AbdElaal Nasser K, Ellakwa Hamed E, Elhalaby AllaaEldin F, Shaheen AbdElhameed E, Aish Ahmed H
a Obstetrics and Gynecology Department , Faculty of Medicine, Menoufia University , Mansoura, Egypt.
b Resident of Obstetrics and Gynecology at the Ministry of Health , Shoubra General Hospital , Cairo , Egypt.
J Obstet Gynaecol. 2019 Apr;39(3):340-344. doi: 10.1080/01443615.2018.1527298. Epub 2019 Jan 11.
Surgical scalpels are traditionally used for skin incisions during a Caesarean delivery; the great evolutions in electrosurgical devices bring an alternative method for skin incision by the usage of cutting diathermy. This was a prospective randomised comparative study conducted during the period from March 2016 to February 2017 on 200 patients, 100 patients had skin incisions using the surgical scalpel, while 100 patients had skin incisions with a diathermy, in order to judge the variations in the postoperative pain, the incision time, the incision blood loss, the operative time, the wound healing and the wound complications. We observed a significant difference between the two groups regarding the incision time (p < .001), incisional blood loss (p < .001), operative time (p < .001) and the postoperative pain (p < .001), where these parameters were less in the diathermy group. No significant difference observed between the two groups regarding the wound healing (p = .389) and wound complications (p = .470). We can conclude that the proper usage of diathermy in making the skin incision during a Caesarean section in this study achieved better results than the scalpel incision. Impact statement What is already known on this subject? Surgical scalpels are traditionally used in making the skin incisions during a Caesarean section; diathermy incisions, on the contrary, are less popular among the surgeons. It has been hypothesised that the application of extreme heat may result in a significant postoperative pain and poor wound healing. There has been a widespread use of diathermy for hemostasis but fear of production of large scars and improper tissue healing has restricted their usage in making skin incisions. What do the results of this study add? The use of diathermy for skin incisions in Caesarean section in this study was associated with a reduced incisional blood loss, incisional time, operative time and postoperative pain. It had no effect on wound closure and was not associated with any delay in wound healing. Also, the wound complications rate was equal in both types of incisions. What are the implications of these findings for clinical practice and/or further research? Most surgeons prefer the scalpel in making skin incision during a Caesarean section due to the fear of surgical site infection. Our findings proved different, we proved that cutting diathermy could be accepted as an alternative technique for making a skin incision without increased rates of wound infections. Also, the advantages of cutting diathermy will give benefits to both the patients and the surgeons.
传统上，剖宫产手术中使用手术刀进行皮肤切口；电外科设备的巨大发展带来了一种通过使用切割透热法进行皮肤切口的替代方法。这是一项前瞻性随机对照研究，于2016年3月至2017年2月期间对200例患者进行，100例患者使用手术刀进行皮肤切口，100例患者使用透热法进行皮肤切口，以判断术后疼痛、切口时间、切口失血量、手术时间、伤口愈合情况及伤口并发症的差异。我们观察到两组在切口时间（p＜0.001）、切口失血量（p＜0.001）、手术时间（p＜0.001）和术后疼痛（p＜0.001）方面存在显著差异，透热法组的这些参数较低。两组在伤口愈合（p = 0.389）和伤口并发症（p = 0.470）方面未观察到显著差异。我们可以得出结论，在本研究中，剖宫产手术中正确使用透热法进行皮肤切口比手术刀切口取得了更好的效果。影响声明关于该主题已知的信息是什么？传统上，剖宫产手术中使用手术刀进行皮肤切口；相反，透热法切口在外科医生中不太受欢迎。据推测，极端热量的应用可能导致显著的术后疼痛和伤口愈合不良。透热法已广泛用于止血，但对产生大疤痕和组织愈合不当的担忧限制了其在皮肤切口中的使用。本研究的结果增加了什么？本研究中剖宫产手术使用透热法进行皮肤切口与切口失血量减少、切口时间、手术时间和术后疼痛减轻相关。它对伤口闭合没有影响，也与伤口愈合延迟无关。此外，两种切口的伤口并发症发生率相同。这些发现对临床实践和/或进一步研究有何意义？由于担心手术部位感染，大多数外科医生在剖宫产手术中更喜欢使用手术刀进行皮肤切口。我们的发现不同，我们证明切割透热法可被接受为一种替代技术，用于进行皮肤切口且不会增加伤口感染率。此外，切割透热法的优点将使患者和外科医生都受益。
