Comparative Healing of Surgical Incisions Created by a Standard “Bovie,” The Utah Medical Epitome Electrode, and a Bard-Parker Cold Scalpel Blade in a Porcine Model: A Pilot Study

Abstract

A comparative study of skin incision healing using a standard "bovie" and a new design electroscalpel, Utah Medical Products Epitome Electrode (Midvale, UT), was conducted in a porcine model. Wounds were evaluated objectively at 14 and 28 days after surgery using wound bursting strength measurements and histologic wound scoring. Each electrosurgical device was compared with wound healing of cold scalpel incisions as the gold standard using the same criteria. Statistical differences of healing between the bovie and the Epitome indicating preferential healing for the Epitome wounds were demonstrated for bursting strength at 14 days (p = 0.002). Comparisons of the measured "zone of coagulation necrosis" produced by the electroscalpels demonstrated significantly decreased thermal tissue damage favoring the Epitome (p = 0.0003). Greater differences in wound healing favoring the cold scalpel occurred in comparisons of bovie with cold scalpel than Epitome with cold scalpel, and overall results demonstrated healing for the Epitome wounds closely approximated that for cold scalpel. The authors conclude that this new generation electroscalpel provides measurable improvements in incisional wound healing compared to established electrosurgical technology.

Comparative Healing of Rat Fascia Following Incision with Three Surgical Instruments

“…Central to their design is the use of continuous-waveform radiofrequency (RF) energy, delivered via an uninsulated metal electrode, to cut tissue by thermal ablation, thus producing a simultaneous hemostatic effect [3,4]. While prized for hemostatic control and dissection capability, conventional electrosurgical devices are associated with significant thermal damage to incised tissues, low surgical precision with the potential for injury to adjacent structures (eg, bowel, nerves, blood vessels), and delayed wound healing [5][6][7][8][9][10][11][12][13].…”

“…Accordingly, these limitations have led to improvements in electrosurgical device design including low-stick electrode coatings, ultrasonic blades, sealing technology, and feedback controlled RF generators [6][7][8][9]13]. Some of these innovations have demonstrated incremental improvement in reducing thermal damage during dissection while preserving bleeding control; however, the use of continuous RF energy and a large uninsulated electrode has remained unchanged despite many generations of traditional electrosurgical technology.…”

Comparative Healing of Surgical Incisions Created by the PEAK PlasmaBlade, Conventional Electrosurgery, and a Scalpel

“…4 -12 Consequently, a number of new electrosurgical technologies have been introduced, such as insulated cutting electrodes, ultrasonic blades, and feedback-controlled radiofrequency generators. [5][6][7][8][9]12 Some of these developments have demonstrated incremental improvements in reducing the thermal damage while preserving hemostatic ability. However, substantial room for improvement remains in electrosurgical technology that can approach the surgical precision and favorable wound-healing characteristics of the scalpel while also providing hemostasis.…”

“…Thus, we investigated the healing profile of incisions created by a traditional scalpel, conventional electrosurgery, and the PlasmaBlade using an established porcine skin model. 12 We examined objective parameters including blood loss, wound tensile strength, histologic coagulation necrosis, and inflammation. In addition, we evaluated instrument operating temperature, wound cosmesis, and scarring.…”

Favorable Tissue Effects of Quantum Molecular Resonance Device (Vesalius®) Compared with Standard Electrocautery

“…However, the surgical procedure was simplified as much as possible; therefore we tend to attribute the histopathological changes to the device used, which was the only difference between groups. Further investigation with Vesalius should be performed on larger animal models such as rabbits or pigs, allowing more complex thoracic procedures and comprehensive evaluation [18] .…”