比较 PEAK PlasmaBlade、传统电外科和标准手术刀切割的人皮肤外科切口的愈合情况。
Comparative healing of human cutaneous surgical incisions created by the PEAK PlasmaBlade, conventional electrosurgery, and a standard scalpel.
机构信息
La Jolla, Palo Alto, San Francisco, and Stanford, Calif. From the Department of Bioengineering, Moores Cancer Center, and the Department of Chemistry and Biochemistry, Nanoengineering, Bioengineering, University of California San Diego; the Department of Clinical Affairs, PEAK Surgical, Inc.; the Department of Pathology, University of California San Francisco; the Pathology Service 113B, Veterans Affairs Medical Center; and the Department of Plastic and Reconstructive Surgery, Stanford University Medical Center.
出版信息
Plast Reconstr Surg. 2011 Jul;128(1):104-111. doi: 10.1097/PRS.0b013e31821741ed.
BACKGROUND
The authors investigated thermal injury depth, inflammation, and scarring in human abdominal skin by comparing the histology of incisions made with a standard "cold" scalpel blade, conventional electrosurgery, and the PEAK PlasmaBlade, a novel, low-thermal-injury electrosurgical instrument.
METHODS
Approximately 6 and 3 weeks before abdominoplasty, full-thickness incisions were created in the abdominal pannus skin of 20 women, using a scalpel (scalpel), the PlasmaBlade, and a conventional electrosurgical instrument. Fresh (0-week) incisions were made immediately before surgery. After abdominoplasty, harvested incisions were analyzed for scar width, thermal injury depth, burst strength, and inflammatory response.
RESULTS
Acute thermal injury depth was reduced 74 percent in PlasmaBlade incisions compared with conventional electrosurgical instrument (p < 0.001). Significant differences in inflammatory response were observed at 3 weeks, with mean CD3 response (T-lymphocytes) 40 percent (p = 0.01) and 21 percent (p ≈ 0.12) higher for the conventional electrosurgical instrument and PlasmaBlade, respectively, compared with the scalpel. CD68 response (monocytes/macrophages) was 52 percent (p = 0.05) and 16 percent (p ≈ 0.35) greater for a conventional electrosurgical instrument and the PlasmaBlade, respectively. PlasmaBlade incisions demonstrated 65 percent (p < 0.001) and 42 percent (p < 0.001) stronger burst strength than a conventional electrosurgical instrument, with equivalence to the scalpel at the 3- and 6-week time points, respectively. Scar width was equivalent for the PlasmaBlade and the scalpel at both time points, and 25 percent (p = 0.01) and 12 percent (p = 0.15) less than for electrosurgery, respectively.
CONCLUSIONS
PlasmaBlade incisions demonstrated reduced thermal injury depth, inflammatory response, and scar width in healing skin compared with electrosurgery. These results suggest that the PlasmaBlade may provide clinically meaningful advantages over conventional electrosurgery during human cutaneous wound healing.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.(Figure is included in full-text article.).
背景
作者通过比较标准“冷”手术刀刀片、传统电外科和新型低热损伤电外科器械 PEAK PlasmaBlade 切割的人腹部皮肤切口的组织学，研究了热损伤深度、炎症和瘢痕形成。
方法
在腹部整形术之前约 6 周和 3 周，使用手术刀（手术刀）、PlasmaBlade 和传统电外科仪器在 20 名女性的腹部赘肉皮肤上进行全层切口。在手术前立即进行新鲜（0 周）切口。腹部整形术后，分析采集的切口的宽度、热损伤深度、爆裂强度和炎症反应。
结果
与传统电外科仪器相比，PlasmaBlade 切口的急性热损伤深度降低了 74%（p < 0.001）。在第 3 周观察到炎症反应的显著差异，传统电外科仪器和 PlasmaBlade 的平均 CD3 反应（T 淋巴细胞）分别高 40%（p = 0.01）和 21%（p ≈ 0.12），与手术刀相比。CD68 反应（单核细胞/巨噬细胞）分别高 52%（p = 0.05）和 16%（p ≈ 0.35），传统电外科仪器和 PlasmaBlade 相比。PlasmaBlade 切口的爆裂强度比传统电外科仪器分别强 65%（p < 0.001）和 42%（p < 0.001），分别在第 3 周和第 6 周与手术刀相当。PlasmaBlade 切口和手术刀在两个时间点的疤痕宽度相当，分别比电外科手术窄 25%（p = 0.01）和 12%（p = 0.15）。
结论
与电外科相比，PlasmaBlade 切口在愈合皮肤中表现出较低的热损伤深度、炎症反应和疤痕宽度。这些结果表明，PlasmaBlade 在人类皮肤伤口愈合过程中可能比传统电外科具有更显著的临床优势。
临床问题/证据水平：治疗，II.（全文文章中包含图表。）
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