Comparative Evaluation of Wound Outcome between Electrocautery and Scalpel Incision

Background: The use of cutting electrocautery instead of scalpel for skin incision is still suboptimal worldwide. There are many studies which include its use in general surgical operations but without use of prothetic material. Aim: The objective of this study was to evaluate whether the application of extreme heat by cutting electrocautery may result in significant postoperative pain and poor wound healing with increased risk of wound infection in presence of underlying prosthetic material and poor cosmesis because of excessive tissue damage and scarring respectively as per previous hypothesis or it’s safe and effective instead. Subjects and Methods: A total of 196 Patients were allocated consecutively to either electrocautery (n=98) or scalpel (n=98) groups. The duration used in making the skin incision; the incisional blood loss and the ensuing length and depth of the wound were noted. Postoperative pain; duration of wound healing and the occurrence of surgical site infection and cosmetic outcome were also noted. Results: The ages ranged from 16 to 73 years. The demography, case distribution and body mass index were similar in both groups. The incision time was shorter in the electrocautery group (P <0.001). The blood loss was less with the electrocautery compared to the scalpel (6.53±3.84 ml vs. 18.16±7.36 ml, P<0.001). The cumulative numerical rating scale score for pain was 12.65 (standard deviation SD 8.06) and 17.12 (SD 9.49) in the diathermy and scalpel groups respectively (P<0.001). There was no statistically significant difference in wound infection and wound closure (epithelialization time) (P=0.206). Conclusion: The use of cutting electrocautery in making skin incision during inguinal hernioplasty is as safe as scalpel in terms of wound healing and cosmesis and is also associated with reduced incision time, incisional blood loss, and postoperative pain.