using the biportal endoscopic technique, with the surgeon standing on the opposite side and making skin incisions on the same side of the foramen stenosis. After widening of the V-point and exposing the nerve root using a high-speed drill, we used a curved osteotome to undercut the facet joint from inside the foramen to complete the nerve root decompression. Results: The study followed patients for an average of 15.5 months and found significant improvements in the visual analog scale for arm pain, from 7.3 ± 2.2 to 0.9 ± 0.7 (P &lt; 0.005), and the Neck Disability Index, from 54.6 ± 16.9 to 14.6 ± 12.6 (P &lt; 0.005). Almost all patients (94.4%) had good or excellent results. Hospitalization lasted an average of 3.2 days and postoperative magnetic resonance imaging showed successful neural decompression. Complications were minimal, with only two cases of asymptomatic root abrasions and one case of transient neuralgia. One patient required re-operation due to incomplete decompression.Conclusion: BEPCF is a safe and effective surgical technique for treating cervical radiculopathy. The surgeon can achieve good neural decompression and preserve the facet joint using the inside-out approach in an ergonomic setting.

Comparison Of Midline Abdominal Surgery Using Scalpel Versus Electrocautery Incision in Rural Indian Population

The scalpel was considered a gold standard for making skin incisions until the inception of diathermy. Nowadays, electrodes used in making diathermy incisions generate a pure sinusoidal current which produces cleavage in the tissue planes without creating damage to surrounding areas, thus leading to minimal burn-related wound complications.4 Hence, this study was carried out to determine whether electrocautery is safe and effective for making skin incisions as compared to a scalpel for midline abdominal surgery. OBJECTIVE: The object of the study was to compare electrocautery incision with scalpel incision in terms of incision time, blood loss, postoperative pain and wound infection. The objective was to determine whether electrocautery is safe and effective for making skin incisions as compared to a scalpel for midline abdominal surgery. Methodology: Patients scheduled for midline abdominal surgeries and willing to participate in the study were randomized into two groups- group A (electrocautery group) and group B (scalpel group). Results: In this study, 52 patients were included and divided into two groups, of which 26 were in group A and 26 were in group B. Intraoperative blood loss and incision time are less while using electrocautery as compared to a scalpel. In terms of postoperative pain and wound complications, there was no discernible variance between the two groups. Conclusion: The use of electrocautery for making skin incisions in midline abdominal surgery was associated with less intraoperative blood loss and less incision time as compared to a scalpel. There was no variance in postoperative pain and wound complications between the two groups. With the above advantages of electrocautery, we conclude that electrocautery is a safe and effective alternative to a scalpel in making skin incisions in midline laparotomy.

Cutting Monopolar Needle Electrode of Electrosurgery, a Safe Tool for Skin Incision in Neurosurgery

In ancient time heat was used to treat wounds. Now a days electrosurgery unit (ESU) is an important part of operation theatre equipments utilized by almost every surgeon. Electrocautery and diathermy are the term used by many operations theatre medical and paramedical persons including surgeons for electrosurgery. They altogether are three different things. Cutting monopolar needle electrode of electrosurgery is a safe tool for skin incision in neurosurgery but hardly very few surgeons are utilizing it as a tool for making skin incision. Reason for not using it probably is the fear of poor wound healing and deep burn of underline tissue or awareness about it. The objective of this case study is to bring awareness about 'cutting monopolar needle electrode of electrosurgery' as an available tool for skin incision in neurosurgery with less blood loss and marked reduction in incision time than stainless steel surgical blade.

Comparison between scalpel incision and electrocautery incision in midline abdominal surgery: a comparative study

Background: Fear of poor wound healing have curtailed the use of diathermy for making skin incision. Scalpel produces little damage to surrounding tissue but causing more blood loss. Our aim of study was to compare electrocautery incision with scalpel incision in terms of incision time, blood loss, postoperative pain and wound infection.Methods: Total of 104 patients were included in the study undergoing midline abdominal surgery. Patients were randomized into electrocautery (group A) and scalpel (group B). The incision dimension, incision time and blood loss were noted intraoperatively. Postoperative pain was noted on postoperative day 2 using visual analog scale. Wound complications were recorded on every postoperative day till the patient was discharged.Results: 52 patients in each of the two groups were analyzed. There was significant difference found between group A and group B in terms of mean incision time per unit wound area, 8.16±1.59 s\cm2 and 11.02±1.72 s\cm2 respectively (p value=0.0001). The mean blood loss per unit wound area was found to be significantly lower in group A (0.31±0.04 ml\cm2) as compared to group B (1.21±0.21), p value=0.0001. There was no significant difference noted in terms of postoperative pain and wound infection between both groups.Conclusions: Electrocautery can be considered safe in making skin incision in midline laparotomy compared to scalpel incision with comparable postoperative pain and wound infection with less intraoperative blood loss and less time consuming.

Randomised Controlled Clinical Trial of Scalpel Versus Diathermy for Abdominal Skin Incisions

Since the early twentieth century, diathermy has been increasingly used for tissue dissection and haemostasis, but the surgeons, however, are reluctant to use surgical diathermy for making skin incisions. This reluctance is now being challenged by multiple studies suggesting diathermy to be a safer option. This was a randomised, clinical study conducted in the department of General and Gastrointestinal Surgery at Calcutta Medical Research Institute, Kolkata in 2017. The study was done to evaluate the diathermy as an effective alternative to scalpel blade in making skin incisions in elective abdominal surgeries. A total of 72 patients undergoing abdominal surgeries were included and randomly divided into diathermy and scalpel groups. Both groups were compared based on incisional blood loss, early postoperative pain, wound complication rates, and cosmetic outcome of scar by Patient-Observer Scar Assessment Scale. After exclusion, a total of 72 patients, 36 each from the two groups, were analysed based on the above mentioned parameters. We found that the incisional blood loss is significantly lesser in the diathermy group in comparison to that of the scalpel group (p < 0.001). Also, the early postoperative pain was significantly lesser in the diathermy group (p < 0.001). Postoperative wound complication rates were comparable between the two groups, and postoperative scar cosmesis is significantly better with the use of diathermy (p < 0.001). In our study, we found that the diathermy is an effective and safe alternative to the steel scalpel blade for making abdominal skin incisions in elective procedures.

After Incision, the Skin Knife Blade Is No More Contaminated Than a Fresh Knife Blade.

The rationale for discarding the skin knife blade and replacing it with another blade for deeper dissection is to prevent bacteria that may be present on the skin from being carried into the deeper layers of the wound. This practice is very controversial because numerous, yet limited, studies exist that support and refute the findings. The purpose of this study was to directly compare the rate of contamination of a skin knife blade with a control blade. We took the surface samples using Replicate Organism Detection and Counting plates of 344 knife blades immediately after making skin incision during the following four types of orthopaedic cases: total hip arthroplasty, total knee arthroplasty, lumbar spine surgery, and cervical spine surgery. At the same time, we sampled 344 control blades. The comparison of positives skin versus control, overall and within each subgroup was done using a bivariate two-sample z-test for the equality of proportions. Overall, 35 (5.1%) of the 688 specimens had a positive result. No difference was noted in the rate of positive cultures for the 344 skin blades 4.9% and the 344 control blades 5.2%. No differences were observed in the rate of positive specimens for skin blades (7.4%, 3.4%, 7.7%, and 3.9%) and control blades (2.5%, 4.1%, 7.7%, and 9.2%) for total hip arthroplasty, total knee arthroplasty, C spine, and L spine, respectively. No differences were observed regarding skin prep, room number, case order, room turnover time, or in-room to incision time. Staphylococus species was the predominant bacteria identified. We found no evidence to support the theoretical advantage of changing the knife blade after making skin incision to avoid contamination. Contamination rates were the same for both the skin and control blades overall and for all subgroup analysis.

Evaluation of various carbon dioxide laser settings on the time and number of laser beam passes required to make a full-thickness skin incision and amount of laser-induced tissue artifact.

To evaluate the time and number of laser beam passes required to make full-thickness skin incisions and extent of laser-induced tissue artifacts following use of a CO2 laser at various settings. 24 skin specimens from six 5-month-old porcine carcasses. 4 full-thickness skin specimens were harvested from the flank regions of each carcass within 30 minutes after euthanasia and randomly assigned to 4 treatment groups. Three 5-cm-long incisions were made in each specimen with a CO2 laser (beam diameter, 0.4 mm) set to deliver a continuous wave of energy alone (groups 1 and 2) or in superpulse mode (groups 3 and 4) at 10 (groups 1 and 3) or 20 (groups 2 and 4) W of power. The time and number of passes required to achieve a full-thickness incision were recorded, and extent of laser-induced tissue artifact (as determined by histologic evaluation) was compared among the 4 groups. Mean time required to make a full-thickness skin incision for groups 2 and 4 (power, 20 W) was significantly less than that for groups 1 and 3 (power, 10 W). Mean number of passes was lowest for group 2 (continuous wave at 20 W). Extent of laser-induced tissue artifact was greatest for group 4 (superpulse mode at 20 W). Results provided preliminary information regarding use of CO2 lasers to make skin incisions in veterinary patients. In vivo studies are necessary to evaluate the effect of various CO2 laser settings on tissue healing and patient outcome.

Clinical Outcome of Surgical Diathermy in Elective Surgery-Prospective Randomized Controlled Tria

Background: Recent studies suggest that surgical diathermy shows better clinical outcome in the context of incision time, wound related postoperative pain, postoperative wound infections, and length of postoperative hospital stay and cosmetic outcome of scar in cases of elective surgical patients. Objectives: Compare the efficacy and safety of surgical diathermy versus conventional surgical blade for making skin incisions in elective mid-line laparotomy and to evaluate weather cutting diathermy is an effective and better alternative to surgical blade incision.&#x0D; Materials and Methods: This prospective study was carried out in the department of surgery at BSMMU, Dhaka over a period of one year. Sample size was 64 with a follow up duration for 6 month. In Group I (D), skin incision was taken with diathermy, and in Group II (S), incision was taken with surgical blade.&#x0D; Results: Compared with a scalpel incision, cutting diathermy resulted in significantly shorter incision times and reduced post-operative wound related pain (P = &lt;0·001), shorter duration of postoperative hospital stay (P = 0.003) with no differences in the wound complication rate and cosmetic outcome of scar.&#x0D; Conclusions: The study has demonstrated that surgical cutting diathermy is a safe and effective method to make skin incisions in elective surgery&#x0D; KYAMC Journal Vol. 10, No.-3, October 2019, Page 143-146

Cardioprotective effect of lithium chloride on a rat model of myocardial infarction

Aim. To investigate the cardioprotective effect of lithium chloride in vivo on a rat model of myocardial infarction.Methods. Twelve male Sprague-Dawley rats were randomly divided into two groups of six, with both groups modelling cardiac ischaemia and subsequent reperfusion. At the start of reperfusion, 30 mg/kg of 4.2% lithium chloride solution was intravenously administered via a catheter to the test group and 0.5 ml/kg of saline solution was administered to the comparison group. A control group comprised sham-operated rats that were not injected with any drugs other than anaesthesia during making skin incision. At the end of each experiment, the total area of the risk zone and areas of the infarction zone and left ventricle were calculated for each animal using a double-staining technique with 2% methylene blue and 1% triphenyltetrazolium chloride. A further series of experiments using 15 male Sprague-Dawley rats (third group) was performed to assess the protein content of glycogen synthase-3β in myocardial tissue. The method was similar to that for the earlier experiments; however, at the end of the experiments, the hearts were removed and homogenised, following which the concentration of glycogen synthase-3β was determined using electrophoresis.Results. The group treated with lithium chloride showed a significant decrease in the area of the infarction zone compared with the group treated with saline. The difference in the indices between the two groups was &gt;26% (p &lt; 0.05).Conclusion. This study demonstrated that 30 mg/kg of 4.2% lithium chloride solution, administered at the onset of reperfusion, exerted a protective effect on cardiomyocytes in a rat model of myocardial infarction by reducing the area of the infarction zone compared with that in the control group. This effect was probably mediated by an almost two-fold increase in the content of the phosphorylated form of glycogen synthase-3β in the myocardium. Received 23 June 2019. Revised 6 August 2019. Accepted 7 August 2019. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Author contributionsConception and study design: A.N. KuzovlevData collection and analysis: O.A. GrebenchikovStatistical analysis: A.V. ErshovDrafting the article: A.V. Lobanov, E.R. ShayhutdinovaCritical revision of the article: V.V. LikhvantsevAll authors approved final version to be published

Scalpel versus diathermy skin incision in Caesarean section

Surgical scalpels are traditionally used for skin incisions during a Caesarean delivery; the great evolutions in electrosurgical devices bring an alternative method for skin incision by the usage of cutting diathermy. This was a prospective randomised comparative study conducted during the period from March 2016 to February 2017 on 200 patients, 100 patients had skin incisions using the surgical scalpel, while 100 patients had skin incisions with a diathermy, in order to judge the variations in the postoperative pain, the incision time, the incision blood loss, the operative time, the wound healing and the wound complications. We observed a significant difference between the two groups regarding the incision time (p < .001), incisional blood loss (p < .001), operative time (p < .001) and the postoperative pain (p < .001), where these parameters were less in the diathermy group. No significant difference observed between the two groups regarding the wound healing (p = .389) and wound complications (p = .470). We can conclude that the proper usage of diathermy in making the skin incision during a Caesarean section in this study achieved better results than the scalpel incision.Impact statementWhat is already known on this subject? Surgical scalpels are traditionally used in making the skin incisions during a Caesarean section; diathermy incisions, on the contrary, are less popular among the surgeons. It has been hypothesised that the application of extreme heat may result in a significant postoperative pain and poor wound healing. There has been a widespread use of diathermy for hemostasis but fear of production of large scars and improper tissue healing has restricted their usage in making skin incisions.What do the results of this study add? The use of diathermy for skin incisions in Caesarean section in this study was associated with a reduced incisional blood loss, incisional time, operative time and postoperative pain. It had no effect on wound closure and was not associated with any delay in wound healing. Also, the wound complications rate was equal in both types of incisions.What are the implications of these findings for clinical practice and/or further research? Most surgeons prefer the scalpel in making skin incision during a Caesarean section due to the fear of surgical site infection. Our findings proved different, we proved that cutting diathermy could be accepted as an alternative technique for making a skin incision without increased rates of wound infections. Also, the advantages of cutting diathermy will give benefits to both the patients and the surgeons.

Scalpel versus diathermy skin incisions in cesarean sections

Objective The aim was to compare the use of diathermy versus scalpel in making skin incision during cesarean section to judge the variations in postoperative pain, incision time, incisional blood loss, operative time, wound healing, and wound complications. Background Surgical scalpels are traditionally used for making skin incisions during cesarean delivery. The evolutions in electrosurgical devices bring an alternative method for making skin incision by the usage of cutting diathermy. Patients and methods This was a prospective, randomized comparative study conducted during the period from March 2016 to February 2017 on 200 patients; 100 patients had skin incisions using the surgical scalpel, while 100 patients had skin incisions with diathermy. The comparison between the two groups was done regarding postoperative pain, incision time, incisional blood loss, operative time, wound healing, and wound complications. Results We observed a significant difference between the two groups regarding incision time (P Conclusion The use of diathermy for skin incisions to perform cesarean section in this study was associated with reduced incisional blood loss, incisional time, operative time, and postoperative pain. It had no effect on wound complications, and was not associated with any delay in wound healing. We can conclude that the usage of diathermy in making skin incision during cesarean section in this study achieved better results than scalpel incision.

Diathermy versus scalpel incisions in elective abdominal surgery: a comparative study

Background: Scalpel incisions produce little damage to surrounding tissues. There has been a widespread use of diathermy for hemostasis but fear of production of large scars and improper tissue healing has restricted their usage in making skin incisions. Use of diathermy in skin incisions reduces bleeding and makes the incision quicker, but there are no differences in wound burst strength. Objective of the study was to compare the use of diathermy and scalpel incisions in elective abdominal surgery’s to see the variations in incisional time, blood loss during incision, postoperative pain and wound complicationsMethods: This was a prospective randomized study, which included patients above 18 years who underwent elective abdominal surgery. The patients were randomly included into Group A or Group B. In Group A incision was made with a scalpel and in group B with diathermy. Data was analyzed for incisional time, blood loss during incision, postoperative pain and wound complications.Results: There was a significant increase in mean time taken for incision in Group A when compared to Group B. Mean incision blood loss was found to be significantly higher in group A compared to group B patients. Postoperative pain was significantly higher in group A (p value &lt;0.05) on postoperative day 1. Among wound complications, no statistically significant differences were seen between the two groups.Conclusions: Electrocautery incisions were safe, less time consuming, reduced blood loss and had less postoperative pain. We conclude that diathermy could be accepted as an alternative method for surgical skin incisions.

Application of Radio Frequency in the Management of Neurofibroma

The usual practice of making skin incisions by a scalpel leads to more bleeding and time spent on achieving hemostasis. An alternative to this is to use electromagnetic radiation of high frequency in the form of radiofrequency to make skin inciosns that are more precise, accurate, associated with less bleeding and in turn less time consuming giving more defined result. Neurofibromatosis type 1 is associated with multiple swellings all over the body with surgical management required for aesthetic reasons or for symptomatic swellings.

Evaluation of Pain Following the Use of Scalpel versus Diathermy for Skin Incision in Ear, Nose, Throat and Head and Neck Surgeries

Many studies have shown the benefits of diathermy over scalpel for making skin incisions in terms of post operative pain and post operative analgesics requirement. The objective of the study is to compare the pain following incision by scalpel and diathermy for skin in ENT surgery. We conducted a prospective, randomized study and compared early post operative pain and analgesics requirement in patients undergoing ENT and Head and Neck surgery in Department of ENT at Kathmandu Medical College from September 2016 to August 2017. The statistical analysis was done using MS Excel and SPSS software. Out of 65 participants, 31 were allocated in scalpel group and 30 were allocated in diathermy group. The mean VAS score was significantly greater in scalpel group as compared to diathermy group in post operative 12, 24 and 48 hours (P<0.05). The mean ketorolac requirement was significantly more in scalpel group than in diathermy group in post operative 24 hours. The early post operative pain is less in ENT-Head and Neck surgery patients with skin incision by diathermy as compared to the patients with skin incision by scalpel.

Anatomy and Applications of the #15 Scalpel Blade and Its Variations.

Scalpels have been used to make skin incisions since the advent of “modern” dermatosurgery. #15 Scalpel blade and #3 handle (Bard-Parker handle) are most frequently used by a dermatosurgeon. Besides the proper equipment, appropriate technique is mandatory to ensure a “precise” incision. In this article, we discuss about the anatomy, variations, and different uses of the #15 scalpel blade and the ideal method of making a “precise” skin incision.

A Comparative Study of Electrocautery Versus Cold Scalpel For Skin Incision In Inguinal Hernia Repair

Introduction: Electrocautery has been widely used except for the skin incisions; this is because of the fear of scarring of skin, post operative pain, poor wound healing and wound infection in view of devitalisation of tissues. Although still not very popular, yet the use of diathermy instead of scalpel for making skin incision and underlying tissue dissection is gradually gaining wide acceptance. The purpose of this study was to compare the scalpel incision with electrocautery incision over skin in patients undergoing hernia repair.Aims and Objectives: To compare the skin wound made by the diathermy and scalpel with a view in; intraoperative incision time, post operative pain, requirement of analgesia and the quality of wound healing.Material and Methods: This is hospital based comparative study, undergone elective inguinal hernia repair in the department of general surgery at Nepalgunj medical college teaching hospital, Kohalpur from the period of July 2015 to January 2016. Group A, contained 30 patients who underwent skin incision with scalpel and Group B, also contained 30 patients who underwent skin incision with electrocautery. These groups were compared and statistical analysis using SPSS (version 20) was done and p value 0.05 was taken as significant.Results: Compared with a scalpel incision, cutting diathermy resulted in significantly shorter incision time (p &lt;0.002). The two groups did not differ in relation to post operative pain and the post operative analgesics requirements. The postoperative complications viz, seroma and purulent collections were in both the groups though the hematoma collection was seen more in scalpel skin incision.Conclusion: Skin incision made by cutting diathermy was less time taking and there was no appreciable differences in postoperative pain, the requirements of analgesia and the rate of wound complications like seroma, and purulent collection, though the hematoma was seen more in scalpel skin incision. So the use of diathermy for making skin incision is as safe as the use of scalpel in patients undergoing inguinal hernia repair. JNGMC Vol. 14 No. 1 July 2016, Page: 14-17

A comparative study to evaluate the outcome between electrocautery versus scalpel skin incision in tension free inguinal hernioplasty: a tertiary care teaching centre experience

Background: The use of cutting electrocautery instead of scalpel for skin incision is still suboptimal worldwide. There are many studies which include its use in general surgical operations but without use of prothetic material mostly, so our study aimed at its use in operations which include use of prosthetic material during abdominal wound closure means in tension free inguinal hernioplasty, exclusively. The objective of this study was to evaluate whether the application of extreme heat by cutting electrocautery may result in significant postoperative pain and poor wound healing with increased risk of wound infection in presence of underlying prosthetic material and poor cosmesis because of excessive tissue damage and scarring respectively as per previous hypothesis or it’s safe and effective instead. Methods: This is a retrospective clinical study conducted in the Department of Surgery, of a teaching tertiary care hospital in Sola, Ahmedabad between May 2013 to April 2014. Patients were allocated consecutively to have either scalpel or cutting electrocautery incisions. The duration used in making the skin incision; the incisional blood loss and the ensuing length and depth of the wound were noted. Postoperative pain; duration of wound healing and the occurrence of surgical site infection and cosmetic outcome were also noted. Results: A total of 196 consecutive patients included to inguinal hernioplasty using the tension-free technique and fulfilling the inclusion criteria for the study were allocated alternately to either electrocautery (n=98) or scalpel (n=98) groups. The ages ranged from 16 to 73 years. The demography, case distribution and body mass index were similar in both groups. The incision time was shorter in the electrocautery group (P <0.001). The blood loss was less with the electrocautery compared to the scalpel (6.53±3.84 ml vs. 18.16±7.36 ml, P<0.001). The cumulative numerical rating scale score for pain was 12.65 (standard deviation SD 8.06) and 17.12 (SD 9.49) in the diathermy and scalpel groups respectively (P<0.001). There was no statistically significant difference in wound infection and wound closure (epithelialization time) (P=0.206). Conclusions: The use of cutting electrocautery in making skin incision during inguinal hernioplasty is as safe as scalpel in terms of wound healing and cosmesis and is also associated with reduced incision time, incisional blood loss, and postoperative pain.