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Torres-Augusto Neto R, Comachio CA, de Almeida LCQ, de Azambuja Carvalho PH, Dos Santos Trento G, Pereira-Filho VA. Tissue response to different incision tools in animal model. Oral Maxillofac Surg 2023; 27:631-638. [PMID: 35915281 DOI: 10.1007/s10006-022-01105-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 07/26/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study is to compare the repair of incisions performed with microdissection electrocautery tip, conventional electrocautery tip, high potency diode laser, and conventional scalpel blade in a in vivo model. METHODS Different incisions were performed in adults Holtzman rats using the four types of instruments: microdissection electrocautery tip, conventional electrocautery tip, high potency diode laser, and conventional scalpel blade, in different periods of healing process. Thirty rats were divided into 5 groups, according to the period of euthanasia-24 h, 48 h, 72 h, 7 days, and 14 days. All animals received four incisions, each by a different method. Quantitative histological and histomorphometric analyses were performed using hematoxylin and eosin (HE) and Picrosirius Red staining. RESULTS Inflammatory profile and tissue repair presented small statistically significance differences comparing conventional scalpel blade and microdissection tip; moreover, both presented quantitatively superior to the others. CONCLUSION It is believed that the microdissection tip can perform a dynamic incision just as a common scalpel blade, but more effective. Furthermore, it can promote a better hemostatic control of the surgical field that is comparable to conventional electrocautery tip without affecting tissue repair.
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Affiliation(s)
- Renato Torres-Augusto Neto
- School of Dentistry, Araraquara - Diagnosis and Surgery Department, São Paulo State University (UNESP), Rua Humaitá, 1680 - Centro - Araraquara, Araraquara, SP, 14801-903, Brazil.
| | - Cássio Amaro Comachio
- School of Dentistry, Araraquara - Diagnosis and Surgery Department, São Paulo State University (UNESP), Rua Humaitá, 1680 - Centro - Araraquara, Araraquara, SP, 14801-903, Brazil
| | - Lilian Caldas Quirino de Almeida
- School of Dentistry, Araraquara - Diagnosis and Surgery Department, São Paulo State University (UNESP), Rua Humaitá, 1680 - Centro - Araraquara, Araraquara, SP, 14801-903, Brazil
| | - Pedro Henrique de Azambuja Carvalho
- School of Dentistry, Araraquara - Diagnosis and Surgery Department, São Paulo State University (UNESP), Rua Humaitá, 1680 - Centro - Araraquara, Araraquara, SP, 14801-903, Brazil
| | - Guilherme Dos Santos Trento
- School of Dentistry, Araraquara - Diagnosis and Surgery Department, São Paulo State University (UNESP), Rua Humaitá, 1680 - Centro - Araraquara, Araraquara, SP, 14801-903, Brazil
| | - Valfrido Antônio Pereira-Filho
- School of Dentistry, Araraquara - Diagnosis and Surgery Department, São Paulo State University (UNESP), Rua Humaitá, 1680 - Centro - Araraquara, Araraquara, SP, 14801-903, Brazil
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Lim B, Seth I, Dooreemeah D, Lee CHA. Delving into New Frontiers: assessing ChatGPT's proficiency in revealing uncharted dimensions of general surgery and pinpointing innovations for future advancements. Langenbecks Arch Surg 2023; 408:446. [PMID: 37999815 DOI: 10.1007/s00423-023-03173-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE The advent of artificial intelligence (AI) has significantly influenced various medical domains, including general surgery. This research aims to assess ChatGPT, an AI language model, in its ability to shed light on the historical facets of general surgery and pinpoint opportunities for innovation. METHODS A series of 7 pertinent questions on field of general surgery was posed to ChatGPT. The AI-generated responses were meticulously examined for their relevance, accuracy, and novelty. Additionally, the study explored the AI's ability to recognize knowledge gaps and propose inventive solutions. Expert general surgeons and general surgical residents possessing comprehensive research experience assessed ChatGPT's answers by comparing them to established guidelines and existing literature. RESULTS ChatGPT presented information that was relevant and accurate, albeit superficial. However, it exhibited convergent thinking and was unable to produce truly groundbreaking ideas to transform general surgery. Instead, it pointed to current popular trends with significant potential for further development. It failed to provide references when prompted and even created references that could not be verified in exhibiting databases. CONCLUSION While ChatGPT demonstrated a comprehensive understanding of existing general surgical knowledge and the capacity to generate relevant, evidence-based material, it displayed limitations in producing truly groundbreaking concepts or discoveries beyond current knowledge. These results highlight the necessity of enhancing AI-driven models to facilitate the emergence of new insights and promote synergistic, human-AI partnerships for expediting advancements within the general surgery domain.
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Affiliation(s)
- Bryan Lim
- Department of Surgery, Peninsula Health, Melbourne, VIC, 3199, Australia.
- Central Clinical School at Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Ishith Seth
- Department of Surgery, Peninsula Health, Melbourne, VIC, 3199, Australia
- Central Clinical School at Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
- Department of Surgery, Bendigo Hospital, Victoria, 3550, Australia
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Nunes I, Nicholson W, Theron G. FIGO good practice recommendations on surgical techniques to improve safety and reduce complications during cesarean delivery. Int J Gynaecol Obstet 2023; 163 Suppl 2:21-33. [PMID: 37807585 DOI: 10.1002/ijgo.15117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
FIGO is actively contributing to the global effort to reduce maternal morbidity, mortality, and disability worldwide. Cesarean delivery rates are increasing globally, without signs of slowing down. Bleeding associated with cesarean delivery has become an important cause of hemorrhage-related maternal deaths in many low- and middle-income countries. Correct surgical techniques to improve safety and reduce complications of cesarean delivery is of the utmost importance. This article presents FIGO's good practice recommendations for effective surgical techniques to reduce cesarean complications. Evidence-based information is included where data are available. An expanded WHO Surgical Safety Checklist for maternity cases is suggested. Different incision techniques through the layers of the abdominal wall with appropriate indications are discussed. Hysterotomy through a transverse incision is described, as are indications for low vertical and classical incisions. Important precautions when extracting the fetus are explained. Uterine closure includes a safe method ensuring adequate reapproximation of the upper segment if a vertical incision is made. The paper concludes with the management of two common bleeding problems following delivery of the placenta.
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Affiliation(s)
- Inês Nunes
- Centro Hospitalar Vila Nova de Gaia/Espinho, Department of Obstetrics and Gynaecology, CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Wanda Nicholson
- George Washington University Milken School of Public Health, Washington, District of Columbia, USA
| | - Gerhard Theron
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Tanskanen TJ, Ryhänen JO, Pääkkönen MJI. Scalpel versus Electrocautery for Surgical Skin Incision in Open Carpal Tunnel Release. J Hand Surg Asian Pac Vol 2023; 28:321-326. [PMID: 37173141 DOI: 10.1142/s2424835523500339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Background: Electrocautery is an option for skin incision for the neck, abdominal or inguinal surgery, but is not generally used for hand surgery. The aim of this study was to clarify whether electrocautery skin incision would be beneficial in open carpal tunnel release (OCTR). Methods: A total of 16 patients with carpal tunnel syndrome underwent skin incision for OCTR using either a scalpel (n = 9) or a microdissection diathermy needle (n = 7). Postoperative pain was assessed using a visual analogue scale (VAS 0-100 mm) daily from postoperative days 1 till 7. Results: The diathermy group reported higher VAS scores (mean 80 mm) on the first postoperative day versus the scalpel group mean of 35 mm (p < 0.001). We continued measuring pain for 7 days after the surgery and found higher VAS scores for the diathermy group in the first 6 days. Conclusions: The use of electrocautery is associated with greater pain score in the first postoperative 6 days following OCTR. Level of Evidence: Level III (Therapeutic).
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Clancy C, Dunne SS, Baban C, Tormey S, Merrigan A, O'Connell NH, Coffey JC, Dunne CP. A hypothesis for association between electrical surgical incision techniques and surgical site infection. J Hosp Infect 2022; 128:36-38. [PMID: 35853544 DOI: 10.1016/j.jhin.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022]
Affiliation(s)
- C Clancy
- School of Medicine, University of Limerick, Limerick, Ireland
| | - S S Dunne
- School of Medicine, University of Limerick, Limerick, Ireland
| | - C Baban
- School of Medicine, University of Limerick, Limerick, Ireland; Department of Surgery, University Hospital Limerick
| | - S Tormey
- School of Medicine, University of Limerick, Limerick, Ireland; Department of Surgery, University Hospital Limerick
| | - A Merrigan
- Department of Surgery, University Hospital Limerick
| | - N H O'Connell
- School of Medicine, University of Limerick, Limerick, Ireland; Department of Clinical Microbiology, University of Limerick Hospitals Group, Limerick, Ireland; Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
| | - J C Coffey
- School of Medicine, University of Limerick, Limerick, Ireland; Department of Surgery, University Hospital Limerick; Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
| | - C P Dunne
- School of Medicine, University of Limerick, Limerick, Ireland; Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland.
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Radmilović-Radjenović M, Sabo M, Radjenović B. Application of multi-component fluid model in studies of the origin of skin burns during electrosurgical procedures. Comput Methods Biomech Biomed Engin 2021; 24:1409-1418. [PMID: 33667151 DOI: 10.1080/10255842.2021.1890721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This paper reports on safety challenges regarding spark created when the applied electric field exceeds the dielectric breakdown strength as a source of complication during electrosurgery. Despite the unquestionable benefits of electrosurgery, such as minimal chances of infection and fast recovery time, the interaction of the electrosurgical tool with the tissue may result in tissue damage and force feedback to the tool. Some risks of complications often depend on a surgeon's knowledge of instruments and safety aspects of technical equipment that can be eliminated by clarifying the causation and conditions of their development. Current trends in electrosurgery include computational algorithms and methods to control the effect of delivered energy to the patient. For this study, calculations were performed by using the COMSOL simulation package based on a multi-component plasma fluid model. The emphasis is put on conditions that lead to the breakdown of the dielectric medium. It was found that breakdown occurs most easily when both electrodes are cylindrical. For configurations with one or two spherical electrodes, breakdown voltages are higher up to 25% and 48%, respectively. With decreasing the cathode radius, the breakdown voltage may decrease even to 41%. On the other hand, the temperature increase lowers the breakdown voltage. Also, electrical asymmetries appear to be a response to the non-symmetry of the electric field between the electrodes causing differences in the breakdown voltage between 36% and 70%. The results presented here could be very useful for the design of surgical devices to prevent potential complications of electrosurgical procedures.
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Affiliation(s)
| | - Martin Sabo
- Faculty of Informatics and Information Technologies, Slovak University of Technology in Bratislava, Bratislava, Republic of Slovakia
| | - Branislav Radjenović
- Institute of Physics Belgrade, University of Belgrade, Pregrevica, Belgrade, Serbia
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Ntalouka MP, Brotis AG, Bareka MV, Stertsou ES, Fountas KN, Arnaoutoglou EM. Multimodal Analgesia in Spine Surgery: An Umbrella Review. World Neurosurg 2021; 149:129-139. [PMID: 33610874 DOI: 10.1016/j.wneu.2021.02.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE In recent years, there has been a growing interest regarding the implementation of multimodal analgesia as an important component of the ideal perioperative patient management. The aim of the current umbrella review was to establish the role of multimodal analgesia in patients undergoing spine surgery during the immediate postoperative period. METHODS A systematic review of the pertinent literature was performed. The evaluation was based on a multitude of primary endpoints including the postoperative requirements for patient-controlled analgesia, pain intensity, back-related disability, overall functionality, patient satisfaction, complications, length of hospitalization, and costs. RESULTS The results were summarized using a meta-analysis in the presence of quantitative data or in a narrative review, otherwise. There was a large body of high-quality evidence supporting that the implementation of multimodal analgesia improves patient outcome in terms of the intensity of postoperative pain, the requirements for postoperative opioid analgesia, and the opioid-associated side effects. Similarly, limited high-quality evidence supported that multimodal analgesia improved patients' functionality and satisfaction while decreasing the length of hospitalization and overall costs of surgery. However, the results were inconclusive as far as the disability was concerned. CONCLUSIONS Multimodal analgesia seems to have an essential role for the optimal management of patients undergoing spine surgery. Future research is required to optimize the multimodal analgesia protocols in this group of patients.
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Affiliation(s)
- Maria P Ntalouka
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, Larissa, Greece.
| | - Alexandros G Brotis
- Department of Neurosurgery, General University Hospital of Larissa, Larissa, Greece
| | - Metaxia V Bareka
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, Larissa, Greece
| | - Eleonora S Stertsou
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, Larissa, Greece
| | - Kostantinos N Fountas
- Department of Neurosurgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Eleni M Arnaoutoglou
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, Larissa, Greece
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Maat L, Porte PJ, Verweij LM, Wagner C. Proficient until proven unproficient? Exploring attitudes and perceptions of medical specialists on proficiency, proficiency requirements and proficiency tests for electrosurgery. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2020; 31:209-219. [PMID: 32039863 DOI: 10.3233/jrs-191034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The correct and safe use of electrosurgery requires medical specialists to be proficient. Minimum proficiency requirements and proficiency tests are a manner to structurally assure proficiency. The objective of this study is to explore attitudes and perceptions of medical specialists on proficiency, proficiency requirements and proficiency tests for the safe use of electrosurgery. METHODS A qualitative study among medical specialists using semi-structured interviews. RESULTS The participants recognized that the use of electrosurgery poses risks to the safety of patients and perioperative staff. According to some participants, increased awareness on the risks of electrosurgery is required. Most medical specialists however thought that proficiency of users of electrosurgery is sufficiently assured. Medical specialists stated to support proficiency requirements when they are endorsed by their scientific association. Proficiency tests encountered much resistance. Medical specialists argued that electrosurgery should not be tested as a single device but should be embedded in a larger entity, for example in a broader course or proficiency test. CONCLUSIONS When assuring proficiency of users of electrosurgery, the positive attitude towards proficiency requirements and the more negative attitude towards proficiency tests should be taken into account.
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Affiliation(s)
- Laura Maat
- The Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, Utrecht, The Netherlands
| | - Petra J Porte
- The Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, Utrecht, The Netherlands
| | - Lisanne M Verweij
- The Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, Utrecht, The Netherlands
| | - Cordula Wagner
- The Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, Utrecht, The Netherlands.,Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, The Netherlands
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9
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AbdElaal NK, Ellakwa HE, Elhalaby AF, Shaheen AE, Aish AH. Scalpel versus diathermy skin incision in Caesarean section. J OBSTET GYNAECOL 2019; 39:340-344. [DOI: 10.1080/01443615.2018.1527298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Nasser K. AbdElaal
- Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Mansoura, Egypt
| | - Hamed E. Ellakwa
- Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Mansoura, Egypt
| | - AllaaEldin F. Elhalaby
- Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Mansoura, Egypt
| | - AbdElhameed E. Shaheen
- Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Mansoura, Egypt
| | - Ahmed H. Aish
- Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Mansoura, Egypt
- Resident of Obstetrics and Gynecology at the Ministry of Health, Shoubra General Hospital, Cairo, Egypt
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10
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Chiappa C, Fachinetti A, Boeri C, Arlant V, Rausei S, Dionigi G, Rovera F. Wound healing and postsurgical complications in breast cancer surgery: a comparison between PEAK PlasmaBlade and conventional electrosurgery - a preliminary report of a case series. Ann Surg Treat Res 2018; 95:129-134. [PMID: 30182018 PMCID: PMC6121169 DOI: 10.4174/astr.2018.95.3.129] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/08/2017] [Accepted: 10/23/2017] [Indexed: 12/01/2022] Open
Abstract
Purpose PEAK PlasmaBlade is a recent and distinctive type of electrosurgical device. Previous studies have already documented some meaningful advantages of this device over conventional electrosurgery. This study compared the use of PEAK PlasmaBlade to standard electrosurgery in mastectomy and breast conservative surgery. The purpose was to test the impact of PEAK PlasmaBlade on the wound-healing process and on postsurgical complications in breast cancer surgery. Methods Sixty patients undergoing breast cancer surgery were enrolled. The PEAK PlasmaBlade was used for 20 of those. A standard electrosurgical device was used for the other 40 patients. The 2 groups were homogenous in age, body mass index, comorbidities and type of surgery. We recorded wound complications, serum drainage amount and duration of stay, blood loss, time of surgery, length of hospital stay, and total number of medications required. Results The 2 groups were not significantly different in terms of patient characteristics. A statistically significant reduction in incidence of seroma was observed in the PEAK group: only 10% versus 37.5% of the patients in the conventional electrosurgery group developed this complication (Fisher exact test, P = 0.034). Conclusion Seroma is the most important wound complication in breast surgery. The research of new instruments that might reduce its incidence is desirable. In order to validate or deny the results of this study, it is necessary to enroll more subjects and to consider the impact of this device on axillary lymph node dissection.
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Affiliation(s)
- Corrado Chiappa
- First Division of Surgery - Senology Research Center, Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - Anna Fachinetti
- First Division of Surgery - Senology Research Center, Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - Carlo Boeri
- First Division of Surgery - Senology Research Center, Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - Veronica Arlant
- First Division of Surgery - Senology Research Center, Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - Stefano Rausei
- First Division of Surgery - Senology Research Center, Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - Gianlorenzo Dionigi
- Department of Human Pathology in Adulthood and Childhood "G. Barresi" University Hospital - Policlinico "G. Martino" - The University of Messina, Messina, Italy
| | - Francesca Rovera
- First Division of Surgery - Senology Research Center, Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
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Clark JJC, Abildgaard JT, Backes J, Hawkins RJ. Preventing infection in shoulder surgery. J Shoulder Elbow Surg 2018; 27:1333-1341. [PMID: 29444755 DOI: 10.1016/j.jse.2017.12.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/06/2017] [Accepted: 12/12/2017] [Indexed: 02/01/2023]
Abstract
Although rare, infection after shoulder surgery can represent a devastating complication. Infection can negatively affect clinical outcomes, and eradication often requires a protracted treatment course. Staphylococcus aureus, Staphylococcus epidermidis, and Cutibacterium acnes are among the most frequently isolated pathogens. Perioperative measures can be implemented to reduce infection risk. Here we review various perioperative practices and their efficacy at reducing infection after shoulder surgery.
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Wahab PUA, Madhulaxmi M, Senthilnathan P, Muthusekhar MR, Vohra Y, Abhinav RP. Scalpel Versus Diathermy in Wound Healing After Mucosal Incisions: A Split-Mouth Study. J Oral Maxillofac Surg 2018; 76:1160-1164. [PMID: 29406253 DOI: 10.1016/j.joms.2017.12.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 12/14/2017] [Accepted: 12/17/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to analyze and compare the healing of scalpel and diathermy incision wounds in the oral mucosa. MATERIALS AND METHODS This is a prospective split-mouth study conducted from January 2015 to April 2017 among patients undergoing either Le Fort I or anterior maxillary osteotomy (or both). The study groups were classified based on the different techniques used to make the incision (group A, incision made by a scalpel; group B, incision made by diathermy). Wound healing was assessed on the first, third, seventh, and tenth postoperative days using the Southampton scoring system. Data were statistically analyzed using the Student t test for continuous variables and the χ2 test for categorical variables, and P < .05 was considered significant. RESULTS Among the 113 participants included in the study, the age range was 16 to 35 years and male patients comprised 50.4%. The rates of postoperative complications of wound healing were 68.1% (n = 77) in group A and 77% (n = 87) in group B. Wound healing showed a statistically significant difference between the techniques (P < .001). CONCLUSIONS The findings of this study suggest that wounds caused by scalpel incisions healed better than those caused by diathermy incisions in the oral mucosa.
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Affiliation(s)
- P U Abdul Wahab
- Reader, Department of Oral and Maxillofacial Surgery, Saveetha Dental College, Saveetha Institue of Medical and Technical Sciences, Chennai, India
| | - Marimuthu Madhulaxmi
- Reader, Department of Oral and Maxillofacial Surgery, Saveetha Dental College, Saveetha Institue of Medical and Technical Sciences, Chennai, India.
| | - Periyasamy Senthilnathan
- Professor, Department of Oral and Maxillofacial Surgery, Saveetha Dental College, Saveetha Institue of Medical and Technical Sciences, Chennai, India
| | - Marimuthu Ramaswamy Muthusekhar
- Professor and Head of Department, Department of Oral and Maxillofacial Surgery, Saveetha Dental College, Saveetha Institue of Medical and Technical Sciences, Chennai, India
| | - Yogaen Vohra
- Consultant Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, Saveetha Dental College, Saveetha Institue of Medical and Technical Sciences, Chennai, India
| | - Rajendra Prabhu Abhinav
- Senior Lecturer, Department of Oral and Maxillofacial Surgery, Saveetha Dental College, Saveetha Institue of Medical and Technical Sciences, Chennai, India
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Peneva M, Gjorgjeska A, Dzokik G, Ginoski V, Breshkovska H, Dzoleva-Tolevska R. Electrosurgical microneedle versus scalpel skin incisions in the facial region. SANAMED 2018. [DOI: 10.24125/sanamed.v13i3.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective: Electrosurgery is widely used in surgical procedures, but mainly for subcutaneous and deep layer dissections. The aim of this study was to clinically evaluate the results of routine use of electrosurgical microneedle in performing skin incisions in the facial regions. Material and methods: Eighty patients with both benign and malignant skin lesions in the facial regions undergoing surgery were enrolled in this study. In group A comprising 40 patients, cold steel surgical scalpel N° 15 was used for the surgical procedure. Electrosurgical microneedle with 0.06 mm tip radius and generator unit KLS Martin Electrosurgical Unit ME MB 2 set on cutting mode, power 12 W was used for performing the surgery in group B including the same number of patients. Differences between incision time, excision time, blood loss and the wound related complications were evaluated. Results: The two groups did not significantly differ in the speed of incision and speed of excision although both the speed of incision and the speed of excision were found to be slightly faster in the electrosurgery group. There was significantly less blood loss in the electrosurgery group compared with the scalpel group.Statistical analysis did not confirm as significant the difference in complications between the two groups although most of the complications were associated with the patients operated with scalpel. Conclusion: Electrosurgery presents safe and effective way of work. In that manner, it is very important to choose the right generator unit's settings and the right type of electrode.
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Panovski MJ, Fildishevski IV, Ognjenovic LL, Dejanova-Ilijevska VI. New Surgical Technologies Could Facilitate Surgical Hemostasis in Hemophilic Patients. Open Access Maced J Med Sci 2017; 5:295-298. [PMID: 28698745 PMCID: PMC5503725 DOI: 10.3889/oamjms.2017.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/02/2017] [Accepted: 04/05/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND It's assumed that surgery in haemophilia can be accomplished these days safely. AIM The aim of this study was to investigate the influence of new surgical technologies in the perioperative management and outcome of surgical procedures in haemophiliacs. METHODS Two patients with mild haemophilia A underwent surgery (laparoscopic appendectomy and inguinal hernia repair). In both patients, the replacement therapy, with factor VIII, started 30 min before surgery. We used the available surgical technologies and techniques with a proven value in the best clinical practice, to achieve proper and permanent hemostasis. Postoperatively, the replacement therapy and thromboembolic prophylaxis was continued according to the international guidelines for the management of haemophilia. RESULTS The operative and post-operative periods were uneventful. No significant differences were found in the operation time in our hemophilic patients versus non-hemophilic patients. Significant differences related to the hospital stay duration were found in both patients compared with controls, due to the necessary replacement therapy. CONCLUSION With new surgical technologies, proper and permanent hemostasis can be achieved, without prolonging the operation time.
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Affiliation(s)
- Milcho J. Panovski
- University Clinic for Digestive Surgery, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Igor V. Fildishevski
- University Clinic for Digestive Surgery, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Ljubomir Lj. Ognjenovic
- University Clinic for Digestive Surgery, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Violeta I. Dejanova-Ilijevska
- National Center for Hemophilia, Republic Institute for Transfusiology, Vodnjanska 17, Skopje 1109, Republic of Macedonia
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15
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Scott JE, Swanson EA, Cooley J, Wills RW, Pearce EC. Healing of canine skin incisions made with monopolar electrosurgery versus scalpel blade. Vet Surg 2017; 46:520-529. [PMID: 28369982 DOI: 10.1111/vsu.12650] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 11/23/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the influence of monopolar electrosurgery in cutting mode set at 10, 20, or 30 W on surgery time, hemostasis, and healing of cutaneous wounds compared to scalpel incisions. STUDY DESIGN Randomized blinded control trial. ANIMALS Dogs (n = 15). METHODS Four skin incisions were created on either side of the dorsal midline with a scalpel, or monopolar electrosurgery at 10, 20, and 30 W. Surgical time and incisional bleeding were measured. Each incision was assessed daily for edema, erythema and discharge, and complications. Healing was evaluated via histology at 7 days. Results were analyzed for significance at P ≤ .05. RESULTS Surgical time and hemostasis were improved in all electrosurgery groups. Erythema was reduced in all electrosurgical incisions for days 1-4, but was greater in wounds created via electrosurgery at 20 W than those made with a scalpel blade by day 7. No difference was noted in the degree of edema or presence of wound discharge. All histologic variables of tissue healing were lower in electrosurgical incisions than scalpel incisions (P < .001). Ten incisional complications occurred, all associated with electrosurgery. CONCLUSIONS The use of monopolar electrosurgery at 10, 20, and 30 W in a cutting waveform improved hemostasis and surgical time when incising canine skin, but delayed healing and increased complications within the first 7 days compared to scalpel incisions.
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Affiliation(s)
- Jacqueline E Scott
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi
| | - Elizabeth A Swanson
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi
| | - Jim Cooley
- Department of Pathobiology & Population Medicine, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi
| | - Robert W Wills
- Department of Pathobiology & Population Medicine, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi
| | - Emily C Pearce
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi
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16
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Meakin LB, Murrell JC, Doran ICP, Knowles TG, Tivers MS, Chanoit GPA. Electrosurgery reduces blood loss and immediate postoperative inflammation compared to cold instruments for midline celiotomy in dogs: A randomized controlled trial. Vet Surg 2017; 46:515-519. [PMID: 28314089 PMCID: PMC5516192 DOI: 10.1111/vsu.12641] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/25/2016] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To compare the use of an electrosurgical device with traditional cold instruments (scalpel and scissors) for midline celiotomy incision. STUDY DESIGN Prospective randomized controlled clinical trial. SAMPLE POPULATION One hundred and twenty client-owned dogs undergoing abdominal surgery. METHODS Dogs were prospectively recruited and randomized to receive electroincision or cold instrument incision. For cold incision, surgeons used basic surgical instruments including scalpel and scissors. For electroincision, surgeons only used the electrosurgical device in cutting mode. Time for the approach, blood loss, and the incision length were recorded. A blinded observer assessed pain and incision redness, swelling, and discharge at 24 and 48 hours postoperative (graded 0-3). Owner assessment of incision healing was recorded by telephone interview. RESULTS Blood loss during surgery was significantly lower for electroincision (mean 0.7, SD 1.7 mL) than cold incision (mean 3.0, SD 4.3 mL, P < .0001) with no significant difference in incision length or time for approach. Electroincision was associated with significantly less incision redness (cold median 1, range 0-3; electroincision median 0, range 0-2, P = .02) and less incision discharge (cold median 0.5 range 0-3; electroincision median 0, range 0-1, P = .006) at 24 hours postoperative. There was no significant difference in pain scores or incision healing in dogs receiving the two techniques. No incisional hernias were reported. A surgical site infection occurred in 1 dog (cold incision). CONCLUSIONS Electroincision for a celiotomy approach in the dog reduces blood loss, and incision redness and discharge in the immediate postoperative period without affecting the occurrence of wound complications such as infection and dehiscence (including linea alba).
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Affiliation(s)
- Lee B Meakin
- School of Veterinary Sciences, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom
| | - Jo C Murrell
- School of Veterinary Sciences, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom
| | - Ivan C P Doran
- School of Veterinary Sciences, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom
| | - Toby G Knowles
- School of Veterinary Sciences, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom
| | - Michael S Tivers
- School of Veterinary Sciences, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom
| | - Guillaume P A Chanoit
- School of Veterinary Sciences, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom
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17
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Intradermal Infiltration of Local Anesthetic-Rapid and Bloodless Deepithelialization of the Breast Pedicle. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1225. [PMID: 28280667 PMCID: PMC5340482 DOI: 10.1097/gox.0000000000001225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 12/16/2016] [Indexed: 12/01/2022]
Abstract
Supplemental Digital Content is available in the text. Breast reduction is one of the most commonly performed plastic surgery procedures, and pedicle deepithelialization remains a time-consuming step of the operation. This is especially true when using an inferior pedicle. We present a novel technique of intradermal infiltration of the breast pedicle with local anesthetic to facilitate efficient, bloodless deepithelialization. The senior author uses a 20-ml syringe to inject 0.25% lidocaine and 1:400,000 epinephrine just beneath the epidermis of the breast pedicle to create a series of wheals. Approximately 20 ml of local anesthetic is used per pedicle. After injection of local anesthetic, the breast pedicle is deepithelialized in less than 3 minutes. The plane is bloodless, allowing improved visualization secondary to the epinephrine-induced hemostasis. The senior author has had only one case of nipple necrosis in 20 years of experience. Intradermal infiltration of local anesthetic with epinephrine hydrodissects between the epidermis and dermis and provides hemostasis to facilitate rapid deepithelialization.
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18
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Kezurer N, Farah N, Mandel Y. Endovascular Electrodes for Electrical Stimulation of Blood Vessels for Vasoconstriction - a Finite Element Simulation Study. Sci Rep 2016; 6:31507. [PMID: 27534438 PMCID: PMC4989140 DOI: 10.1038/srep31507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 07/22/2016] [Indexed: 01/04/2023] Open
Abstract
Hemorrhagic shock accounts for 30-40 percent of trauma mortality, as bleeding may sometimes be hard to control. Application of short electrical pulses on blood vessels was recently shown to elicit robust vasoconstriction and reduction of blood loss following vascular injury. In this study we present a novel approach for vasoconstriction based on endovascular application of electrical pulses for situations where access to the vessel is limited. In addition to ease of access, we hypothesize that this novel approach will result in a localized and efficient vasoconstriction. Using computer modeling (COMSOL Multiphysics, Electric Currents Module), we studied the effect of endovascular pulsed electrical treatment on abdominal aorta of pigs, and compared the efficiency of different electrodes configurations on the electric field amplitude, homogeneity and locality when applied on a blood vessel wall. Results reveal that the optimal configuration is the endovascular approach where four electrodes are used, spaced 13 mm apart. Furthermore, computer based temperature investigations (bio-heat model, COMSOL Multiphysics) show that the maximum expected temperature rise is of 1.2 degrees; highlighting the safety of the four endovascular electrodes configuration. These results can aid in planning the application of endovascular pulsed electrical treatment as an efficient and safe vasoconstriction approach.
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Affiliation(s)
- Noa Kezurer
- Mina and Everard Goodman Faculty of Life Sciences, Optometry and Visual Science Track and Bar-Ilan’s Institute for Nanotechnology and Advanced Materials (BINA), Bar-Ilan University, Ramat-Gan, Israel
| | - Nairouz Farah
- Mina and Everard Goodman Faculty of Life Sciences, Optometry and Visual Science Track and Bar-Ilan’s Institute for Nanotechnology and Advanced Materials (BINA), Bar-Ilan University, Ramat-Gan, Israel
| | - Yossi Mandel
- Mina and Everard Goodman Faculty of Life Sciences, Optometry and Visual Science Track and Bar-Ilan’s Institute for Nanotechnology and Advanced Materials (BINA), Bar-Ilan University, Ramat-Gan, Israel
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19
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Fernandez-Moure JS, Van Eps JL, Peress L, Cantu C, Olsen RJ, Jenkins L, Cabrera FJ, Tasciotti E, Weiner BK, Dunkin BJ. Increased use of surgical energy promotes methicillin-resistant Staphylococcus aureus colonization in rabbits following open ventral hernia mesh repair. Surg Endosc 2016; 31:852-860. [DOI: 10.1007/s00464-016-5043-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 06/11/2016] [Indexed: 12/14/2022]
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20
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Abstract
The diversity implicit in exotic animal surgery requires a tailored approach to optimize successful outcomes. Outlined is information on patient preparation, instrumentation, hemostatic techniques, and magnification as it pertains to the exotic animal. Application of topical antiseptic solutions and judicious removal of pelage and feathers will decrease bacterial load during patient preparation. The use of specific barrier protection ensures proper aseptic technique and enables optimal patient monitoring. Magnification combined with a focal light source enhances visual acuity, allowing for better use of delicate instrumentation and identification of anatomic structures.
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Affiliation(s)
- Kevin T Kroner
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA
| | - Casey Budgeon
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA
| | - Sara A Colopy
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA.
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21
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Surgical site infections in dermatologic surgery: etiology, pathogenesis, and current preventative measures. Dermatol Surg 2015; 41:537-49. [PMID: 25888316 DOI: 10.1097/dss.0000000000000364] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) after dermatologic surgery continue to represent undesirable complications that affect patients in several aspects. The etiology and pathogenesis of SSIs are not completely understood, and as a result, current preventative measures are debatable. OBJECTIVE To review and summarize the current available literature specific to SSIs in dermatologic surgery. The pathogenesis of SSIs, factors contributing to SSIs, current preventative guidelines, and evidence supporting their use are explored. METHODS A review of the medical literature. RESULTS AND CONCLUSIONS Most measures used to prevent SSIs in dermatologic surgery are based on studies of wounds in general surgery. Evidence specific to dermatologic surgery is scarce. More research related to the pathogenesis of SSIs is needed to establish effective preventative measures that are key to reducing incidences of SSIs.
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22
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Prakash LD, Balaji N, Kumar SS, Kate V. Comparison of electrocautery incision with scalpel incision in midline abdominal surgery – A double blind randomized controlled trial. Int J Surg 2015; 19:78-82. [DOI: 10.1016/j.ijsu.2015.04.085] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 04/23/2015] [Indexed: 11/29/2022]
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23
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Aird LNF, Bristol SG, Phang PT, Raval MJ, Brown CJ. Randomized double-blind trial comparing the cosmetic outcome of cutting diathermy versus scalpel for skin incisions. Br J Surg 2015; 102:489-94. [DOI: 10.1002/bjs.9751] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 06/20/2014] [Accepted: 11/17/2014] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Controversy exists about whether cutting diathermy for skin incisions leads to a cosmetically inferior scar. Cosmetic outcomes were compared between skin incisions created with cutting diathermy versus scalpel. Wound infection rates and postoperative incisional pain were also compared.
Methods
This was a randomized double-blind trial comparing cutting diathermy and scalpel in patients undergoing bowel resection. Scar cosmesis was assessed at 6 months after surgery by a plastic surgeon and a research associate using the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). Patients also used POSAS to self-evaluate their scars. Wound infections within 30 days were recorded, and incision pain scores were measured on the first 5 days after operation.
Results
A total of 66 patients were randomized to cutting diathermy (31) or scalpel (35). At 6 months, there was no significant difference between the diathermy and scalpel groups in mean(s.d.) VSS scores (4·9(2·6) versus 5·0(1·9); P = 0·837), mean POSAS total scores (19·2(8·0) versus 20·0(7·4); P = 0·684) or subjective POSAS total scores (20·2(12·1) versus 21·3(10·4); P = 0·725). Neither were there significant differences in wound infection rates between the groups (5 of 30 versus 5 of 32; P = 1·000). Pain scores on day 1 after operation were significantly lower in the diathermy group (mean 1·68 versus 3·13; P = 0·018), but were not significantly different on days 2–5.
Conclusion
Cutting diathermy is a cosmetically acceptable technique for abdominal skin incisions. There is no increased risk of wound infection, and diathermy may convey benefit in terms of early postoperative wound pain. Registration number: NCT01496404 (http://www.clinicaltrials.gov).
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Affiliation(s)
- L N F Aird
- Divisions of General Surgery, University of British Columbia, British Columbia, Canada
| | - S G Bristol
- Divisions of Plastic Surgery, University of British Columbia, British Columbia, Canada
- Department of Surgery, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - P T Phang
- Divisions of General Surgery, University of British Columbia, British Columbia, Canada
- Department of Surgery, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - M J Raval
- Divisions of General Surgery, University of British Columbia, British Columbia, Canada
- Department of Surgery, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - C J Brown
- Divisions of General Surgery, University of British Columbia, British Columbia, Canada
- Department of Surgery, St Paul's Hospital, Vancouver, British Columbia, Canada
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24
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Dissection Technique for Abdominoplasty: A Prospective Study on Scalpel versus Diathermocoagulation (Coagulation Mode). PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e299. [PMID: 25674380 PMCID: PMC4323403 DOI: 10.1097/gox.0000000000000222] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 10/02/2014] [Indexed: 12/01/2022]
Abstract
Background: The purpose of this study was to evaluate the effect of the dissection technique on outcomes and complications after a full abdominoplasty, comparing 2 different techniques used to raise the abdominal flap: the steel scalpel and the diathermocoagulation device on coagulation mode. Methods: A prospective study was performed at a single center from January 2009 to December 2011 of patients submitted to abdominoplasty with umbilical transposition. Two groups were identified: group A, abdominoplasty performed with steel scalpel/knife; and group B, abdominoplasty performed with diathermocoagulation on coagulation mode. Several variables were determined: general characteristics, time until drain removal, daily and total volume of drain output, length of hospital stay, operative time, readmission, reoperation, emergency department visits, and local and systemic complications. Results: A total of 119 full abdominoplasties were performed in women (group A, 39 patients; group B, 80 patients). There were no statistically significant differences between groups with respect to general characteristics, except for body mass index, comorbidities, and weight of the surgical specimen; there were no differences for operative time, systemic complications, hematoma, and necrosis incidence. The scalpel group had a highly significant reduction of 54.56% on total drain output, and a 2.65 day reduction on time to drain removal and no reported cases of seroma or healing problems (difference of 81.25% and 90.00%, respectively, between the 2 groups). Conclusions: Performing abdominal dissection with scalpel had a beneficial effect on patient recovery, as it reduced time requested for drain removal, total drain output, and incidence of seroma and wound healing problems.
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25
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Talpur AA, Khaskheli AB, Kella N, Jamal A. Randomized, clinical trial on diathermy and scalpel incisions in elective general surgery. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e14078. [PMID: 25834739 PMCID: PMC4376978 DOI: 10.5812/ircmj.14078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 11/04/2013] [Accepted: 11/09/2014] [Indexed: 12/02/2022]
Abstract
BACKGROUND Since a long time skin incisions have routinely been made with scalpels. Now a day there is a shift in trend from this method to electrosurgical skin incisions. However, fear of bad scars and improper wound healing has prevented its wide spread use. This Study aimed to compare both methods of skin incisions for different variables. OBJECTIVES The aim of this study was to examine incisional time, blood loss during incision and postoperative wound complications and pain with both methods of skin incision. PATIENTS AND METHODS A prospective, comparative and randomized study was conducted at different hospitals of Hyderabad and Nawabshah, Pakistan from 1(st) of December 2009 to 30(th) of November 2011. The study included patients of either sex above the age of five years with general surgical pathology who were to undergo surgery. these candidates were randomly put into two groups. In Group A patients incision was made with a scalpel and in group B with diathermy. Data was analyzed for age, sex, comorbid illness, incisional time, blood loss during incision making and postoperative pain and wound complications. RESULTS A total of 283 patients completed the follow-up and were included in the final analysis. Group A comprised of 143 (50.53%) patients; 83 (58%) males and 60 (42%) females with a mean age of 36.03 years. Amongst the 140 patients of group B, there were 85 (60.7%) males and 55 (39.3%) females with a mean age of 36.52 years. Twenty-five (17.48%) patients of group A and 27 (19.28%) of group B had comorbid illnesses. Mean incision time was 8.9025-sec/cm(2) for group A and 7.3057 sec/cm(2) for group B patients. Mean blood loss during incision making was 1.8262 mL/cm(2) and 1.1346 mL/cm(2) for group A and B patients, respectively. Pain was 5.2957 for group A patients on day one and 3.1181 for group B patients. Pain score was 2.1049 and 1.6206 on day two and 0.8191 and 0.7192 on day five, for group A and B patients, respectively. Postoperative wound complications were noticed in 26 (18.18%) patients of group A and 22 (15.71%) patients of group B. CONCLUSIONS Diathermy incision is a safe and expedient technique. It takes less time than scalpel incision and loss of blood is also lower during incision. Diathermy is associated with lesser post-operative pain and complications than the scalpel incision. Diathermy should be method of choice in general elective surgery.
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Affiliation(s)
- Altaf Ahmed Talpur
- Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Abdul Basir Khaskheli
- Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Nandlal Kella
- Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Akmal Jamal
- Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
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26
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Advanced Cutting Effect System versus Cold Steel Scalpel: Comparative Wound Healing and Scar Formation in Targeted Surgical Applications. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2014; 2:e234. [PMID: 25426351 PMCID: PMC4236379 DOI: 10.1097/gox.0000000000000208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 09/04/2014] [Indexed: 11/26/2022]
Abstract
Background: Use of electrosurgery for skin incisions has been controversial due to concerns of delayed healing, excessive scarring, and increased infection. Recent studies using modern electrosurgical generators that produce pure sinusoidal “CUT” waveforms have shown reductions in thermal damage along incisions made with these devices compared with their predecessors. This study compares scar formation in incisions made using a cold steel scalpel (CSS) or the ACE Blade and Mega Power Generator (ACE system, Megadyne Medical Products, Draper, Utah) from patient and blinded observer perspectives. Methods: Subjects seeking plastic surgery were enrolled in the study. Incisions on one side of each subject’s body were made with a CSS while equivalent incisions on the contralateral side were made with the ACE system. Differences between incision methods were evaluated by assessment of scar formation by observers and assessment of patient satisfaction relating to scar formation at 120 days postsurgery. Results: Observers rated incision vascularization, pigmentation, thickness, and relief. The mean observer score (± SD) of incisions made with the ACE system was 11.1 ± 4.4 while that of incisions made with the CSS was 10.8 ± 3.7 (P < 0.0001). Patients rated incision pain, itching, discoloration, stiffness, thickness, and irregularity. The mean patient score of incisions made with the ACE system was 9.4 ± 9.2 while that of incisions made with the CSS was 9.3 ± 8.5 (P < 0.0001). Conclusions: Results showed noninferior wound healing/scar formation in skin incisions made with the ACE system compared with incisions made with a CSS.
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27
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Wong-Lun-Hing EM, van Dam RM, Welsh FKS, Wells JKG, John TG, Cresswell AB, Dejong CHC, Rees M. Postoperative pain control using continuous i.m. bupivacaine infusion plus patient-controlled analgesia compared with epidural analgesia after major hepatectomy. HPB (Oxford) 2014; 16:601-9. [PMID: 24151899 PMCID: PMC4105897 DOI: 10.1111/hpb.12183] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 08/25/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES There is debate concerning the best mode of delivery of analgesia following liver resection, with continuous i.m. infusion of bupivacaine (CIB) plus patient-controlled i.v. analgesia (PCA) suggested as an alternative to continuous epidural analgesia (CEA). This study compares these two modalities. METHODS A total of 498 patients undergoing major hepatectomy between July 2004 and July 2011 were included. Group 1 received CIB + PCA (n = 429) and Group 2 received CEA (n = 69). Groups were analysed on baseline patient and surgical characteristics. Primary endpoints were pain severity scores and total opioid consumption. Secondary endpoints were pain management failures, need for rescue medication, postoperative (opioid-related) morbidity and hospital length of stay (LoS). RESULTS In both groups pain was well controlled and >70% of patients had no or minimal pain on PoDs 1 and 2. The numbers of patients experiencing severe pain were similar in both groups: PoD 1 at rest: 0.3% in Group 1 and 0% in Group 2 (P = 1.000); PoD 1 on movement: 8% in Group 1 and 2% in Group 2 (P = 0.338); PoD 2 at rest: 0% in Group 1 and 2% in Group 2 (P = 0.126), and PoD 2 on movement: 5% in Group 1 and 5% in Group 2 (P = 1.000). Although the CIB + PCA group required more opioid rescue medication on PoD 0 (53% versus 22%; P < 0.001), they used less opioids on PoDs 0-3 (P ≤ 0.001), had lower morbidity (26% versus 39%; P = 0.018), and a shorter LoS (7 days versus 8 days; P = 0.005). CONCLUSIONS The combination of CIB + PCA provides pain control similar to that provided by CEA, but facilitates lower opioid consumption after major hepatectomy. It has the potential to replace epidural analgesia, thereby avoiding the occurrence of rare but serious complications.
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Affiliation(s)
- Edgar M Wong-Lun-Hing
- Department of Surgery, Maastricht University Medical CentreMaastricht, the Netherlands
| | - Ronald M van Dam
- Department of Surgery, Maastricht University Medical CentreMaastricht, the Netherlands
| | | | - John K G Wells
- Hepato-biliary Unit, Hampshire Hospitals FTBasingstoke, UK
| | - Timothy G John
- Hepato-biliary Unit, Hampshire Hospitals FTBasingstoke, UK
| | | | - Cornelis H C Dejong
- Department of Surgery, Maastricht University Medical CentreMaastricht, the Netherlands,NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht UniversityMaastricht, the Netherlands
| | - Myrddin Rees
- Hepato-biliary Unit, Hampshire Hospitals FTBasingstoke, UK
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28
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Fry DE. The prevention of surgical site infection in elective colon surgery. SCIENTIFICA 2013; 2013:896297. [PMID: 24455434 PMCID: PMC3881664 DOI: 10.1155/2013/896297] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 11/12/2013] [Indexed: 05/05/2023]
Abstract
Infections at the surgical site continue to occur in as many as 20% of elective colon resection cases. Methods to reduce these infections are inconsistently applied. Surgical site infection (SSI) is the result of multiple interactive variables including the inoculum of bacteria that contaminate the site, the virulence of the contaminating microbes, and the local environment at the surgical site. These variables that promote infection are potentially offset by the effectiveness of the host defense. Reduction in the inoculum of bacteria is achieved by appropriate surgical site preparation, systemic preventive antibiotics, and use of mechanical bowel preparation in conjunction with the oral antibiotic bowel preparation. Intraoperative reduction of hematoma, necrotic tissue, foreign bodies, and tissue dead space will reduce infections. Enhancement of the host may be achieved by perioperative supplemental oxygenation, maintenance of normothermia, and glycemic control. These methods require additional research to identify optimum application. Uniform application of currently understood methods and continued research into new methods to reduce microbial contamination and enhancement of host responsiveness can lead to better outcomes.
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Affiliation(s)
- Donald E. Fry
- Michael Pine and Associates, 1 East Wacker Drive, No. 1210, Chicago, IL 60601, USA
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29
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Stupart DA, Sim FW, Chan ZH, Guest GD, Watters DA. Cautery versus scalpel for abdominal skin incisions: a double blind, randomized crossover trial of scar cosmesis. ANZ J Surg 2013; 86:303-6. [PMID: 24165306 DOI: 10.1111/ans.12434] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of this study was to determine whether there is any difference in cosmetic outcome between using cutting diathermy and using a scalpel to make abdominal skin incisions. METHOD This was a prospective, randomized, double-blind crossover study. The primary end point was wound cosmesis as judged by the patient. In each case, one-half of the skin incision was made using diathermy, and one-half using a scalpel blade. Patients were contacted at 6 months post-operatively, and were asked which half of the wound looked better to them. A panel of 18 surgeons was also shown photographs of the wounds taken after 6 months, and were asked the same question. RESULTS Of the 31 patients with complete follow-up, 11 (35%) reported no difference between the two halves of the wound. Nine (29%) preferred the half incised with diathermy, and 11 (35%) preferred the half incised with the scalpel (P = 0.82, chi-squared test). Twenty-four patients consented to having their wound photographed. There was no difference in the surgeons' preference between the diathermy and scalpel halves of the incision (P = 0.35, signed-rank test). CONCLUSION We found the use of cutting diathermy to make abdominal skin incisions to be cosmetically equivalent to cutting with the scalpel. As previous studies have not shown adverse wound outcomes using this technique, and considering the safety concerns for theatre staff when the scalpel is used, the routine use of cutting diathermy for skin incisions in abdominal surgery is justified.
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Affiliation(s)
- Douglas A Stupart
- Department of Surgery, Geelong Hospital and Deakin University, Geelong, Victoria, Australia
| | - Felix W Sim
- Department of Surgery, Geelong Hospital and Deakin University, Geelong, Victoria, Australia
| | - Zheng H Chan
- Department of Surgery, Geelong Hospital and Deakin University, Geelong, Victoria, Australia
| | - Glenn D Guest
- Department of Surgery, Geelong Hospital and Deakin University, Geelong, Victoria, Australia
| | - David A Watters
- Department of Surgery, Geelong Hospital and Deakin University, Geelong, Victoria, Australia
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Abstract
Surgeons are at risk for injury in the operating room daily. Because of the ubiquity of occupational hazards, injuries remain prevalent and expensive. Although occupational hazards can include musculoskeletal conditions, psychosocial stress, radiation exposure, and the risk of communicable diseases, sharps injuries remain the most common among surgeons in practice and the most frequent route of transmission of blood-borne pathogens. Therefore, increased attention to the health, economic, personal, and social implications of these injuries is essential for appropriate management and future prevention.
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Scientific Surgery. Br J Surg 2013. [DOI: 10.1002/bjs.9122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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