Annals of Maxillofacial Surgery

ORIGINAL ARTICLE - COMPARATIVE STUDY
Year
: 2019  |  Volume : 9  |  Issue : 2  |  Page : 230--234

Evaluation of electrocautery and stainless steel scalpel in oral mucoperiosteal incision for mandibular anterior fracture


Gopal Lahudas Nagargoje, Sheeraz Badal, Syed Ahmed Mohiuddin, Arunachaleshwar Somnath Balkunde, Swati Suresh Jadhav, Dnyandeep Ramkrushna Bholane 
 Department of Oral and Maxillofacial Surgery, Maharashtra Institute of Dental Science and Research Center, Latur, Maharashtra, India

Correspondence Address:
Gopal Lahudas Nagargoje
Department of Oral and Maxillofacial Surgery, Maharashtra Institute of Dental Science and Research Center, Vishwanathpuram, Ambajogai Road, Latur - 413 512, Maharashtra
India

Abstract

Background: Traditionally, mucosal incisions are made by stainless steel scalpel due to its ease of use, accuracy, and minimal tissue damage effect, but these incisions are more bloody and painful. To obviate the inherent disadvantages of scalpel, surgical diathermy was introduced at the beginning of the 20th century. Aim and Objectives: The study aimed to compare the efficacy of electrocautery and stainless steel scalpel in oral mucoperiosteal incisions in terms of time taken for incision, blood loss, pain, edema, and healing for mandibular symphysis or parasymphysis fracture. Materials and Methods: Forty patients who reported to the Department of Oral and Maxillofacial Surgery between December 2015 and November 2017 with symphysis or parasymphysis fracture were divided into two groups by randomized envelope method. Results: The mean time taken and mean blood loss for electrocautery were less than that of stainless steel scalpel. The postoperative pain was significantly reduced at 24 h, 48 h, and 1 week in the diathermy group as compared to the scalpel group. At 24 h and 48 h, the extraoral edema measured was not significant. Wound healing at 24 h and 48 h was better in the scalpel group as compared to the electrocautery group. Conclusion: From present study, we can conclude that electrocautery is better than stainless steel scalpel in relation to time taken for incision, intraoperative blood loss and postoperative pain.



How to cite this article:
Nagargoje GL, Badal S, Mohiuddin SA, Balkunde AS, Jadhav SS, Bholane DR. Evaluation of electrocautery and stainless steel scalpel in oral mucoperiosteal incision for mandibular anterior fracture.Ann Maxillofac Surg 2019;9:230-234


How to cite this URL:
Nagargoje GL, Badal S, Mohiuddin SA, Balkunde AS, Jadhav SS, Bholane DR. Evaluation of electrocautery and stainless steel scalpel in oral mucoperiosteal incision for mandibular anterior fracture. Ann Maxillofac Surg [serial online] 2019 [cited 2020 Feb 27 ];9:230-234
Available from: http://www.amsjournal.com/text.asp?2019/9/2/230/272528


Full Text



 Introduction



Incision for oral and maxillofacial surgery is always a surgeon's choice. Traditionally, mucosal incisions are made by stainless steel scalpels due to its ease of use, accuracy, and minimal tissue damage effect, but these incisions are more bloody and painful.[1] To obviate the inherent disadvantages of steel scalpel, surgical diathermy was introduced at the beginning of the 20th century.[2] With the advent of modern electrosurgical units, this technique is now becoming extremely popular because of rapid hemostasis, faster incision, and reduced overall operative blood loss.[3]

Electrosurgery has been defined as the intentional passage of high-frequency waveforms or currents through the tissues of the body to achieve a controllable surgical effect.[4] Electrocautery involves current frequencies in the range of 400 KHz–10 MHz. Currents up to 500 MA can be safely passed through the patient. Electrocautery may be either monopolar or bipolar. Monopolar electrocautery is more commonly used than bipolar electrocautery. In monopolar electrocautery, high frequency current from an electrocautery machine is delivered to an active electrode held by the surgeon. Density of the current is high, where the electrode touches the body tissues and a pronounced local heating effect occurs. The current subsequently spreads out in the body and then returns to the diathermy machine through the patient plate electrode (a pad which is kept under the patient).[5] Different types of electrode tips are used for different purposes such as ball tip for coagulation and blade tip/needle type for incision or excision of tissues.[6]

Very few studies have been taken up for mucosal incisions in major surgical procedure in the maxillofacial region. The purpose of this study is to compare the traditional scalpel blade incision with that of electrocautery blade in a prospective, controlled, randomized fashion.

 Materials and Methods



This clinical study was conducted between December 2015 and November 2017 at the Department of Oral and Maxillofacial Surgery on 40 healthy patients diagnosed with mandibular symphysis or parasymphysis fracture. Patients were selected irrespective of sex, religion, and socioeconomic status with age group ranging between 18 and 50 years. Informed consent was obtained from all included patients.

These 40 patients were divided into two groups by randomized envelope method. Group A consists of 20 patients receiving incision by stainless steel scalpel with no. 15 blade and Group B consists of 20 patients receiving incision by electrocautery blade.

After endotracheal intubation, under general anesthesia, the surgical field was prepared and isolated. The area to be operated was infiltrated using 2% lignocaine with epinephrine (1:80,000). Incisions were made with a Bard-Parker blade no. 15 in Group A patients and electrocautery blade in Group B patients, the mucoperiosteal flap was reflected to expose the fracture site, and then, the surgical procedure was performed. The flaps were approximated and sutured with 3-0 Vicryl suture. Postoperative intravenous antibiotics, anti-inflammatory drugs, and analgesics were given after surgery for 5 days.

Time taken to complete the mucoperiosteal flap reflection was measured in minutes from the time of incision till the elevation of mucoperiosteal flap. Bleeding was measured by weighing blood-soaked gauzes and collection in suction apparatus from the time of incision till the elevation of the mucoperiosteal flap. Pain assessment was done on 100-mm visual analog scale (VAS), with score 0–10, where 0 indicates no pain and 10 indicates worst pain. Extraoral edema was studied by measuring the horizontal distance from right to left angle of the mandible and the vertical distance from vermilion border of lip to laryngeal prominence with the help of thread. Wound healing was assessed for inflammation, even healing, and surface epithelization by comparing with the adjacent mucosal tissues. Wound healing was assessed using healing scoring system [Table 1].{Table 1}

Any other complications occurred were observed.

The participants were clinically examined at 24 h, 48 h, 7 day, and 1 month, postoperatively.

 Results



Time taken

The mean time taken to complete the mucoperiosteal flap reflection for electrocautery (2.9960 min) was less than that of stainless steel scalpel (4.7910 min), and this difference was statistically highly significant (P < 0.001). These data were presented using joint bar diagram [Table 2].{Table 2}

Blood loss evaluation

The mean blood loss for electrocautery (7.9100 ml) was less than that of stainless steel scalpel (13.3225 ml), and this difference was statistically highly significant (P < 0.001). These data were presented using joint bar diagram [Table 3].{Table 3}

Pain assessment

Pain was recorded postoperatively at 24 h, 48 h, 1 week, and 1 month by VAS ranging from 0 to 10, where 0 indicates no pain and 10 indicates worst pain.

At 24 h, the minimum VAS for stainless steel scalpel group was 1 and maximum VAS was 4, and for electrocautery, minimum VAS was 0 and maximum VAS was 3; the difference in both the groups was statistically significant (P < 0.01).

At 48 h, the minimum VAS for stainless steel scalpel group was 1 and maximum VAS was 3, and for electrocautery, minimum VAS was 0 and maximum VAS was 3; the difference in both the groups was statistically significant (P < 0.01).

At 1 week, the minimum VAS for stainless steel scalpel group was 0 and maximum VAS was 2, and for electrocautery, minimum VAS was 0 and maximum VAS was 1; the difference in both the groups was statistically significant (P < 0.01).

At 1 month, the minimum VAS for stainless steel scalpel group was 0 and maximum VAS was 1, and for electrocautery, VAS was 0; the difference in both the groups was not statistically significant (P > 0.05).

The data were presented by joint bar diagram [Table 4].{Table 4}

Extraoral edema

At 24 h, the mean extraoral edema measured mediolaterally in Group A was 2.900 mm, and in Group B, it was 2.200 mm (not significant P = 0.059). Superoinferiorly, in Group A, it was 1.800 mm, in Group B, it was 1.700 mm (not significant P = 0.746).

At 48 h, the mean extraoral edema measured mediolaterally in Group A was 2.350 mm, and in Group B, it was 0.7864 (not significant P = 0.094). Superoinferiorly, in Group A, it was 1.450 mm, and in Group-B, it was 1.300 mm (not significant P = 0.666).

At 1 week and 1 month, the extraoral edema was also not significant in both the groups mediolaterally and superoinferiorly. The data were presented by joint bar diagram [Table 5].{Table 5}

Wound healing assessment

The participants were clinically examined at 24 h, 48 h, 7 day, and 1 month, postoperatively for assessment of wound healing, and the scores were given from 3 to 1, where score 3 was good healing, score 2 was satisfactory healing, and score 1 was bad healing.

At 24 h, in Group A, 10% (2) of the patients had healing assessment score 2 and 90% (18) had healing assessment score 3. In Group B, 70% (14) of the patients had healing assessment score 2 and 30% (6) had healing assessment score 3 (significant P < 0.01).

At 48 h, in Group A, 10% (2) of the patients had healing assessment score 2 and 90% (18) had healing assessment score 3. In Group B, 60% (12) of the patients had healing assessment score 2 and 40% (8) had healing assessment score 3 (significant P < 0.01).

At 1 week, in Group A, 10% (2) of the patients had healing assessment score 2 and 90% (18) had healing assessment score 3. In Group B, 10% (2) of the patients had healing assessment score 2 and 90% (18) had healing assessment score 3 (not significant P > 0.05).

At 1 month, in Group A, 5% (1) of the patients had healing assessment score 2 and 95% (19) had healing assessment score 3. In Group B, 10% (2) of the patients had healing assessment score 2 and 90% (18) had healing assessment score 3 (not significant P > 0.05).

The data were presented by joint bar diagram [Table 6].{Table 6}

 Discussion



Time taken

Sharma and Sachdeva [7] suggested that the mean time taken for incision and elevation of mucoperiosteal flap was less for electrosurgery (5.1373 min) than that of scalpel surgery (6.5578 min). Bhatsange et al.[8] reported that the time taken for excision by electrocautery was more which is statistically significant than scalpel. Kearns et al.[9] found that the time taken to complete the laparotomy incision was significantly faster with the diathermy than with the scalpel.

However, in this study, the mean time taken to complete the mucoperiosteal flap reflection for electrocautery (2.9960 min) was less than that of stainless steel scalpel (4.7910 min) (highly significant P < 0.001).

Blood loss

Sharma and Sachdeva [7] reported that the mean blood loss for electrosurgery was very less (1.5858 ml) as compared with scalpel surgery (4.1619 ml). Priya et al.[10] reported that the mean blood loss was significantly very less in the diathermy (1.000 ml) group as compared to the scalpel group (6.960 ml). Liboon et al.[1] reported that amount of bleeding was least for electrosurgery and laser, followed by constant-voltage electrocautery (P < 0.001).

In this study, the mean blood loss for electrocautery (7.9100 ml) was less than that of stainless steel scalpel (13.3225 ml) (highly significant P < 0.001).

Pain assessment

Sharma and Sachdeva [7] in their study found that the postoperative pain values in all the three visits were almost same in both electrosurgery and scalpel surgery sites. The difference in pain in both the sites was not statistically significant at all postoperative visits. Kearns et al.[9] in their study found that postoperative pain was significantly reduced on the first (P = 0.04) and second (P = 0.02) postoperative days in the diathermy group as compared to the scalpel group. There was no significant difference in pain scores between the two groups on the third and subsequent postoperative days. Priya et al.[10] in their study reported that there was a significant reduced postoperative pain in the diathermy group as compared to the scalpel group.

In this study, the postoperative pain assessed by VAS was significantly reduced on 24 h, 48 h, and 1 week in the diathermy group as compared to the scalpel group. There was no significant difference in pain scores between the two groups on 1 month postoperative follow-up.

Extraoral edema

Priya et al.[10] reported that the electrocautery group has the less wound healing complications than the stainless steel scalpel group. Chhabda and Agrawal [11] reported that both the groups had the same complication rate. Chau et al.[12] reported that the scalpel and cautery blades do not differ significantly in terms of collateral injury rate or postoperative complication rate.

In this study, extraoral edema measured mediolaterally and superoinferiorly in Group A and Group B was not significant.

Wound healing assessment

Sharma and Sachdeva [7] reported that the difference in healing in both 1st week and 4th week postoperatively was not statistically significant for both the sites. Although there was slight more inflammation at the electrosurgical site as compared to scalpel site in the 1st postoperative week; by the end of 4 weeks, healing was good at both the sites. Pearlman et al.[13] reported that the postoperative wound healing was the same in the scalpel, electrosurgery, and carbon dioxide laser group. Rathofer et al.[14] reported that healing occurred at approximately the same rate in both the electrosurgery and blade loop knife groups.

In this study, the wound healing at 24 and 48 h was better in the scalpel group as compared to the electrocautery group, and the difference in both the groups was statistically significant (P < 0.01). There was no significant difference in wound healing at 1 week and 1 month postoperatively in both the groups (P > 0.05).

 Conclusion



From present study, we can conclude that electrocautery is better than the stainless steel scalpel in relation to time taken for incision, intraoperative blood loss and early postoperative pain. But electrocautery is inferior to scalpel in relation to wound healing. So, in all surgical procedures stainless steel scalpel cannot be completely replaced by electrocautery.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Liboon J, Funkhouser W, Terris DJ. A comparison of mucosal incisions made by scalpel, CO2 laser, electrocautery, and constant-voltage electrocautery. Otolaryngol Head Neck Surg 1997;116:379-85.
2Chalya PL, Mchembe MD, Mabula JB, Gilyoma JM. Diathermy versus scalpel incision in elective midline laparotomy: A prospective randomized controlled clinical study. East Cent Afr J Surg 2013;18:71-7.
3Kumar V, Tewari M, Shukla HS. A comparative study of scalpel and surgical diathermy incision in elective operations of head and neck cancer. Indian J Cancer 2011;48:216-9.
4Osman FS. Dental electrosurgery: General precautions. J Can Dent Assoc 1982;48:641.
5Vedbhushan ST, Mulla MA, Haroonrasid, Chandrashekhar DM. Surgical incision by high frequency cautery. Indian J Surg 2013;75:440-3.
6Babaji P, Singh V, Chawrasia V, Jawale M. Electro surgery in dentistry: Report of cases. J Pediatr Dent 2014;2:20-4.
7Sharma N, Sachdeva SD. A comparative study of electro-surgery and scalpel surgery. Health Talk 2012;5:36-8.
8Bhatsange A, Meshram EP, Waghamare A, Shiggaon L, Mehetre V, Shende A. A clinical and histological comparison of mucosal incisions produced by scalpel, electrocautery, and diode laser: A pilot study. J Dent Lasers 2016;10:37-42.
9Kearns SR, Connolly EM, McNally S, McNamara DA, Deasy J. Randomized clinical trial of diathermy versus scalpel incision in elective midline laparotomy. Br J Surg 2001;88:41-4.
10Priya N, Lamture YR, Luthra L. A comparative study of scalpel versus surgical diathermy skin incisions in clean and clean-contaminated effective abdominal surgeries in AVBRH, Wardha, Maharashtra, India. J Datta Meghe Inst Med Sci Univ 2017;12:21-5.
11Chhabda TS, Agrawal M. Prospective randomized control trial comparing diathermy versus scalpel for skin incisions in patients undergoing elective surgeries. Int J Sci Res 2015;4:1414-9.
12Chau JK, Dzigielewski P, Mlynarek A, Cote DW, Allen H, Harris JR. Steel scalpel versus electrocautery blade: Comparison of cosmetic and patient satisfaction outcomes of different incision methods. J Otolaryngol Head Neck Surg 2009;38:427-33.
13Pearlman NW, Stiegmann GV, Vance V, Norton LW, Bell RC, Staerkel R, et al. A prospective study of incisional time, blood loss, pain, and healing with carbon dioxide laser, scalpel, and electrosurgery. Arch Surg 1991;126:1018-20.
14Rathofer SA, Gardner FM, Vermilyea SG. A comparison of healing and pain following excision of inflammatory papillary hyperplasia with electrosurgery and blade-loop knives in human patients. Oral Surg Oral Med Oral Pathol 1985;59:130-5.