The Experts below are selected from a list of 50898 Experts worldwide ranked by ideXlab platform
Laura A Gallagher - One of the best experts on this subject based on the ideXlab platform.
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effects of steel Scalpel ultrasonic Scalpel co2 laser and monopolar and bipolar electrosurgery on wound healing in guinea pig oral mucosa
Laryngoscope, 2003Co-Authors: Uttam K Sinha, Laura A GallagherAbstract:Objective The study's objective was to compare instrument performance and tissue healing when steel Scalpel, ultrasonic Scalpel, monopolar or bipolar electrosurgical instruments, or CO2 laser was used in an animal oral surgery model. Study Design Prospective, blinded, randomized. Methods Adult guinea pigs (N = 70) were randomly assigned to 5 groups (14 animals per group) for excision of 2-cm, full-thickness oral mucosa using steel Scalpel, ultrasonic Scalpel, monopolar or bipolar electrosurgical instruments, or CO2 laser. Postoperative pain was measured indirectly using weekly body weight changes. Animals from each group were killed on days 0, 7, 14, 21, and 28. Specimens were harvested for blinded histopathological study and tensile strength measurement. Instrument performance (hemostasis, tissue coagulation, tissue sticking) and wound healing (tissue re-epithelialization, degree of inflammation) were primary outcomes. Statistical analysis was performed using analysis of variance. Results The ultrasonic Scalpel was the best tool in controlling hemostasis, tissue coagulation, and tissue sticking. Significantly higher body weight gain (P <.05) was noted at day 7 for monopolar and CO2 laser groups. Greatest tensile strength was seen in the steel Scalpel and ultrasonic Scalpel groups at the end of 28 days. Tissue re-epithelialization was fastest for the steel Scalpel and ultrasonic Scalpel groups (complete by day 7). Complete re-epithelialization of wounds of all treatment groups occurred by day 28. All groups had acute inflammation. Complete resolution of inflammation by day 14 took place in the steel Scalpel and ultrasonic Scalpel groups only. Conclusion Use of the ultrasonic Scalpel produced faster re-epithelialization and greater tensile strength than laser or electrosurgical instruments, with results comparable to those seen with the steel Scalpel.
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Effects of steel Scalpel, ultrasonic Scalpel, CO2 laser, and monopolar and bipolar electrosurgery on wound healing in guinea pig oral mucosa.
Laryngoscope, 2003Co-Authors: Uttam K Sinha, Laura A GallagherAbstract:Objective The study's objective was to compare instrument performance and tissue healing when steel Scalpel, ultrasonic Scalpel, monopolar or bipolar electrosurgical instruments, or CO2 laser was used in an animal oral surgery model. Study Design Prospective, blinded, randomized. Methods Adult guinea pigs (N = 70) were randomly assigned to 5 groups (14 animals per group) for excision of 2-cm, full-thickness oral mucosa using steel Scalpel, ultrasonic Scalpel, monopolar or bipolar electrosurgical instruments, or CO2 laser. Postoperative pain was measured indirectly using weekly body weight changes. Animals from each group were killed on days 0, 7, 14, 21, and 28. Specimens were harvested for blinded histopathological study and tensile strength measurement. Instrument performance (hemostasis, tissue coagulation, tissue sticking) and wound healing (tissue re-epithelialization, degree of inflammation) were primary outcomes. Statistical analysis was performed using analysis of variance. Results The ultrasonic Scalpel was the best tool in controlling hemostasis, tissue coagulation, and tissue sticking. Significantly higher body weight gain (P
Uttam K Sinha - One of the best experts on this subject based on the ideXlab platform.
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effects of steel Scalpel ultrasonic Scalpel co2 laser and monopolar and bipolar electrosurgery on wound healing in guinea pig oral mucosa
Laryngoscope, 2003Co-Authors: Uttam K Sinha, Laura A GallagherAbstract:Objective The study's objective was to compare instrument performance and tissue healing when steel Scalpel, ultrasonic Scalpel, monopolar or bipolar electrosurgical instruments, or CO2 laser was used in an animal oral surgery model. Study Design Prospective, blinded, randomized. Methods Adult guinea pigs (N = 70) were randomly assigned to 5 groups (14 animals per group) for excision of 2-cm, full-thickness oral mucosa using steel Scalpel, ultrasonic Scalpel, monopolar or bipolar electrosurgical instruments, or CO2 laser. Postoperative pain was measured indirectly using weekly body weight changes. Animals from each group were killed on days 0, 7, 14, 21, and 28. Specimens were harvested for blinded histopathological study and tensile strength measurement. Instrument performance (hemostasis, tissue coagulation, tissue sticking) and wound healing (tissue re-epithelialization, degree of inflammation) were primary outcomes. Statistical analysis was performed using analysis of variance. Results The ultrasonic Scalpel was the best tool in controlling hemostasis, tissue coagulation, and tissue sticking. Significantly higher body weight gain (P <.05) was noted at day 7 for monopolar and CO2 laser groups. Greatest tensile strength was seen in the steel Scalpel and ultrasonic Scalpel groups at the end of 28 days. Tissue re-epithelialization was fastest for the steel Scalpel and ultrasonic Scalpel groups (complete by day 7). Complete re-epithelialization of wounds of all treatment groups occurred by day 28. All groups had acute inflammation. Complete resolution of inflammation by day 14 took place in the steel Scalpel and ultrasonic Scalpel groups only. Conclusion Use of the ultrasonic Scalpel produced faster re-epithelialization and greater tensile strength than laser or electrosurgical instruments, with results comparable to those seen with the steel Scalpel.
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Effects of steel Scalpel, ultrasonic Scalpel, CO2 laser, and monopolar and bipolar electrosurgery on wound healing in guinea pig oral mucosa.
Laryngoscope, 2003Co-Authors: Uttam K Sinha, Laura A GallagherAbstract:Objective The study's objective was to compare instrument performance and tissue healing when steel Scalpel, ultrasonic Scalpel, monopolar or bipolar electrosurgical instruments, or CO2 laser was used in an animal oral surgery model. Study Design Prospective, blinded, randomized. Methods Adult guinea pigs (N = 70) were randomly assigned to 5 groups (14 animals per group) for excision of 2-cm, full-thickness oral mucosa using steel Scalpel, ultrasonic Scalpel, monopolar or bipolar electrosurgical instruments, or CO2 laser. Postoperative pain was measured indirectly using weekly body weight changes. Animals from each group were killed on days 0, 7, 14, 21, and 28. Specimens were harvested for blinded histopathological study and tensile strength measurement. Instrument performance (hemostasis, tissue coagulation, tissue sticking) and wound healing (tissue re-epithelialization, degree of inflammation) were primary outcomes. Statistical analysis was performed using analysis of variance. Results The ultrasonic Scalpel was the best tool in controlling hemostasis, tissue coagulation, and tissue sticking. Significantly higher body weight gain (P
Heikki Löppönen - One of the best experts on this subject based on the ideXlab platform.
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post tonsillectomy pain a prospective randomised and double blinded study to compare an ultrasonically activated Scalpel technique with the blunt dissection technique
Anaesthesia, 2001Co-Authors: E. I. Akural, P. T. Koivunen, Seppo Alahuhta, Heikki Teppo, Heikki LöppönenAbstract:Thirty-two patients participated in a study to compare the use of an ultrasonically activated Scalpel (Harmonic Scalpel) for tonsillectomy on one side and a blunt dissection tonsillectomy on the other. Pain scores at rest and on swallowing expressed as the area under curves (AUC) during the 10 h after surgery, intra-operative blood loss and the need for electrocoagulation for haemostasis were significantly higher on the blunt dissection side than on the Harmonic Scalpel side (p < 0.05). However, pain scores expressed as AUC at rest, on swallowing, the day's least, average and worst levels of pain, and the day's worst otalgia during the second week after surgery were significantly higher on the Harmonic Scalpel side than on the blunt dissection side. In conclusion, we found that Harmonic Scalpel tonsillectomy was associated with decreased severity in pharyngeal pain on the day of the operation but increased pharyngeal pain and otalgia during the second postoperative week.
Kittipan Rerkasem - One of the best experts on this subject based on the ideXlab platform.
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Scalpel versus electrosurgery for major abdominal incisions
Cochrane Database of Systematic Reviews, 2017Co-Authors: Kittipat Charoenkwan, Kittipan Rerkasem, Zipporah Iheozorejiofor, Elizabeth MatovinovicAbstract:Background Scalpels or electrosurgery can be used to make abdominal incisions. The potential benefits of electrosurgery may include reduced blood loss, dry and rapid separation of tissue, and reduced risk of cutting injury to surgeons. Postsurgery risks possibly associated with electrosurgery may include poor wound healing and complications such as surgical site infection. Objectives To assess the effects of electrosurgery compared with Scalpel for major abdominal incisions. Search methods The first version of this review included studies published up to February 2012. In October 2016, for this first update, we searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (including In-Process & Other Non-Indexed Citations), Ovid Embase, EBSCO CINAHL Plus, and the registry for ongoing trials (www.clinicaltrials.gov). We did not apply date or language restrictions. Selection criteria Studies considered in this analysis were randomised controlled trials (RCTs) that compared electrosurgery to Scalpel for creating abdominal incisions during major open abdominal surgery. Incisions could be any orientation (vertical, oblique, or transverse) and surgical setting (elective or emergency). Electrosurgical incisions were made through major layers of the abdominal wall, including subcutaneous tissue and the musculoaponeurosis (a sheet of connective tissue that attaches muscles), regardless of the technique used to incise the skin and peritoneum. Scalpel incisions were made through major layers of abdominal wall including skin, subcutaneous tissue, and musculoaponeurosis, regardless of the technique used to incise the abdominal peritoneum. Primary outcomes analysed were wound infection, time to wound healing, and wound dehiscence. Secondary outcomes were postoperative pain, wound incision time, wound-related blood loss, and adhesion or scar formation. Data collection and analysis Two review authors independently carried out study selection, data extraction, and risk of bias assessment. When necessary, we contacted trial authors for missing data. We calculated risk ratios (RR) and 95% confidence intervals (CI) for dichotomous data, and mean differences (MD) and 95% CI for continuous data. Main results The updated search found seven additional RCTs making a total of 16 included studies (2769 participants). All studies compared electrosurgery to Scalpel and were considered in one comparison. Eleven studies, analysing 2178 participants, reported on wound infection. There was no clear difference in wound infections between electrosurgery and Scalpel (7.7% for electrosurgery versus 7.4% for Scalpel; RR 1.07, 95% CI 0.74 to 1.54; low-certainty evidence downgraded for risk of bias and serious imprecision). None of the included studies reported time to wound healing. It is uncertain whether electrosurgery decreases wound dehiscence compared to Scalpel (2.7% for electrosurgery versus 2.4% for Scalpel; RR 1.21, 95% CI 0.58 to 2.50; 1064 participants; 6 studies; very low-certainty evidence downgraded for risk of bias and very serious imprecision). There was no clinically important difference in incision time between electrosurgery and Scalpel (MD -45.74 seconds, 95% CI -88.41 to -3.07; 325 participants; 4 studies; moderate-certainty evidence downgraded for serious imprecision). There was no clear difference in incision time per wound area between electrosurgery and Scalpel (MD -0.58 seconds/cm2, 95% CI -1.26 to 0.09; 282 participants; 3 studies; low-certainty evidence downgraded for very serious imprecision). There was no clinically important difference in mean blood loss between electrosurgery and Scalpel (MD -20.10 mL, 95% CI -28.16 to -12.05; 241 participants; 3 studies; moderate-certainty evidence downgraded for serious imprecision). Two studies reported on mean wound-related blood loss per wound area; however, we were unable to pool the studies due to considerable heterogeneity. It was uncertain whether electrosurgery decreased wound-related blood loss per wound area. We could not reach a conclusion on the effects of the two interventions on pain and appearance of scars for various reasons such as small number of studies, insufficient data, the presence of conflicting data, and different measurement methods. Authors' conclusions The certainty of evidence was moderate to very low due to risk of bias and imprecise results. Low-certainty evidence shows no clear difference in wound infection between the Scalpel and electrosurgery. There is a need for more research to determine the relative effectiveness of Scalpel compared with electrosurgery for major abdominal incisions.
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Scalpel versus electrosurgery for abdominal incisions
Cochrane Database of Systematic Reviews, 2012Co-Authors: Kittipat Charoenkwan, Narain Chotirosniramit, Kittipan RerkasemAbstract:Background Scalpels or electrosurgery can be used to make abdominal incisions. The potential benefits of electrosurgery include reduced blood loss, dry and rapid separation of tissue, and reduced risk of cutting injury to surgeons, though there are concerns about poor wound healing, excessive scarring, and adhesion formation. Objectives To compare the effects on wound complications of Scalpel and electrosurgery for making abdominal incisions. Search methods We searched the Cochrane Wounds Group Specialised Register (searched 24 February 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 2); Ovid MEDLINE (1950 to February Week 3 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations 23 February 2012); Ovid EMBASE (1980 to 2012 Week 07); and EBSCO CINAHL (1982 to 17 February 2012). We did not apply date or language restrictions. Selection criteria Randomised controlled trials (RCTs) comparing the effects on wound complications of electrosurgery with Scalpel use for the creation of abdominal incisions. The study participants were patients undergoing major open abdominal surgery, regardless of the orientation of the incision (vertical, oblique, or transverse) and surgical setting (elective or emergency). Electrosurgical incisions included those in which the major layers of abdominal wall, including subcutaneous tissue and musculoaponeurosis (a strong sheet of fibrous connective tissue that serves as a tendon to attach muscles), were made by electrosurgery, regardless of the techniques used to incise the abdominal skin and peritoneum. Scalpel incisions included those in which all major layers of abdominal wall including skin, subcutaneous tissue, and musculoaponeurosis, were incised by a Scalpel, regardless of the techniques used on the abdominal peritoneum. Data collection and analysis We independently assessed studies for inclusion and risk of bias. One review author extracted data which were checked by a second review author. We calculated risk ratio (RR) and 95% confidence intervals (CI) for dichotomous data, and difference in means (MD) and 95% CI for continuous data. We examined heterogeneity between studies. Main results We included nine RCTs (1901 participants) which were mainly at unclear risk of bias due to poor reporting. There was no statistically significant difference in overall wound complication rates (RR 0.90, 95% CI 0.68 to 1.18), nor in rates of wound dehiscence (RR 1.04, 95% CI 0.36 to 2.98), however both these comparisons are underpowered and a treatment effect cannot be excluded. There is insufficient reliable evidence regarding the effects of electrosurgery compared with Scalpel incisions on blood loss, pain, and incision time. Authors' conclusions Current evidence suggests that making an abdominal incision with electrosurgery may be as safe as using a Scalpel. However, these conclusions are based on relatively few events and more research is needed. The relative effects of Scalpels and electrosurgery are unclear for the outcomes of blood loss, pain, and incision time.
Kittipat Charoenkwan - One of the best experts on this subject based on the ideXlab platform.
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Scalpel versus electrosurgery for major abdominal incisions
Cochrane Database of Systematic Reviews, 2017Co-Authors: Kittipat Charoenkwan, Kittipan Rerkasem, Zipporah Iheozorejiofor, Elizabeth MatovinovicAbstract:Background Scalpels or electrosurgery can be used to make abdominal incisions. The potential benefits of electrosurgery may include reduced blood loss, dry and rapid separation of tissue, and reduced risk of cutting injury to surgeons. Postsurgery risks possibly associated with electrosurgery may include poor wound healing and complications such as surgical site infection. Objectives To assess the effects of electrosurgery compared with Scalpel for major abdominal incisions. Search methods The first version of this review included studies published up to February 2012. In October 2016, for this first update, we searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (including In-Process & Other Non-Indexed Citations), Ovid Embase, EBSCO CINAHL Plus, and the registry for ongoing trials (www.clinicaltrials.gov). We did not apply date or language restrictions. Selection criteria Studies considered in this analysis were randomised controlled trials (RCTs) that compared electrosurgery to Scalpel for creating abdominal incisions during major open abdominal surgery. Incisions could be any orientation (vertical, oblique, or transverse) and surgical setting (elective or emergency). Electrosurgical incisions were made through major layers of the abdominal wall, including subcutaneous tissue and the musculoaponeurosis (a sheet of connective tissue that attaches muscles), regardless of the technique used to incise the skin and peritoneum. Scalpel incisions were made through major layers of abdominal wall including skin, subcutaneous tissue, and musculoaponeurosis, regardless of the technique used to incise the abdominal peritoneum. Primary outcomes analysed were wound infection, time to wound healing, and wound dehiscence. Secondary outcomes were postoperative pain, wound incision time, wound-related blood loss, and adhesion or scar formation. Data collection and analysis Two review authors independently carried out study selection, data extraction, and risk of bias assessment. When necessary, we contacted trial authors for missing data. We calculated risk ratios (RR) and 95% confidence intervals (CI) for dichotomous data, and mean differences (MD) and 95% CI for continuous data. Main results The updated search found seven additional RCTs making a total of 16 included studies (2769 participants). All studies compared electrosurgery to Scalpel and were considered in one comparison. Eleven studies, analysing 2178 participants, reported on wound infection. There was no clear difference in wound infections between electrosurgery and Scalpel (7.7% for electrosurgery versus 7.4% for Scalpel; RR 1.07, 95% CI 0.74 to 1.54; low-certainty evidence downgraded for risk of bias and serious imprecision). None of the included studies reported time to wound healing. It is uncertain whether electrosurgery decreases wound dehiscence compared to Scalpel (2.7% for electrosurgery versus 2.4% for Scalpel; RR 1.21, 95% CI 0.58 to 2.50; 1064 participants; 6 studies; very low-certainty evidence downgraded for risk of bias and very serious imprecision). There was no clinically important difference in incision time between electrosurgery and Scalpel (MD -45.74 seconds, 95% CI -88.41 to -3.07; 325 participants; 4 studies; moderate-certainty evidence downgraded for serious imprecision). There was no clear difference in incision time per wound area between electrosurgery and Scalpel (MD -0.58 seconds/cm2, 95% CI -1.26 to 0.09; 282 participants; 3 studies; low-certainty evidence downgraded for very serious imprecision). There was no clinically important difference in mean blood loss between electrosurgery and Scalpel (MD -20.10 mL, 95% CI -28.16 to -12.05; 241 participants; 3 studies; moderate-certainty evidence downgraded for serious imprecision). Two studies reported on mean wound-related blood loss per wound area; however, we were unable to pool the studies due to considerable heterogeneity. It was uncertain whether electrosurgery decreased wound-related blood loss per wound area. We could not reach a conclusion on the effects of the two interventions on pain and appearance of scars for various reasons such as small number of studies, insufficient data, the presence of conflicting data, and different measurement methods. Authors' conclusions The certainty of evidence was moderate to very low due to risk of bias and imprecise results. Low-certainty evidence shows no clear difference in wound infection between the Scalpel and electrosurgery. There is a need for more research to determine the relative effectiveness of Scalpel compared with electrosurgery for major abdominal incisions.
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Scalpel versus electrosurgery for abdominal incisions
Cochrane Database of Systematic Reviews, 2012Co-Authors: Kittipat Charoenkwan, Narain Chotirosniramit, Kittipan RerkasemAbstract:Background Scalpels or electrosurgery can be used to make abdominal incisions. The potential benefits of electrosurgery include reduced blood loss, dry and rapid separation of tissue, and reduced risk of cutting injury to surgeons, though there are concerns about poor wound healing, excessive scarring, and adhesion formation. Objectives To compare the effects on wound complications of Scalpel and electrosurgery for making abdominal incisions. Search methods We searched the Cochrane Wounds Group Specialised Register (searched 24 February 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 2); Ovid MEDLINE (1950 to February Week 3 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations 23 February 2012); Ovid EMBASE (1980 to 2012 Week 07); and EBSCO CINAHL (1982 to 17 February 2012). We did not apply date or language restrictions. Selection criteria Randomised controlled trials (RCTs) comparing the effects on wound complications of electrosurgery with Scalpel use for the creation of abdominal incisions. The study participants were patients undergoing major open abdominal surgery, regardless of the orientation of the incision (vertical, oblique, or transverse) and surgical setting (elective or emergency). Electrosurgical incisions included those in which the major layers of abdominal wall, including subcutaneous tissue and musculoaponeurosis (a strong sheet of fibrous connective tissue that serves as a tendon to attach muscles), were made by electrosurgery, regardless of the techniques used to incise the abdominal skin and peritoneum. Scalpel incisions included those in which all major layers of abdominal wall including skin, subcutaneous tissue, and musculoaponeurosis, were incised by a Scalpel, regardless of the techniques used on the abdominal peritoneum. Data collection and analysis We independently assessed studies for inclusion and risk of bias. One review author extracted data which were checked by a second review author. We calculated risk ratio (RR) and 95% confidence intervals (CI) for dichotomous data, and difference in means (MD) and 95% CI for continuous data. We examined heterogeneity between studies. Main results We included nine RCTs (1901 participants) which were mainly at unclear risk of bias due to poor reporting. There was no statistically significant difference in overall wound complication rates (RR 0.90, 95% CI 0.68 to 1.18), nor in rates of wound dehiscence (RR 1.04, 95% CI 0.36 to 2.98), however both these comparisons are underpowered and a treatment effect cannot be excluded. There is insufficient reliable evidence regarding the effects of electrosurgery compared with Scalpel incisions on blood loss, pain, and incision time. Authors' conclusions Current evidence suggests that making an abdominal incision with electrosurgery may be as safe as using a Scalpel. However, these conclusions are based on relatively few events and more research is needed. The relative effects of Scalpels and electrosurgery are unclear for the outcomes of blood loss, pain, and incision time.
