Dear Readers:
Complications can increase the clinical quality of life and economic burden of patient surgery. Causes may originate from patient, surgeon, technique and/or environmental variables associated with pre-, intra-, and/or post-operative management. Gradually, research is clarifying the effects and interactions of all these variables to improve outcomes for patients undergoing surgery. As new techniques emerge, they are tested in randomized controlled trials (RCTs) for evidence of efficacy and safety. This Evidence Corner reviews two such RCTs that evaluate safety and efficacy of two electro-surgical techniques for cutting tissue. Will either replace the scalpel or scissors? Only time and further research will tell.

Laura Bolton, PhD, FAPWCA
Adjunct Associate Professor
Department of Surgery, UMDNJ
WOUNDS Editorial Advisory Board Member and Department Editor

Diathermy or Scalpel for General Surgery

     Reference: Shamim M. Diathermy vs. scalpel skin incisions in general surgery: double-blind, randomized, clinical trial. World J Surg. 2009;33(8):1594–1599.

     Rationale: Thermal surgery offers an alternative to conventional surgery with a scalpel.

     Objective: Compare measured outcomes of general surgery incisions made using diathermy versus scalpel.

     Methods: A prospective, double-blind, RCT compared outcomes of elective or emergency general surgery performed using either diathermy (n = 185) or surgical scalpels (n = 184) at Fatima Hospital-Baqai Medical University and Shamsi Hospitals in Karachi, Pakistan, from January 2006 to December 2007. The only excluded patients were those with missing data or those lost to post-surgical follow up. Investigators measured and analyzed surgical wound classification, length and depth of incision, time to make the incision, duration of operation, incisional blood loss, postoperative pain, length of hospital stay, time to heal and postoperative complications.

     Results: Time to make the incision was shorter with less blood loss during surgery and lower patient-reported pain levels during the first 48 hours after surgery for the diathermy group (P < 0.001). There was no significant difference between the two groups in complete healing time or duration of hospital stay. Post-surgical complications did not significantly differ for different surgical wound classification levels.

     Author’s Conclusions: Patients with a general surgery incision made using diathermy experienced shorter surgery time with less blood loss and early postoperative pain compared to those whose surgical incision was made using a scalpel.

Electrocautery or Scissors for Cutaneous Flaps

     Reference: Barbaros U, Erbil Y, Aksakal N, et al. Electrocautery for cutaneous flap creation during thyroidectomy: a randomised, controlled study. J Laryngol Otol. 2008;122(12):1343–1348.

     Rationale: Fear persists that electrocautery may delay wound healing and increase the likelihood of infection.

     Objective: Evaluate risk factors for complications following cutaneous flap surgery performed using electrocautery or scissors during thyroidectomy.

     Methods: A prospective RCT compared the incidence of post surgical complications for cutaneous flap dissections made for thyroidectomies using electrocautery (n = 126) or scissors (n = 113) in an acute care University Hospital in Turkey. Within each group effects of age, gender, body mass index, American Society of Anesthesiology score, flap tissue weight, operating time, incision length, cutaneous tissue depth, thyroid function, and surgeon experience were correlated with the rate of post-operative wound complications.