To Compare Cosmetic Outcome using Cutting Diathermy against Scalpel for Incising Skin during Elective Abdominal Surgery: A Randomised Controlled Trial

• Main Authors: Yash Thakkar, Ramesh Dumbre, Arun Fernandes, Deepak Phalgune
• Format: Article
• Language: English
• Published: JCDR Research and Publications Private Limited 2019-10-01
• Series: Journal of Clinical and Diagnostic Research
• Subjects: cosmesis; patient and observer scar assessment scale; visual analogue scale score
• Online Access: https://jcdr.net/articles/PDF/13211/42349_CE[Ra1]_F(SHU)_PF1(AJ_OM)_PFA_GC(AaG_SL)_PN(SL).pdf

Introduction: Use of diathermy has become ubiquitous in majority of surgical specialities for its convenience and advantages with respect to haemostasis and sharps safety. However, its use for incising epidermis and dermis of the skin remains controversial because of the fear of thermal burns, resulting in a scar that is cosmetically inferior to that from the use of a scalpel. Aim: To compare the cosmetic outcome of cutting diathermy against scalpel for incising skin during Elective Abdominal Surgery. Materials and Methods: Two hundred eighteen patients admitted for elective open abdominal procedures were randomised for skin incision, into scalpel and cutting diathermy group. Postoperative wound pain was measured using Visual Analogue Scale (VAS) score after 6, 12, 24 and 48 hours. At 1, 3 and 6 months after surgery, patient’s surgical scars were evaluated by using Patient and Observer Scar Assessment Scale (POSAS). Inter-group comparison of categorical and continuous variables was done using chi-square test/Fisher’sexact test and Unpaired t-test respectively. Results: Mean VAS score in scalpel group was significantly higher as compared to diathermy group. Mean total score of POSAS patient scale, mean total and overall score of POSAS observer scale at 1 and 3 months was significantly higher in diathermy group compared to scalpel group. Mean total and overall score of POSAS patient scale and mean total and overall score of POSAS observer scale at 6 months did not differ significantly between two study groups. Conclusion: Cutting diathermy incisions in elective open abdominal procedures had less postoperative pain and better cosmetic outcome in healing as measured by POSAS at one month and 3 months whereas cosmetic outcome was comparable to scalpel incisions at six months follow-up.