Aazath Akbar, N (2023) A Randomized Controlled Trial to Compare the Use of Cutting Electrocautery Versus Scalpel for Skin Incisions. Masters thesis, Madras Medical College, Chennai.
Full text not available from this repository.Abstract
INTRODUCTION: The outcome of every surgical intervention begins from the planning of the type, site and method of incision which has a wide influence over a number surgical variables such as ease of the operation, accessibility, cosmesis, maneauverability, and post operative pain. The choice of application of incision selection has transformed in a number of ways ranging from using traditional methods to the use of novel electrosurgical equipments. Such maneauvering of inscional varieties needs, needless to say a lot scrutiny and perusal. Hence this study is aimed at comparing a number of outcome variables between the usage of scalpel versus the cutting diathermy, a prinicipal mode of electrosurgical energy. Though a number of parameters are being touted as beneficial in using both methods of insicion, an inhospital study among the two types of surgical incisions helps in better selection and hence optimal patient outcomes in every surgical domain. AIMS AND OBJECTIVES: To compare the outcome variables of incision time,blood loss,wound character and post operative pain between the usage of scalpel and cutting diathermy in elective surgeries. METHODOLOGY: Design of study: Randomised controlled study. Study centre: Rajiv Gandhi Government General Hospital, Madras medical College, Chennai – 03. INCLUSION CRITERIA: Patients who are posted for elective surgeries in the general surgical theatre. EXCLUSION CRITERIA: Patients with clotting disorder. Patients with known infectious or inflammatory skin conditions. Patients with collagen vascular diseases. Patients with bodily states of poor wound healing such as uncontrolled diabetes, malignancy and chronic steroid use. Patients with known retroviral diseases. DISCUSSION: RANDOMIZED CONTROLLED STUDY TO COMPARE THE USE OF CUTTING ELECTROCAUTERY VERSUS SCALPEL FOR SKIN INCISIONS: Scarring from scalpel incisions is minimal. Diathermy has been widely used for haemostasis, but incisions into the skin have been avoided due to concerns about scarring and improper tissue healing. Using diathermy to make an incision in the skin speeds up the healing process and decreases blood loss, but it has no effect on the strength of the wound. The purpose of this study was to evaluate the differences between diathermy and scalpel incisions for elective abdominal surgeries in terms of incision duration, intraoperative blood loss, postoperative pain, and wound complications. Incisions in the skin and dissections of tissue planes are increasingly being performed using diathermy, as evidenced by a number of studies. It speeds up the process of stopping bleeding, cuts down on the length of time needed for the operation as a whole, and leaves the wound looking healthy and minimal. Modern electrocautery units (using pure sinusoidal current) have led to a rise in the popularity of cautery for skin incision in recent years. Using electrocautery instead of a scalpel has been shown to shorten the duration of surgery, minimise blood loss, lessen pain immediately after surgery, and reduce the need for painkillers later on. In our study equal number of participants were divided to diathermy and scalpel (50%) respectively. GENDER: In the current study, males accounted to 59% and females to 41%. There is no significant difference between two groups when compared between males and females which is statistically significant with p-value>0.05.Nandurkar et al [1] 81% of scalpel Group patients and 76.2% of diathermy Group patients were male. In both groups, the distribution of males and females was similar. AGE: The mean age in the study was 40 years with SD 11. The mean age in diathermy group was 38 (SD 11) and in scalpel group 42 years (SD 11) and it was not statistically significant. VS et Subjects in their study had a mean age of 46.718.3 years (meanSD) in the scalpel group and a mean age of 50.416.0 years (meanSD) in the diathermy group. In both studies, participants aged 51-60 made up the largest age group (31% and 23.8%, respectively). Distribution of ages was similar between the two groups (p = 0.372). Guru K et al [11] reported no significant statistical difference between two groups in their study in terms of age and gender. INCISON TIME AND RELATED BLOOD LOSS: The mean incision time was 8.70 with SD 0.56 and the mean incision related blood loss was 2.1ml/cm2 (SD 0.4). There is significant difference between the incision time when compared with two groups which is statistically significant with p-value<0.05.Also There is significant difference between the blood loss between when two groups which is statistically significant with p-value<0.05. With scalpel group, the average incision time was significantly longer (36.88.8 vs. 27.010.1; p.001), according to one study [1]. Similarly, the diathermy group had significantly less blood loss than the scalpel group (2.61.5 ml vs. 3.41.5 ml, p =.021). However, there was no discernible difference in the mean incision length between the two groups. Statistically, there was no significant difference between the two lengths (72 cm and 6.92.9 cm; p =.811). After comparing electrocautery and scalpel, Talpur et al. [2] found that the former resulted in significantly shorter incision times and less blood loss. The figures were 7.3057sec/cm2 and 8.9025sec/cm2, and 1.1346 ml/cm2 and 1.8262ml/cm2, respectively. Ly et al [3] conducted a systematic review and meta-analysis of fourteen randomised trials with a total of 2541 patients (1267 undergoing abdominal wall incision by cutting diathermy and 1274 by scalpel) and found that diathermy may offer significant advantages in a number of variables, such as operative blood loss, incision time, and postoperative pain. 7 They found that diathermy incisions resulted in significantly less blood loss than scalpel incisions (mean difference 0.72 ml/cm2; P0.001) and required significantly less time overall (mean difference 36 seconds; P0.001). Guru K et al [11] reported outcome parameters like incision length, wound assessment, and POD suture removal were not statistically different between the two groups (P value > 0.05). Among the study population, the median blood loss was 10 ml (interquartile range [IQR] 9–14] for cases and 15 ml (IQR] 14–15] for controls; this difference was statistically significant (P Value less than 0.001).Pandey et al [12] reported minimal blood loss with diathermy group. Both Chau JK et al. (210.3368.82 in the electrocautery group and 23982.99 in the scalpel group) and Dixon AR et al. (9022 in the electrocautery group and 12625 in the scalpel group) found that diathermy incision took less time than scalpel incision.[13,14] POSTOPERATIVE PAIN: The postoperative pain in the current study was studied among the participants on postoperative day 1 to 5 and was graded in severity as mild, moderate and severe. Only on day 1, 71% reported moderate pain, subsequently, 73 to 88% reported mild pain on respective POD days. There is significant difference between day 1 to day 5 of post operative pain when compared with two groups which is statistically significant with p-value,<0.05 . Post operative pain was less in diathermy group. Nandurkar et al [1] reported in their study that As of Day 0, each and every one of the subjects in both groups had been experiencing at least grade 2 pain. On day 1, all of scalpel Group reported pain at the Grade 1 level, while in Group dithermy, 88.1% reported pain at that level and 11.9% reported no pain at all. On day 1, there was a statistically significant difference in pain scores between the two groups. They all reported no pain by Day 2, which is a significant improvement. While using electrocautery to perform prosthetic mesh inguinal hernioplasties, Chrysos et al. [15] found no increase in wound complication rates, concluding that it is just as safe as the scalpel. In their study, Stoltz et al [16]. found no significant difference in the rates of early and late wound healing between a scalpel incision and an electrosurgical thoracotomy incision. Postoperative scar evaluation revealed no discernible distinction between the scalpel and diathermy groups. Dixon et al [14] found that electrosurgical needle incision was significantly more effective, consistently quicker, and yielded better cosmetic results with minimal complications than scalpel incision. It's an easy method that causes no extra distress for the patient and has a high success rate. WOUND COMPLICATIONS: The present study reports no wound complications on postoperative day 1 and day 2. On day 3, 6.7% reported wound complications and to a maximum of 27% on day 5. There is significant difference between two groups when compared with wound complication which is statistically significant with p-value<0.05. In group Scalpel group, wound complication is seen lesser compared to diathermy. At G0, G1, G2, and G3, Nandurkar et al [1] found no statistically significant differences in wound characteristics between the two groups. The primary intention of 2.4% of scalpel group patients was absent, and 2.4% of patients had delayed healing. For the people in diathermy group, 4.8% didn't have primary intent, and 2.4% had delayed healing. When comparing primary intention and delayed healing complications, neither group significantly differed from the other. Consistent with previous research by Ombolaji et al.,[4] we found that the electrocautery group experienced significantly less postoperative pain on day 1 after surgery (p value = 0.021). 8 Consistent with the present study, Kearns et al [5] found that the diathermy group experienced significantly less postoperative pain within the first 48 hours following surgery. On postoperative day 0 and subsequent days, there was no discernible difference in pain levels between the two groups. Electrocautery, as noted by Aird et al.,[6] greatly lessened postoperative wound pain. 10 Findings from the current study are in line with those from studies by Siraj et al., Gilmore et al., and Shivagouda et al.,[7,8,9] all of which found that elective laparotomies performed with electrocautery incisions were significantly more beneficial than scalpel incisions in terms of reduced early postoperative pain. In the current study, there was no discernible difference between electrocautery and scalpel use in terms of wound complications. There was no statistically significant difference between electrocautery and scalpel wound healing, according to the research of Talpur et al. [2]. Patients with gastrointestinal malignancies who underwent surgery with either a scalpel or electrocautery showed no statistically significant difference in wound infection when comparing the two incision methods, according to a study by Eren et al. [10] According to Gilmore et al [8], no one in either group experienced wound infection or dehiscence. However, wound discharge was seen in four patients treated conservatively with daily dressing in the scalpel group. CONCLUSIONS: This study concludes that, among the compared variables incision time ,incision related blood loss ,and post operative pain were significantly lesser among the diathermy group. With regards to wound character and complications there was no discernible differences among the two groups, Hence this study concludes that the use of diathermy to be a safe and effective means in the application of elective surgical incisions.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 220120100502 |
| Uncontrolled Keywords: | Cutting Electrocautery, Scalpel, Skin Incisions. |
| Subjects: | MEDICAL > General Surgery > MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 15 Jan 2024 01:32 |
| Last Modified: | 19 Jan 2024 15:39 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/21292 |
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