Electric Cautery Lowers the Contamination Threshold for Infection of Laparotomies

doi:10.1016/S0002-9610(98)00020-8

The American Journal of Surgery

Volume 175, Issue 4, April 1998, Pages 263-266

https://doi.org/10.1016/S0002-9610(98)00020-8 Get rights and content

Abstract

Background: Interplay between wound resistance factors and bacterial innoculum determines the risk of surgical infection. Since cautery causes more damage than the scalpel, our hypothesis is that lower numbers of bacteria are required to infect wounds made by electric cautery than to infect wounds made with a scalpel.

Methods: Abdominal fascia was incised in 375 rats by cold knife, cutting current, or coagulation current. Wounds were innoculated with increasing numbers of bacteria and histologically scored at 7 days for necrosis, inflammation, and abscess.

Results: Coagulation current causes more inflammation, necrosis, and abscesses than the scalpel at all bacterial levels. Electric cutting current is intermediate, causing more damage than the scalpel only after contamination reached 10⁵. Above this threshold most wounds were infected in all groups.

Conclusions: Electric coagulation current should be used only when the need for meticulous hemostasis outweighs the considerably increased risk of infection. Electric cutting current is less destructive but also less hemostatic; indications for its use are difficult to identify.

Section snippets

Materials and Methods

After approval of the protocol by the Institutional Animal Care and Use Committee of the Naval Medical Research Institute, adult Sprague Dawley rats (Harlan Sprague Dawley, Indianapolis, Indiana) weighing 250-g to 300 g were obtained and housed according to NIH guidelines for the care of laboratory animals. The animals were equally divided by gender and then randomly assigned to one of three incisions (cold knife, electric cutting current, or electric coagulating current) and one of five levels

Results

Eighteen animals (4.8%, evenly distributed) died of anesthetic complications within 6 hours of surgery and were excluded from further analysis. Electric coagulation produced significantly (P <0.01) more tissue necrosis and inflammation than the cold knife at all levels of bacterial contamination (Fig. 1). Coagulation current also caused greater inflammation and necrosis than the cutting current until bacterial contamination reached 10⁹. Comparison of the cutting current with the scalpel showed

Comments

“Diseases which medicine does not cure, iron cures; those which iron cannot cure, fire cures; those which fire cannot cure are to be reckoned incurable.”[10]

Surgeons’ adherence to this aphorism can be traced from Egyptian fulguration of breast tumors (3000 BC) and Hippocratic applications of heat as the treatment for abscesses and hemorrhage (400 BC) until the concept was challenged by Ambrose Paré in 1536.[11]The young French military surgeon was surprised by the dramatic clinical improvement

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During skin approximation, a toothed forceps should be used for stronger grasp and avoidance of blood flow disruption (Fig. 5d). With excessive cauterization or incorrect application of forceps, tissue devitalization can occur, which may lead to increased inflammation, elevated risk of infection, and poor wound healing.97,100,101 Incisions should be irrigated using normal saline with or without antibiotics (Fig. 9), although there is no evidence that antibiotic-containing irrigation is better for the prevention of wound infection.97,102,103
The field of neurostimulation for the treatment of chronic pain is a rapidly developing area of medicine. Although neurostimulation therapies have advanced significantly as a result of technologic improvements, surgical planning, device placement, and postoperative care are of equal importance to optimize outcomes. This Neurostimulation Appropriateness Consensus Committee (NACC) project intends to provide evidence-based guidance for these often-overlooked areas of neurostimulation practice.
Authors were chosen based on their clinical expertise, familiarity with the peer-reviewed literature, research productivity, and contributions to the neuromodulation literature. Section leaders supervised literature searches of MEDLINE, BioMed Central, Current Contents Connect, Embase, International Pharmaceutical Abstracts, Web of Science, Google Scholar, and PubMed from the last NACC publication in 2017 to the present. Identified studies were graded using the United States Preventive Services Task Force criteria for evidence and certainty of net benefit. Recommendations are based on evidence strength and consensus when evidence was scant.
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Prevention of Infection in Foot and Ankle Surgery
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Scalpel Versus Diathermy in Wound Healing After Mucosal Incisions: A Split-Mouth Study
2018, Journal of Oral and Maxillofacial Surgery
The aim of this study was to analyze and compare the healing of scalpel and diathermy incision wounds in the oral mucosa.
This is a prospective split-mouth study conducted from January 2015 to April 2017 among patients undergoing either Le Fort I or anterior maxillary osteotomy (or both). The study groups were classified based on the different techniques used to make the incision (group A, incision made by a scalpel; group B, incision made by diathermy). Wound healing was assessed on the first, third, seventh, and tenth postoperative days using the Southampton scoring system. Data were statistically analyzed using the Student t test for continuous variables and the χ² test for categorical variables, and P < .05 was considered significant.
Among the 113 participants included in the study, the age range was 16 to 35 years and male patients comprised 50.4%. The rates of postoperative complications of wound healing were 68.1% (n = 77) in group A and 77% (n = 87) in group B. Wound healing showed a statistically significant difference between the techniques (P < .001).
The findings of this study suggest that wounds caused by scalpel incisions healed better than those caused by diathermy incisions in the oral mucosa.
Cutting electrocautery versus scalpel for surgical incisions: a systematic review and meta-analysis
2017, Journal of Surgical Research
Although cutting electrocautery can be superior to the scalpel in reducing blood loss and incisional time, several reports associated electrocautery with higher rates of wound infection, impaired healing, and worse cosmesis. We performed this systematic review and meta-analysis to compare cutting electrocautery versus scalpel for surgical incisions.
We conducted a computerized literature search of five electronic databases and included all published original studies comparing cutting electrocautery and scalpel surgical incisions. Relevant data were extracted from eligible studies and pooled as odds ratios (ORs) or standardized mean difference (SMD) values in a meta-analysis model, using RevMan and Comprehensive Meta-analysis software.
Forty-one studies (36 randomized trials, four observational, and one quasirandom study) were included in the pooled analysis (6422 participants). Compared with the scalpel incision, cutting electrocautery resulted in significantly less blood loss (SMD = −1.16, 95% CI [−1.60 to −0.72]), shorter incisional (SMD = −0.63, 95% CI [−0.96 to −0.29]) and operative times (SMD = −0.59, 95% CI [−1.12 to −0.05]), and lower pain scores (SMD = −0.91, 95% CI [−1.27 to −0.55]) with no significant differences in terms of wound infection rates (OR = 0.92, 95% CI [0.74-1.15]) or overall subjective scar score (SMD = −0.49, 95% CI [−1.72 to 0.75]).
Surgical incision using electrocautery can be quicker with less blood loss and postoperative pain scores than the scalpel incision. No statistically significant difference was found between both techniques in terms of postoperative wound complications, hospital stay duration, and wound cosmetic characteristics. Therefore, we recommend routine use of cutting electrocautery for surgical incisions.
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Gynecologic surgery is unique in that potential pathogens may come from the skin or may ascend from the vagina and endocervix to the vaginal cuff. Literature suggests that the inoculum required to initiate infection is 105 bacteria/mL, which is decreased in the presence of a foreign body [3,13]. When inoculating mice with successively larger counts of coagulase-positive staphylococcus in the presence of silk suture, over half the animals demonstrated infection with inocula of 103 or higher [14].
To describe the type and quantity of bacteria found intraoperatively on the abdomen, vagina, surgical gloves, instrument tips, and uterus at distinct time points during total laparoscopic hysterectomy (TLH).
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Anaerobic growth was not seen on the instrument tips, in the vagina, or on the abdomen of any patient. Aerobic bacterial growth was not seen in the vagina of any patient. On the surgeon's gloves after uterine manipulator placement, no patients demonstrated sufficient bacterial growth to potentially cause surgical site infection (≥5000 CFU/mL). On the surgeon's gloves following uterine extraction, 1 patient demonstrated sufficient growth to potentially cause infection. None of the patients developed surgical site infections postoperatively.
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¹: This work was supported by the Naval Medical Research and Development Command, work unit 61153N MR04120.001-1002.

²: The first two authors contributed equally to this work.

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Scientific PaperElectric Cautery Lowers the Contamination Threshold for Infection of Laparotomies 12

Abstract

Section snippets

Materials and Methods

Results

Comments

Surg Clin North Am

Am J Surg

Am J Surg

Estimated costs of postoperative wound infections. A case-control study of marginal hospital and social security costs

Epidemiol Infect

Quantitative methods for quality improvement

Pharmacotherapy

Selected aspects of the socioeconomic impact of nosocomial infectionsmorbidity, mortality, cost and prevention

Infect Control Hosp Epidemiol

A cost-effectiveness evaluation of three antimicrobial regimens for the prevention of infective complications after abdominal surgery

Arch Surg

Cost analysis of antibiotic prophylaxis in clean head and neck surgery

Arch Otolaryngol Head Neck Surg

Postoperative wound infectiona prospective study of determinant factors and prevention

Surgery