Wiegand Michael J, Kubacki Gregory W, Gilbert Jeremy L
Department of Bioengineering, Clemson University, Clemson, South Carolina, USA.
Clemson University-Medical University of South Carolina Program in Bioengineering, Clemson University, Charleston, South Carolina, USA.
J Biomed Mater Res B Appl Biomater. 2021 Dec;109(12):2057-2067. doi: 10.1002/jbm.b.34853. Epub 2021 Apr 29.
Electrosurgical techniques are used during surgery to cauterize, and their damaging effects have primarily been documented in terms of tissue necrosis, charring, and localized heat accumulation. Metallic implants as well as the surgical blade can experience incidental electrosurgical current arcing that results in the generation and transfer of melted metallic particles. This work examines the composition, particle size distribution, and chemical state of the melted alloy surfaces and particles produced in vitro. Using scanning electron microscopy and energy dispersive spectroscopy, a flash-melting particle generation phenomenon between source 304 SSL blades and polished cobalt-chromium-molybdenum (CoCrMo) and titanium-6-aluminum-4-vandaium (Ti6Al4V) surfaces was documented where 304 SSL mixed heterogeneously with the CoCrMo and Ti6Al4V ejecting "splatter" particles from the cautery site. The spherical micron-sized particles were embedded with sub-micron-sized particles with 42% of the total sample population measuring between 0.25 and 0.35 μm in diameter. CoCrMo-304 SSL particles were principally made of high concentrations of iron, oxygen, and nickel with embedded sub-micron-sized particles containing oxygen, chromium, and cobalt with lower concentrations of iron and molybdenum. Ti6Al4V-304 SSL interactions resulted in similar micron-sized particles made up of high concentrations of iron, nickel, and chromium with embedded sub-micron-sized particles containing titanium, oxygen, and small amounts of aluminum. X-ray photoelectron spectroscopy of damaged CoCrMo surfaces confirmed the presence of chromium (VI) following dry electrocautery contact in coagulation mode. The structural effects of electrocautery-induced damage are becoming visible in retrieval analysis, but the long-term physiological implications during the lifetime of the implant from this damage mode have yet to be defined.
电外科技术在手术中用于烧灼，其破坏作用主要表现为组织坏死、烧焦和局部热积聚。金属植入物以及手术刀片可能会出现偶然的电外科电流电弧，导致熔化的金属颗粒的产生和转移。这项工作研究了体外产生的熔化合金表面和颗粒的成分、粒径分布和化学状态。使用扫描电子显微镜和能量色散光谱，记录了源304不锈钢刀片与抛光的钴铬钼（CoCrMo）和钛-6-铝-4-钒（Ti6Al4V）表面之间的闪熔颗粒生成现象，其中304不锈钢与CoCrMo和Ti6Al4V不均匀混合，从烧灼部位喷出“飞溅”颗粒。球形微米级颗粒中嵌入了亚微米级颗粒，总样本群体中有42%的颗粒直径在0.25至0.35μm之间。CoCrMo-304不锈钢颗粒主要由高浓度的铁、氧和镍组成，嵌入的亚微米级颗粒含有氧、铬和钴，铁和钼的浓度较低。Ti6Al4V-304不锈钢相互作用产生了类似的微米级颗粒，由高浓度的铁、镍和铬组成，嵌入的亚微米级颗粒含有钛、氧和少量铝。对受损CoCrMo表面的X射线光电子能谱分析证实，在凝固模式下进行干式电烧灼接触后存在六价铬。电烧灼引起的损伤的结构效应在取出分析中已可见，但这种损伤模式对植入物使用寿命期间的长期生理影响尚未明确。
