Comparative Healing of Rat Fascia Following Incision with Three Surgical Instruments

Chang, Edward I.; Carlson, Grace; Vose, Joshua G.; Huang, Eric J.; Yang, George P.

doi:10.1016/j.jss.2010.12.019

Cited by 25 publications

(40 citation statements)

References 28 publications

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“…The LTD used in this study has previously been shown to significantly decrease the depth of thermal injury during dissection of skin and fascia in clinical and preclinical studies, minimizing collateral tissue damage, and providing a healing profile equivalent to scalpel. [14][15][16][17][18][19] This LTD has also been shown to reduce scarring and wound necrosis 20 as well as to improve surgery time, hospital stay, and cost in select applications. 21 This LTD has not yet been assessed in ACDF; thus, this pilot study was designed to evaluate and compare its properties with ES in a cadaveric model.…”

Section: Discussionmentioning

confidence: 99%

Preclinical Comparison of Thermal Tissue Effects from Traditional Electrosurgery and a Low-Temperature Electrosurgical Device during Anterior Cervical Discectomy and Fusion

et al. 2018

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Background: Exposure of the anterior cervical spine requires dissection in proximity to critical neurovascular structures. Monopolar electrosurgical (ES) devices generate heat in contacted tissues, resulting in thermal damage and temperature change. This study examined depth of thermal injury and temperature change associated with use of a lowtemperature electrosurgical device (LTD) compared to traditional electrosurgery during a cadaveric anterior cervical discectomy and fusion (ACDF) dissection.Methods: ACDF was performed, using ES or LTD, on cervical spines (C3-4 and C4-5) from 2 fresh human cadavers with intact neck soft tissues and no history of surgery. Cadavers were maintained at 22-238C, and fiber-optic temperature sensors (Neoptix, Qu´ebec City, Qu´ebec, Canada) were placed near relevant structures to measure changes during dissection. Depth of thermal injury was assessed by hematoxylin and eosin and Masson's trichrome histology of fixed tissue specimens.Results: Use of the LTD resulted in a statistically significant reduction in temperature change at platysma (3.0 6 1.04 vs. 11.41 6 3.108C, P ¼ .003), carotid sheath (7.32 6 1.13 vs. 15.57 6 2.568C, P ¼ .007), and longus colli (6.11 6 1.32 vs. 12.9 6 3.628C, P ¼ .016) compared to ES. Temperature change at the trachea was similar between groups (6.06 6 1.99 vs. 4.96 6 1.898C, P ¼ .528). Histology showed that LTD produced less mean and maximal depth of thermal injury compared to ES (mean: 0.5 vs. 1.2 mm; max: 0.9 vs. 1.8 mm; P , .05).Conclusions: The results of this pilot study demonstrate that anterior cervical spine exposure using an LTD reduces tissue temperature change and depth of thermal injury compared to ES.Clinical Relevance: Although exploratory, these results suggest that use of an LTD during ACDF may reduce the extent of thermal tissue injury during dissection. Future studies in live animal models are warranted to determine if thermal injury is a potential cause of common exposure-related complications, such as dysphagia and dysphonia.

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Section: Discussionmentioning

confidence: 99%

Preclinical Comparison of Thermal Tissue Effects from Traditional Electrosurgery and a Low-Temperature Electrosurgical Device during Anterior Cervical Discectomy and Fusion

et al. 2018

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“…Previous animal- and human-based studies have already confirmed some meaningful advantages in the use of PEAK PlasmaBlade instead of conventional electrosurgery, such as equivalent hemostatic capacity, less thermal injury depth, reduced inflammatory response, increased wound strength, and reduced scar width associated with a better aesthetic outcome [5678]. An interesting study, conducted by Dogan et al [9], showed that plasmakinetic surgery in mastectomy shortens the drainage amount and duration compared to electrocautery.…”

Section: Introductionmentioning

confidence: 99%

Wound healing and postsurgical complications in breast cancer surgery: a comparison between PEAK PlasmaBlade and conventional electrosurgery – a preliminary report of a case series

et al. 2018

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PurposePEAK 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.MethodsSixty 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.ResultsThe 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).ConclusionSeroma 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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“…Consistent with this finding, pre-clinical and clinical models of cutaneous wound healing have shown that use of the PlasmaBlade enables the surgeon to incise tissue with the precision of a scalpel and the bleeding control of traditional electrosurgery, but with reduced thermal damage that results in improved wound-healing dynamics [9,10,16,17]. The results of the case reported here, in which the differential healing of mastectomy wounds treated with the PlasmaBlade and traditional electrosurgery was observed, are consistent with these previous findings.…”

Section: Discussionmentioning

confidence: 75%

Traditional electrosurgery and a low thermal injury dissection device yield different outcomes following bilateral skin-sparing mastectomy: a case report

Fine

Vose²

2011

J Med Case Reports

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IntroductionAlthough a skin- and nipple-sparing mastectomy technique offers distinct cosmetic and reconstructive advantages over traditional methods, partial skin flap and nipple necrosis remain a significant source of post-operative morbidity. Prior work has suggested that collateral thermal damage resulting from electrocautery use during skin flap development is a potential source of this complication. This report describes the case of a smoker with recurrent ductal carcinoma in situ (DCIS) who experienced significant unilateral skin necrosis following bilateral skin-sparing mastectomy while participating in a clinical trial examining mastectomy outcomes with two different surgical devices. This unexpected complication has implications for the choice of dissection devices in procedures requiring skin flap preservation.Case presentationThe patient was a 61-year-old Caucasian woman who was a smoker with recurrent DCIS of her right breast. As part of the clinical trial, each breast was randomized to either the standard of care treatment group (a scalpel and a traditional electrosurgical device) or treatment with a novel, low thermal injury dissection device, allowing for a direct, internally controlled comparison of surgical outcomes. Post-operative follow-up at six days was unremarkable for both operative sites. At 16 days post-surgery, the patient presented with a significant wound necrosis in the mastectomy site randomized to the control study group. Following debridement and closure, this site progressively healed over 10 weeks. The contralateral mastectomy, randomized to the alternative device, healed normally.ConclusionWe hypothesize that thermal damage to the subcutaneous microvasculature during flap dissection may have contributed to this complication and that the use of a low thermal injury dissection device may be advantageous in select patients undergoing skin- and nipple-sparing mastectomy.

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Comparative Healing of Rat Fascia Following Incision with Three Surgical Instruments

Cited by 25 publications

References 28 publications

Preclinical Comparison of Thermal Tissue Effects from Traditional Electrosurgery and a Low-Temperature Electrosurgical Device during Anterior Cervical Discectomy and Fusion

Preclinical Comparison of Thermal Tissue Effects from Traditional Electrosurgery and a Low-Temperature Electrosurgical Device during Anterior Cervical Discectomy and Fusion

Wound healing and postsurgical complications in breast cancer surgery: a comparison between PEAK PlasmaBlade and conventional electrosurgery – a preliminary report of a case series

Traditional electrosurgery and a low thermal injury dissection device yield different outcomes following bilateral skin-sparing mastectomy: a case report

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