Advanced Cutting Effect System versus Cold Steel Scalpel

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.

Patient and Physician Assessment of Surgical Scars

“…Eight studies analyzed patient- and clinician-reported scar assessment with respect to different surgical incisions (Table 2 and Figure 2). Patient-reported scar ratings concurred with physician-reported scar findings in 6 studies .…”

“…More than half of studies included in this review (16 of 29 [55%]) showed patient and physician indifference in scar rating from competing surgical incision or closure methods. The method of surgical skin incision, 13,14 type of procedure, [15][16][17][18][19][20][21][22] method of wound closure, [23][24][25] suturing technique, 25 or postoperative wound care 23 did not result in measurable differences in scar appearance. While these findings may reflect true nondifference in the scar outcomes from these varying surgical techniques, several studies 27,31,32,39 reported objective scar variations that did not translate into different scar ratings from both patients and physicians.…”

“…Patient and clinician preference for scar outcomes were determined based on statistically significant (P < .05) higher scar ratings for 1 intervention compared with other studied interventions. Studied interventions included method of surgical skin incision, 13,14 type of procedure, [15][16][17][18][19][20][21][22] method of wound closure, [23][24][25] suturing technique, 25 or postoperative wound care. 23 Key findings for each study were transcribed and later compared with recorded patient and clinician ratings to ensure accuracy of scar rating determination.…”

“…A total of 4485 patients were included, with individual study sample sizes ranging from 11 to 2041. Eleven trials [14][15][16][17][18][19][20][21][22]33,36 assessing patient satisfaction outcomes after sex-specific procedures (cesarean delivery, mammoplasty) enrolled 962 women. Of the remaining patients, 926 (26.7%) were male and 2545 (73.3%) were female.…”

“…Patient-reported scar ratings concurred with physician-reported scar findings in 6 studies. 13,14,27,32,35,39 The majority of these showed patient and physician indifference to the studied surgical interventions, with only 1 study 35 yielding superior ratings from both patients and physicians regarding the preferred orientation of incisions along skin folds in patients undergoing hip arthroplasty. Patient and clinician disagreement in scar assessment was noted in 2 studies, 30,37 with patients preferring shorter incisions in parathyroidectomy and transverse incisions in carotid endarterectomy, respectively, while clinicians showed indifference between the surgical incisional methods in both instances.…”