Oley Mendy Hatibie, Oley Maximillian Christian, Kepel Billy Johnson, Manginstar Christian, Rawung Rangga, Langi Fima Lanra Fredrik G, Barends David, Aling Deanette Michelle R, Wagiu Angelica Maurene Joicetine, Faruk Muhammad
Division of Plastic Reconstructive & Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Sam Ratulangi University, Manado, North Sulawesi, Indonesia.
Division of Plastic Reconstructive & Aesthetic Surgery, Department of Surgery, R. D. Kandou Hospital, Manado, North Sulawesi, Indonesia.
Ann Med Surg (Lond). 2021 Nov 1;71:103006. doi: 10.1016/j.amsu.2021.103006. eCollection 2021 Nov.
The scalpel was once the gold standard for surgical incisions. Electrosurgery has started to supplant scalpels but is not yet acceptable for skin incisions due to the risk of burns and deeper injury relative to the scalpels' neat incision with less tissue damage. The unnecessary burden of excessive scar formation makes comparing these two methods challenging. Therefore, this study aims to compare post-incision skin scarring created after monopolar electrosurgery and scalpel surgery, and evaluate the Patient and Observer Scar Assessment Scale (POSAS) suitability for assessing skin incision scars by comparing patients' and observers' scores.
This self-controlled study involved patients undergoing elective and emergency skin surgery procedures. A singular wound site was created using two incision methods (monopolar electrosurgery and scalpel) simultaneously. Post-incision scar tissue formation was evaluated using the POSAS, a subjective scar assessment tool that involved patients self-reporting on pain, itching, color, thickness flexibility, and surface relief. Observer-rated vascularity, pigmentation, thickness, flexibility, and surface relief both using a 5-point Likert-type scale. We performed this assessment three months post-surgery, and the results were analyzed by a battery of statistical tests and linear mixed models.
Twenty patients were included in this study. Data analyzed using the paired -test or Wilcoxon rank-sum test indicated no statistically significant differences between the scar tissue created by monopolar electrosurgery and scalpels according to both the patients and the observers. Correlation analyses between the patients' and observers' total POSAS scores indicated these followed a moderate linear relationship (r = 0.51; p < 0.001). Linear mixed models further supported the agreement of POSAS total scores between patients and observers. They also confirmed that electrosurgery was not inferior to the scalpel technique.
Scar tissue from skin incisions made by monopolar electrosurgery were indistinguishable from those created with a scalpel. The POSAS instrument is an acceptable means of assessing scar formation on the skin.
手术刀曾是手术切口的金标准。电外科手术已开始取代手术刀，但由于存在烧伤风险以及相对于手术刀整齐切口而言对组织损伤更深，导致其在皮肤切口方面仍未被广泛接受。过度瘢痕形成带来的不必要负担使得比较这两种方法具有挑战性。因此，本研究旨在比较单极电外科手术和手术刀手术后的切口皮肤瘢痕形成情况，并通过比较患者和观察者的评分来评估患者和观察者瘢痕评估量表（POSAS）对评估皮肤切口瘢痕的适用性。
本自我对照研究纳入了接受择期和急诊皮肤外科手术的患者。在同一伤口部位同时使用两种切口方法（单极电外科手术和手术刀）。使用POSAS评估切口后瘢痕组织形成情况，这是一种主观瘢痕评估工具，包括患者对疼痛、瘙痒、颜色、厚度、柔韧性和表面平整度的自我报告。观察者使用5点李克特量表对血管分布、色素沉着、厚度、柔韧性和表面平整度进行评分。我们在术后三个月进行了此项评估，并通过一系列统计测试和线性混合模型对结果进行分析。
本研究共纳入20名患者。使用配对t检验或Wilcoxon秩和检验分析数据表明，单极电外科手术和手术刀形成的瘢痕组织在患者和观察者的评估中均无统计学显著差异。患者和观察者的POSAS总评分之间的相关性分析表明，二者呈中度线性关系（r = 0.51；p < 0.001）。线性混合模型进一步支持了患者和观察者POSAS总评分的一致性。这些模型还证实电外科手术并不逊色于手术刀技术。
单极电外科手术造成的皮肤切口瘢痕组织与手术刀造成的瘢痕组织并无差异。POSAS工具是评估皮肤瘢痕形成的一种可接受方法。
