Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico of Rome University, Rome, Italy.
Department of Pathology, Campus Bio-Medico of Rome University, Rome, Italy.
Int Wound J. 2018 Oct;15(5):717-721. doi: 10.1111/iwj.12915. Epub 2018 Mar 30.
Cutaneous ulceration is a difficult medical problem and a major source of morbidity for patients. In the surgical treatment of ulcers, debridement is the first step, and it can be carried out using several surgical tools. Recently, new surgical devices have emerged using plasma-mediated electrical discharges with a lower peak temperature. A prospective single-blind trial was conducted on chronic ulcers not responsive to common non-surgical management. Patients were randomly separated into 2 groups: Group A received surgical debridement with conventional electrocautery, and Group B received surgical debridement using the plasma-mediated device. Histological samples were collected intraoperatively to evaluate the thermal damage during the surgical procedure and 2 weeks after surgery to evaluate the inflammatory response and collagen deposition. The width of coagulation necrosis at the incision margins in Group B was significantly shorter compared with Group A (P = .001). The inflammatory cell infiltration showed a cellular distribution percentage that was quite equal between the 2 groups. The granulation tissue showed an abundant deposition of dense and mature collagen in Group B, compared with Group A, where the mature collagen appeared in small quantities (P < .001). Microbial culture showed a lower incidence of postoperative infections in Group B compared with the control group (P < .05). The study demonstrated, based on the results, that the new technology with the use of a lower temperature electrosurgical device represents an effective therapeutic weapon for the surgical treatment of skin ulcers, both vascular and extravascular types.
皮肤溃疡是一个医学难题，也是患者发病率的主要来源。在溃疡的外科治疗中，清创是第一步，可以使用几种外科工具进行。最近，出现了使用等离子介导的放电的新型外科设备，其峰值温度较低。对常规非手术治疗反应不佳的慢性溃疡进行了一项前瞻性单盲试验。患者随机分为 2 组：A 组接受常规电灼术的外科清创，B 组接受等离子介导设备的外科清创。术中采集组织样本以评估手术过程中的热损伤，并在术后 2 周评估炎症反应和胶原蛋白沉积。与 A 组相比，B 组切口边缘的凝固性坏死宽度明显更短（P =.001）。两组之间的炎症细胞浸润百分比分布相当。与 A 组相比，B 组的肉芽组织显示出丰富的致密和成熟胶原蛋白沉积，而 A 组中成熟胶原蛋白的含量较少（P <.001）。微生物培养显示 B 组术后感染的发生率低于对照组（P <.05）。该研究表明，基于结果，使用低温电外科设备的新技术代表了治疗血管性和非血管性皮肤溃疡的有效治疗手段。
