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.
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.
Received for publication September 8, 2010; accepted January 7, 2011.
Clinical Trial Registry Information: clinicaltrials.gov, a service of the U.S. National Institutes of Health; registration no. NCT00943150 (http://clinicaltrials.gov/ct2/show/NCT00943150).
Disclosure: This study was funded by PEAK Surgical, Inc. Dominique Y. Atmodjo and Joshua G. Vose are employees of PEAK; Eric J. Huang and Howard L. Rosenberg are consultants to PEAK. Geoffrey C. Gurtner received an unrestricted research grant provided by PEAK. None of the other authors has any relevant disclosures.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal's Web site (www.PRSJournal.com).
Geoffrey C. Gurtner, M.D., Department of Plastic and Reconstructive Surgery, Stanford University School of Medicine, 257 Campus Drive, GK-201, Stanford, Calif. 94305, email@example.com