Electric cautery lowers the contamination threshold for infection of laparotomies.
BACKGROUND
Interplay between wound resistance factors and bacterial innoculum determines the risk of surgical infection. Since cautery causes more damage than the scalpel, our hypothesis is that lower numbers of bacteria are required to infect wounds made by electric cautery than to infect wounds made with a scalpel.


METHODS
Abdominal fascia was incised in 375 rats by cold knife, cutting current, or coagulation current. Wounds were innoculated with increasing numbers of bacteria and histologically scored at 7 days for necrosis, inflammation, and abscess.


RESULTS
Coagulation current causes more inflammation, necrosis, and abscesses than the scalpel at all bacterial levels. Electric cutting current is intermediate, causing more damage than the scalpel only after contamination reached 10(5). Above this threshold most wounds were infected in all groups.


CONCLUSIONS
Electric coagulation current should be used only when the need for meticulous hemostasis outweighs the considerably increased risk of infection. Electric cutting current is less destructive but also less hemostatic; indications for its use are difficult to identify.
Soballe
P W
PW
Naval Medical Research Institute and the Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA.
Nimbkar
N V
NV
Hayward
I
I
Nielsen
T B
TB
Drucker
W R
WR
D000818:Animals; D001424:Bacterial Infections / Q000209:etiology*; D004564:Electrocoagulation / Q000009:adverse effects*; D013502:General Surgery / Q000266:history; D049669:History, 16th Century; D049672:History, 19th Century; D049673:History, 20th Century; D049690:History, Ancient; D007249:Inflammation / Q000209:etiology; D009336:Necrosis; D051381:Rats; D017207:Rats, Sprague-Dawley; D013530:Surgical Wound Infection / Q000209:etiology*