Deepithelization is a key component of breast reduction and other plastic surgical procedures.1–5 It is commonly performed with a scalpel or scissors. Although other deepithelization techniques are reported, these methods may require special equipment. Choice of technique depends on the surgeon and is most often a matter of preference and training. A new tool was recently introduced to facilitate deepithelization, the Epicut (MicroAire Surgical Instruments, Charlottesville, Va.). This handheld, knife-like device contains a single blade, shaped like a “V,” that is designed to deepithelize in a single, cutting/shearing motion (Figs. 1 and 2). The manufacturer promises a short learning curve and reduced operating time.
We set out to evaluate this device in practice to assess its ability to reduce operative time and complications associated with its use. Institutional review board approval was sought and granted. A side-by-side, controlled trial was carried out simultaneously by two surgeons on healthy subjects scheduled to undergo elective bilateral breast reduction surgery. Twenty consecutive subjects scheduled to undergo bilateral breast reduction were enrolled. Patients not willing to participate were excluded. Each procedure was performed by two surgeons. Surgeon A performed 10 reductions on the right using the Epicut. In those 10 cases, surgeon B performed the deepithelization on the left breast using a knife blade for five cases and a pair of scissors for five cases. For the remaining 10 cases, the surgeons switched roles. Data collected during the operation included deepithelization time (cm2), specimen weight (g), and complications. Data were compared and analyzed with standard statistical methods utilizing the t test.
The average age of the 20 subjects was 39.8 years (range, 21 to 63 years). Traditional Wise pattern reduction was used in all cases (eight superior pedicles and 12 inferior pedicles). The mean specimen weight was 967.5 g (range, 205 to 2549 g). In this pilot study, statistical significance was not achieved. Deepithelization time was calculated as a function of area deepithelized (seconds per square centimeter of breast skin treated, or seconds/cm2). In comparing the Epicut with other methods (scissors and scalpel), the deepithelization time was 5.0 versus 5.3 seconds/cm2 (SD 1.7 seconds/cm2). In comparing the Epicut with the scalpel alone, the deepithelization time was 5.0 versus 5.5 seconds/cm2 (SD 1.96 seconds/cm2), and in comparing the Epicut with scissors alone, the deepithelization time was 5.1 versus 5.0 seconds/cm2 (SD 1.58 seconds/cm2) (Table 1). No intraoperative or postoperative complications were noted in either the study group or the control group. The learning curve of the Epicut was also examined. Deepithelization time using the Epicut for the first five subjects compared with that for the last five subjects was 5.5 versus 5.0 (SD 1.98 seconds/cm2), reflecting an improvement in deepithelization time of 0.5 seconds/cm2.
In this pilot study, the Epicut deepithelized breast reduction pedicles as fast as, or faster than, traditional methods. It was fastest when compared with using the scalpel and demonstrated no real difference versus the scissors. Further studies may demonstrate a significant difference. However, as with the scissors and scalpel, the Epicut will most likely prove most beneficial as a matter of surgeon preference and training.
Martin I. Newman, M.D.
Jeffery Umansky, M.D.
Michel C. Samson, M.D.
Department of Plastic and Reconstructive Surgery
Cleveland Clinic Florida
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