A Study Comparing the Results of Diathermy Versus Scalpel for Inguinal Skin Incisions

INTRODUCTION

Traditionally, scalpels have been the standard tool for making skin incisions. However, since the advent of electrocautery, it has gained popularity for tasks like coagulation and cutting. Electrosurgery involves the use of high-frequency electric current to achieve specific clinical outcomes, and the term “diathermy” is derived from the Greek words “therma” (heat) and “dia” (through), meaning “heating through tissues.” Carl France Nagelschmidt, a German physician, first coined the term in 1909.^[1–3]

Electrosurgery, also referred to as surgical diathermy or electrocautery, is widely used in surgical procedures for coagulation, fulguration, and cutting. There are two main types of diathermy: monopolar and bipolar. In monopolar diathermy, the electrical current flows from one electrode near the target tissue to a separate electrode placed elsewhere on the body, usually near the leg or buttocks. In contrast, bipolar diathermy uses both electrodes on a single device, with the current passing only through the tissue being treated, minimising the risk to surrounding tissues.^[4,5]

While scalpels are commonly used for skin incisions, they often lead to bleeding that can obstruct the surgical field. Diathermy offers an alternative, primarily used for tissue destruction and hemostasis. However, surgeons often avoid diathermy for skin incisions due to concerns about wound infection, delayed healing, and scarring.^[6–8] This study aims to compare the effectiveness of diathermy and scalpel incisions in terms of incision time, blood loss, wound characteristics, and scar assessment in abdominal surgeries at a tertiary care hospital in Gulbarga.

MATERIAL AND METHODS

A total of 81 patients were included in the study, divided equally into two groups: Group A (40 patients) underwent scalpel incisions and Group B (41 patients) underwent diathermy incisions [Table 2 and Figure 1]. Both groups were operated on by the same surgical unit. Patients were informed about the benefits and risks of each incision method, and consent was obtained. All surgeries were performed under spinal anaesthesia, with a standard antibiotic protocol using Inj. Ceftriaxone [Table 3 and 4].

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Figure 1:

a) Operative incision with scalpel, b) Operative incision with diathermy.

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Randomisation was done using a chit system. In the scalpel group, incisions were made with a no. 22 scalpel blade, with haemostasis achieved by applying pressure with a sterile swab. Diathermy was only used for deeper incisions. In the diathermy group, a monopolar diathermy pencil was used at a 20 CUT mode with 434 KHz [Figure 2 and 3]. Blood loss during the incision was measured by weighing sterile swabs pre- and post-incision, and incision time was recorded with a stopwatch [Table 5]. Postoperative pain was managed with Inj. Diclofenac and, if needed, Inj. Tramadol and assessed using a visual analogue scale (VAS). Wounds were evaluated using the South Hampton wound scoring system on days 4, 10, and 28 [Table 6, 7 and 8].

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Figure 2:

a) Postoperative image of scalpel, b) Postoperative image of diathermy.

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Figure 3:

a) Healed incision after 1 month of Scalpel, b) Healed incision after 1 month of diathermy.

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RESULTS

DISCUSSION

Diathermy incisions have historical roots dating back to ancient times and offer several advantages over traditional scalpel incisions, including reduced incision time, lower blood loss, and shorter postoperative recovery. Unlike scalpels, diathermy uses heat to vaporise tissue, creating an incision without spreading heat to adjacent tissues.^[9–12]

Electrocautery is considered safe and effective for surgical skin incisions, showing benefits such as faster incision time, reduced blood loss, and lower postoperative pain compared to scalpel incisions. Studies indicate no significant difference in postoperative wound complications, hospital stay duration, or wound cosmetic outcomes between the two techniques.^[10,13–17] For instance, a randomised trial revealed that cutting diathermy is the preferred technique for abdominal skin incisions, with no increased risk of wound infection. Additionally, several studies have demonstrated that diathermy incisions result in less postoperative pain.^{[14,15,18,19]}

In elective surgeries, diathermy offers significant benefits over scalpel use, while in emergency surgeries, the results regarding wound healing and complications are more variable. However, the choice between scalpel and diathermy does not significantly impact early postoperative and long-term wound complications, making the decision dependent on the surgeon’s skill and experience.^[18–20]

The use of Manchester Scar Score in assessing wound outcomes showed that the mean and median scar scores were slightly higher in scalpel incisions, though the difference was not statistically significant. This aligns with several studies that found no significant difference in scar outcomes between diathermy and scalpel incisions. Further research is needed to fully understand the impact of electrocautery on wound healing and complications.^[20–25]

CONCLUSION

Diathermy incision, or electrocautery, is a well-established and effective surgical technique, offering several advantages over traditional scalpel incisions. It reduces procedural time, minimises blood loss, and decreases postoperative pain and complications, making it an attractive option for many surgeries. Our study highlights that diathermy results in less intraoperative blood loss, reduced postoperative pain, and no scar dissimilarity appearance in the techniques, with comparable wound healing outcomes. Diathermy also eliminates the risk of sharp injuries associated with scalpel blades, though precautions must be taken to prevent fire and electrical burns.

However, choosing between diathermy and scalpel depends on factors such as the surgeon’s experience, the specifics of the procedure, diathermy equipment and specifications, and patient considerations. While diathermy offers clear benefits, there are situations where a scalpel may be preferred or necessary. Ultimately, the decision should be based on a careful evaluation of the surgical context and the expertise of the surgical team.