title: Craniosynostosis incision: scalpel or cautery?
abstract: There is an ongoing debate regarding the optimal instrument for scalp incisions: the scalpel or electrocautery. The argument generally focuses on improved healing after an incision made with a knife and decreased bleeding when using electrocautery. This study compares the use of scalpel and electrocautery in making coronal incisions for patients undergoing surgical correction of craniosynostosis. The outcome metric used is wound healing within 6 months after surgery. All patients presenting to the University of North Carolina Children's Hospital with craniosynostosis between July 1, 2007 and January 1, 2010 requiring a coronal incision for surgical correction were prospectively enrolled. In all of these patients, half of the coronal incision was made with knife; the other half, with needle tip cautery. Side of the incision was specified at the time of surgery in the operative report. Patients were excluded from the study if the instrument for incision was not specified or if only 1 modality was used for the entire incision. Sixty-eight patients underwent cranial vault reconstruction, of which 58 met inclusion criteria. Of the 58 matched pairs, 55 were analyzed statistically. The 3 excluded cases were those who had midline complications. There were 17 wound complications (15%): 8 in the knife group, 6 in the cautery group, and 3 at midline (with indeterminate side for the problem). We found no statistically significant difference in wound healing between incisions made with a knife or with electrocautery.
authors: From the *Division of Plastic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; †Division of Plastic Surgery, Texas A&M-Scott & White, Temple, Texas; and ‡Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
authors: Jeyhan S
authors: JS
authors: Wood
authors: Benjamin J
authors: BJ
authors: Kittinger
authors: Victor L
authors: VL
authors: Perry
authors: Adeyemi
authors: A
authors: Adenola
authors: John A
authors: JA
authors: van Aalst
mesh_terms: D002648:Child; D003398:Craniosynostoses / Q000601:surgery*; D003399:Craniotomy / Q000295:instrumentation* / Q000379:methods; D004564:Electrocoagulation / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000295:instrumentation; D012535:Scalp / Q000601:surgery; D013525:Surgical Instruments / Q000009:adverse effects; D014945:Wound Healing