Surgical Scalpel Research Articles

Enhanced restoration of in situ-damaged hairs by intradermal transplantation of trichogenous dermal cells.

We developed a nude rat model for determining the capacity of trichogenous cells to restore in vivo-damaged hair follicles (HFs). A surgical scalpel was inserted into the rat's dermis to generate the in vivo-damaged pelage HFs, the HFs whose lower parts were lost, but the upper parts containing sebaceous and bulge regions remained intact. Dermal papilla cells (DPCs) and dermal sheath cells (DSCs) from EGFP transgenic rat vibrissae were propagated in culture, and each alone (DPC or DSC) or a mixture (DPC/DSC) was transplanted into the intradermal path made by a scalpel. It was found that the in vivo-damaged HFs had hair self-restoration ability, and the transplanted trichogenic dermal cells prominently enhanced this ability, DPC/DSC transplants being more effective in enhancement than DPC or DSC alone. The restored bulbs contained EGFP-positive cells, shed their original straight shafts, generated new shafts, and further developed into hairs with a sebaceous gland and bulge structures by ~6 weeks post-transplantation. Compared to the preceding animal models, this model is less invasive, requires fewer donor cells and allows repeated operations with higher reproducibility and accuracy. The present study suggests that conditions causing in situ-damaged HFs, such as androgenic alopecia, in which HFs are damaged and miniaturized, can be restored by functional trichogenous dermal cell transplantation therapy. Copyright © 2015 John Wiley & Sons, Ltd.

Counterion-activated nanoactuator: reversibly switchable killing/releasing bacteria on polycation brushes.

A strategy to release attached bacteria from surface-grafted bactericidal poly((trimethylamino)ethyl methacrylate chloride) (pTMAEMA) brushes has been proposed. The pTMAEMA brushes were fabricated via the surface-initiated atom transfer radical polymerization for contact killing of bacteria, including Escherichia coli, Staphylococcus epidermidis and Stenotrophomonas maltophilia. The bacteria-conditioning surfaces, afterward, were washed with electrolyte solutions containing anions with different lipophilic characteristic, charge density, polarity and adsorbility to quaternary ammonium groups in polymers. Because of the special ion-pairing interactions, the interfacial properties, including wettability and ζ-potential, can be manipulated in a controlled manner. Therefore, the counterion-assisted modulation of pTMAEMA brushes facilitates the bacterial release and regeneration of antimicrobial polymer films. The physicochemical properties of polymer brushes and their interactions with counterions were characterized using an ellipsometer, contact angle goniometer, X-ray photoelectron spectroscopy and an electrokinetic analyzer. The repetitive killing and releasing actions of pTMAEMA through unlocking and locking counterions were demonstrated, showing the robust effectiveness of the pTMAEMA-based nanoactuator in controlling the physical action by the chemical stimuli. The real-world implementation of the nanoactuator was demonstrated with a surgical scalpel by repelling killed bacteria and retaining reusability.

Comparison of labial frenectomy procedure with conventional surgical technique and diode laser

Background: An Aberrant frenum encroaches the gingival health when it is attached too closely to the gingival margin, either due to interference in the plaque control or due to a muscle pull. Such condition has to be treated by frenectomy which can be performed by scalpel, electrocautery, or with soft tissue lasers. Hence, the aim of the study is to compare the degree of postoperative pain and healing experienced by patients during frenectomy procedure with surgical scalpel and diode laser technique. Materials and Methods: A total of 20 subjects ranging from 16 to 40 years of age group with papillary or papillary penetrating frenal attachment in the maxillary anterior region were selected. Enrolled subjects were randomly divided into two groups as follows Group A (n = 10): Comprised of 10 subjects selected for conventional scalpel technique. Group B (n = 10): Comprised of 10 subjects selected for diode laser technique. Various parameters such as pain, inflammation, swelling, difficulty of procedure, and wound healing were evaluated at intervals of 1 week, 1 month, and 3rd month. Results: The results indicated patients treated with the diode laser had less postoperative pain (P < 0.0001) and required fewer analgesics (P < 0.001) as compared to patients treated with the conventional scalpel technique. Wound healing at 7th day and after 1 month for both the groups showed statistical significant difference with better outcome in Group A. However, wound healing at the end of 3 months did not show any significant difference between the groups. Conclusion: Based on current findings and clinical outcome, diode lasers provide better patient perception and an efficient and satisfactory option for procedures such as frenectomy.

Effect of low-level laser therapy on gene expression of vascular endothelial growth factor and interleukin-1 ß in scalpel-induced and laser-induced oral wounds in rats

Introduction: The effect of low-level laser therapy (LLLT) on wound healing has been evaluated in several studies; however, little is known about the molecular mechanisms that underlies the biostimulatory effect of this treatment modality. Aim: to evaluate the effect of LLLT on gene expression of vascular endothelial growth factor (VEGF) and interleukin-1beta (IL-1 b) during healing of wounds created by surgical blade and by surgical laser in order to have a better image of their interactive role influenced by the laser irradiation. Materials and Methods: 40 male Wister rats were randomly assigned into four groups (A, B, C and D). In groups A and C, an incision was made in the gingival and mucosal tissues using a surgical scalpel. A similar incision was made in groups B and D using 980 nm diode laser. Group A and B were subjected twice to low level 870 nm diode laser 3 h and 24 h after the incision while group C and D served as controls. 30 min after the second irradiation, the rats belonging to all groups were euthanized, and the wound area was excised. Quantitative reverse-transcriptasepolymerase chain reaction was used to measure the gene expression of VEGF and IL-1b. Results and Discussion: LLLT caused an increase in VEGF gene expression in scalpel-induced wounds and a corresponding decrease in laser-induced wounds but without significant differences. LLLT inhibited the gene expression of IL-1b in both types of wounds, but this inhibition was only significant in scalpel wounds. Conclusion: Biostimulatory effect of LLLT could be mediated through modulation of the immune response by the inhibition of IL-1b.

Electrocautery resection, shaving with a scalpel, and podophyllin: a combination therapy for giant condyloma acuminatum.

Giant condyloma acuminatum (also known as Buschke-Löwenstein tumor) is a rare disease, for which the treatment of choice is still controversial. In the case described in this report, we used a combination of electrocautery and a surgical scalpel to resect a huge genital wart, followed by long-term local treatment with podophyllin. This procedure was relatively fast, easy to perform, involved minimal bleeding, and did not result in any complications. Moreover, combination therapy enabled us to avoid deep resection of the lesion and consequently, sexual function was preserved completely.

1P1-D06 双方向力覚計測型外科メス用ハプティックレコーダによるナイフ形状別の切離手技のRT法を用いた分析

With the objective of developing a system for surgical scalpel cutting skill training, an experiment system, Bidirectional Force Measurement Haptic Recorder was built. Experiment was conducted with the purpose of quantifying the skill difference between the repetitions of trials and shapes of the blade. RT method was applied to evaluate the force and torque sensor data between the conditions. Results showed that difference can be noticeable at the beginning and the end of the round edge knife and throughout the sharp point knife. Certain interval period were found to have clear difference that may be used as discriminant feature for determining the skill. However, the pilot test was conducted on limited material and subject, and therefore, further tests are required to confirm the discussion on multiple condition and evaluated with skilled surgeons performance data.

Analysis and differentiation of paper samples by capillary electrophoresis and multivariate analysis.

This work reports an investigation for the analysis of different paper samples using CE with laser-induced detection. Papers from four different manufactures (white-copy paper) and four different paper sources (white and recycled-copy papers, adhesive yellow paper notes and restaurant serviettes) were pulverized by scratching with a surgical scalpel prior to their derivatization with a fluorescent labeling agent, 8-aminopyrene-1,3,6-trisulfonic acid. Methodological conditions were evaluated, specifically the derivatization conditions with the aim to achieve the best S/N signals and the separation conditions in order to obtain optimum values of sensitivity and reproducibility. The best conditions, in terms of fastest, and easiest sample preparation procedure, minimal sample consumption, as well as the use of the simplest and fastest CE-procedure for obtaining the best analytical parameters, were applied to the analysis of the different paper samples. The registered electropherograms were pretreated (normalized and aligned) and subjected to multivariate analysis (principal component analysis). A successful discrimination among paper samples without entanglements was achieved. To the best of our knowledge, this work presents the first approach to achieve a successful differentiation among visually similar white-copy paper samples produced by different manufactures and paper from different paper sources through their direct analysis by CE-LIF and subsequent comparative study of the complete cellulose electropherogram by chemometric tools.

Hydrosurgery is Effective for Debridement of Diabetic Foot Wounds

Diabetic foot wounds are serious complications of diabetes mellitus. Surgical debridement is a very important part of the management of diabetic wounds. Sharp debridement using the scalpel is normally performed. Versajet II hydrosurgery system is an alternative technique for debridement. To our knowledge, this is the fi rst study conducted to evaluate the use of hydrosurgery debridement for diabetic foot wounds. This pilot study included 15 consecutive patients with diabetic foot wounds who were admitted to the National University Hospital (NUH) and were managed by the Diabetic Foot Team from June 2012 to December 2012. All wounds underwent hydrosurgery debridement. Patients' demographic details, clinical details on wound assessments, and outcome were recorded and analysed. The Versajet II hydrosurgery system was found to show some advantages over standard surgical scalpel debridement. It allowed adequate debridement whilst preserving more viable tissue to promote rapid healing. It could be manoeuvred over complex wound terrain. The time required for debridement was short--an average of 9.5 minutes. Good wound healing was achieved in all 15 cases. Only 1 Versajet debridement was required in 13 cases and 2 required an extra debridement. Twelve wounds were healed by split thickness skin grafting (STSG) and 3 wounds by secondary healing. Two of the STSG were infected but they were subsequently healed by dressings via secondary healing. Although good wound healing was achieved in all 15 cases, further study that uses a larger cohort and a randomised controlled trial is required to fully evaluate the effectiveness, or otherwise, of the Versajet II hydrosurgery system for the debridement of diabetic foot wounds.

Renal Nerve Ablation for Resistant Hypertension

Sympathetic renal denervation, or renal nerve ablation (RNA), has become the new buzz word in hypertension and interventional cardiology. Recent advances in catheter-based approaches have allowed sympathetic fiber interruption through transvascular techniques that are minimally invasive and can be delivered expeditiously and safely. Radiofrequency (RF) energy sources are currently the preferred modalities, but other sources of energy, such as cryoablation, microwave, high-intensity focus ultrasound, and local neurotoxic agent infusion, are under intense investigation. Results thus far have been encouraging and offer promise for the future. The role of the sympathetic nervous system (SNS) in the development of resistant hypertension and cardiovascular disease has long been known, and a great deal of work has been done through the years trying to explore potential interventions to interrupt the sympathetic influence on systemic vasculature and target organs. In this article we attempt an overview of time-dependent interventions on the SNS and examine approaches used in humans and in the many experimental models that offer a better understanding of the role of sympathetic activity in cardiovascular disease. Naturally we focus on methods and techniques addressing sympathetic renal denervation in patients with drug-resistant hypertension, examine the current state of the art, and attempt a look into the future. In 1889, after meticulous experiments on dogs, Bradford1 reported that stimulation of dorsal and splanchnic nerves causes changes in blood pressure (BP) and kidney size measured by plethysmography. Whether BP increased or decreased depended on the anatomic area stimulated, as well as the electric impulse frequency, but outcomes were consistent and reproducible. Neurosurgical treatment of hypertension was independently suggested by researchers in 1923.2 Adson, however, was the first to performed surgical sympathectomy for the treatment of malignant hypertension in 1925.3 During the following years and in the 1930s, Peet in Ann Arbor, Page and …

Comparison of tissue effects in rabbit muscle of surgical dissection devices

While some energy-based surgical dissection and coagulation modalities may offer excellent cutting and coagulation abilities, the impact on healing may differ among devices. We compared the tissue effects of three of these modalities with those of the standard surgical scalpel in rabbit muscle at 24 h and 14 days after surgery by evaluating radiographic and histological data. Linear incisions were made with each device in the dorsal lumbar musculature of rabbits using monopolar electrocautery in cut mode (MPE-Cut) and coagulation mode (MPE-Coag), a ferromagnetic induction loop (FMI), and a traditional scalpel. Magnetic resonance imaging scans and histological sampling were done at 24 h and 14 days. Subjective cutting and coagulation characteristics for each device were also recorded during surgery. The scalpel and FMI appeared to cause the least tissue damage adjacent to the incisions in rabbit dorsal lumbar musculature. The scalpel showed the best healing, while the FMI and MPE-Cut demonstrated good healing. The MPE-Coag showed the worst tissue healing. The scalpel, FMI, and MPE-Cut all exhibited favorable subjective characteristics during surgery. It appears that the FMI may be a better choice for surgical dissection and coagulation in muscle tissue than the MPE coagulation mode because it shows less tissue damage and offers better tissue healing.

Radiofrequency-assisted liver resections for metastatic colorectal cancer: Technique and feasibility

Radiofrequency (RF)-assisted resection techniques are associated with minimal blood loss providing safe hemostasis of the transected liver 1-3 parenchyma. Different RF-assisted liver resection techniques have been developed. The presented RF technique is the sequentional coagulate-cut liver resection technique (?The Belgrade technique?) and the difference from other techniques is the way the electrode is used. A coagulate-cut liver resection cycle can be described as a process of creating a 30-mm long and 6-8 mm wide cylinder of coagulated and desiccated liver tissue by applying RF energy through the non-insulated tip of the electrode inserted into the liver parenchyma and then dividing the coagulated tissue by surgical scalpel or scissors. From January 2001 to January 2014, 830 RF-assisted liver resections were performed for various indications at the HPB unit of the Clinic for Digestive Surgery, Clinical center of Serbia, Belgrade. Among 830 liver resections, 470 resections were performed in 383 patients with colorectal cancer liver metastasis. Sixty-six patients experienced repeated liver resection ranging from a second to a fifth resection. The majority of patients had bi-lobar spread of the disease before the first liver resection was performed. No difference was found in the postoperative morbidity between the patients after the first, the second and the third liver resection (F=0.168; p=0.846). 90-days mortality was 5.7% after the repeated liver resections and 2.5% in patients with one liver resection (X2=2.278; 4,13 p=0.165). Single HPB unit experience has demonstrated that RF-assisted liver resection technique is feasible, safe and effective procedure in the management of patients with CRC liver metastasis.

Gingival Melanin Depigmentation: A Review and Case Report

The color of the gingiva has a tremendous impact on the esthetics of the smile. Clinically gingival melanin hyper pigmentation is presented as ‘black gum’ which is a common esthetic problem especially for those who have gummy smile. Several attempts have been made for removal of gingival pigmentation by different techniques. Each technique had its own supremacy in efficiency and also draw back. In the present cases, an effort has been made to assess the procedure of melanin depigmentation using surgical scalpel technique.

3P2-D06 ナイフ切離時の力学的相互作用の2点間差分計測による対象物モデリング(ハプティックインタフェース)

This research targets on developing a training device to enforce the learning of surgical scalpel dissection skill using robot technology. A prototype of scalpel-oriented Haptic Recorder is assembled with force sensors mounted within the scalpel and under the stage to measure the interaction of scalpel operation skill and dissected object's physical property. An experiment is conducted to evaluate the index computing mechanical work loss during the dissection from the two force sensor measurement. Phenol resin is used as test pieces under three states: dry, water-absorbent, and oil-absorbent. With the result of computed mechanical work loss being different between the test piece conditions the index are shown to have possibility to quantitatively model the dissected object and its possibility of modeling the dissection skill to be assessed.

Massive fibrous epulis—a case report of a 10-year-old lesion

The fibrous epulis, a common tumor-like lesion of the gingiva, appears in the interdental papilla as a result of local irritation. Lesions are asymptomatic and have a variable growth rate. A 75-year-old woman was referred for the evaluation of a large painless gingival mass. It had started 10 years back and has been increasing in size the last year. No bone involvement was noted. The tumor was totally removed by excision with surgical scalpel under local anesthesia without teeth extraction. The microscopic findings were suggestive of a fibrous epulis. Differential diagnosis, clinical considerations and factors to prevent recurrence are discussed.

Evaluation of DLC, WC/C, and TiN Coatings on Martensitic Stainless Steel and Yttria-Stabilized Tetragonal Zirconia Polycrystal Substrates for Reusable Surgical Scalpels

DLC, WC/C, and TiN coated SF 100 martensitic stainless steel and Yttria-Stabilized Tetragonal Zirconia Polycrystal (Y-TZP) surgical scalpels were tested, characterized, and comparatively evaluated with regard to chemical leach, micromorphology, and mechanical properties in order to evaluate their suitability as reusable surgical scalpels. Vickers microhardness (HV), Scratch Hardness Number (), and sharpening by grinding and cutting capabilities of all the coated scalpels were deemed appropriate for reusable surgical scalpels. However, coated Y-TZP scalpels demonstrated higher Vickers microhardness than martensitic stainless steel scalpels coated with the same coatings, except DLC coating on Y-TZP substrate that presented less adhesion than the other coatings. Uncoated and coated martensitic stainless steel scalpels presented corrosion and chemical leach when soaked for a defined period of time in a simulant physiological saline solution, while uncoated and coated Y-TZP scalpels did not present these drawbacks. Therefore, DLC, WC/C, and TiN coated SF 100 martensitic stainless steel surgical scalpels are unsuitable as reusable surgical scalpels, limiting their application to disposable scalpels only, as the uncoated ones, despite their higher microhardness and expected longer cutting capability duration. Based on these experimental results, WC/C and TiN coated Y-TZP scalpels can be proposed as candidates for reusable surgical scalpel applications.

Analysis of Accuracy in Pointing with Redundant Hand-held Tools: A Geometric Approach to the Uncontrolled Manifold Method

This work introduces a coordinate-independent method to analyse movement variability of tasks performed with hand-held tools, such as a pen or a surgical scalpel. We extend the classical uncontrolled manifold (UCM) approach by exploiting the geometry of rigid body motions, used to describe tool configurations. In particular, we analyse variability during a static pointing task with a hand-held tool, where subjects are asked to keep the tool tip in steady contact with another object. In this case the tool is redundant with respect to the task, as subjects control position/orientation of the tool, i.e. 6 degrees-of-freedom (dof), to maintain the tool tip position (3dof) steady. To test the new method, subjects performed a pointing task with and without arm support. The additional dof introduced in the unsupported condition, injecting more variability into the system, represented a resource to minimise variability in the task space via coordinated motion. The results show that all of the seven subjects channeled more variability along directions not directly affecting the task (UCM), consistent with previous literature but now shown in a coordinate-independent way. Variability in the unsupported condition was only slightly larger at the endpoint but much larger in the UCM.

Description of a new, endoscopic technique to remove the over-the-scope-clip in an ex vivo porcine model (with video)

Various studies have demonstrated the usefulness of the over-the-scope-clip (OTSC) to treat perforations, anastomotic leaks, and fistulae. Endoscopic removal of the OTSC was previously described in a series of 3 patients by using the Nd:YAG laser. To evaluate a new endoscopic technique to remove the OTSC. Prospective, single-arm, pilot study in an ex vivo porcine model. Perforations were created by using a surgical scalpel and a blunt trocar. Then they were endoscopically closed with the OTSC. Next, the OTSC was removed under endoscopic control by inserting a 0.035-inch straight hydrophilic tip guidewire into the oval hole on the side of the OTSC jaw. Afterward, the OTSC clip was removed by pulling on the wire. Fifteen perforations were closed: with the OTSC. In all of the cases, the endoscopic closure of the defects was feasible and effective. Successful visualization of the oval hole of the OTSC was possible in 12 cases (80%), and guidewire cannulation was possible in all of these 12 cases (100%). Advancement of the guidewire through the OTSC and then the lumen of the stomach was accomplished in 8 cases (53.3%). In all of the cases with successful cannulation of the orifice, removal of the OTSC was managed safely. The result was an overall success rate of 53.3% (8 of 15 cases). Ex vivo porcine model. Guidewire removal is a new and feasible technique to remove the OTSC. Future studies should refine the technique to enhance visualization and cannulation of the oval hole of the OTSC.

Inspiration from Victorian times in Ultrasonic Surgical Tool Design

This work is devoted to the investigation of performance of surgical tools used in orthopaedics in terms of the occurrence of signs of necrosis, the accuracy of the cut and cutting tool design. For the comparison of the surgical tool performance different types of cutting devices were studied in a series of experiments. A Victorian surgical saw, its copy, a contemporary surgical saw, a surgical scalpel and an ultrasonic blade designed for a surgical application were chosen for the performance assessment. Such geometrical parameters as cutting edge shape, angle of teeth inclination, and sharpness of the cutting tools were analysed in terms of the quality of the cut and signs of necrosis. As a result of the analysis of experimental data obtained and theoretical insight the authors have come up with a creative solution for a novel design for a surgical ultrasonic blade which benefits from the design advantages of each of the analysed surgical tools and eliminates their drawbacks.

A New Technique for Partial Spleenectomy With Radiofrequency Technology

The advantage of partial splenectomy is the preservation of its immunologic function. In this series, 8 patients underwent a spleen preservation procedure with radiofrequency. Four of the partial splenectomy procedures were performed in elective situations, whereas the other 4 cases were performed to control traumatic bleeding in emergency situations. A harrow-like radiofrequency probe with 6 needles was applied to the spleen, and the division of the splenic parenchyma was completed using a surgical scalpel through the midline of the ablated tissue. This safe, fast, and simple technique allows for preservation of splenic function with minimum blood loss.

Applications of OralCDx methodology in the diagnosis of oral leukoplakia

Objective: We aim to evaluate the effectiveness of the brush biopsy technique using OralCDx ® (OralScan Laboratories Inc., Suffern, NY) as a new method for early diagnosis and control of a “potentially malignant disorder” such as oral leukoplakia. Design of the study: We performed a study in which samples were taken using OralCDx ® on 24 patients who visited the Master of Oral Medicine, Oral Surgery and Implantology of the University of Santiago de Compostela between February 2009 and May 2010. These patients presented clinical and histological lesions that were consistent with oral leukoplakia. We evaluated the relationship between the keratinization degree of the lesions and cell representation; the diagnosis obtained through OralCDx ® and biopsies; and sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: 50% of patients were men and 50% women with an average age of 62.38 years. The Kappa coefficient relating keratinization of lesions and cell representation was 0.33, the OralCDx ® - biopsy diagnostic rate reached a Kappa value of 0.66, recording 72.7%,sensitivity and 92.3% specificity, PPV was 88.8%, while NPV reached 80%. Conclusions: cytology sampling with OralCDx ® showed high sensitivity and specificity values, which make it a good tool for monitoring oral leukoplakia, but nowadays the most reliable method that allows us to confirm the exact diagnosis of the lesions and their anatomical and pathological characteristics still is conventional biopsy using a surgical scalpel. Key words: OralCDx®, brush biopsy, oral leukoplakia.