title: Randomized double-blind trial comparing the cosmetic outcome of cutting diathermy versus scalpel for skin incisions.
abstract: BACKGROUND
  Controversy exists about whether cutting diathermy for skin incisions leads to a cosmetically inferior scar. Cosmetic outcomes were compared between skin incisions created with cutting diathermy versus scalpel. Wound infection rates and postoperative incisional pain were also compared.
  
  
  METHODS
  This was a randomized double-blind trial comparing cutting diathermy and scalpel in patients undergoing bowel resection. Scar cosmesis was assessed at 6 months after surgery by a plastic surgeon and a research associate using the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). Patients also used POSAS to self-evaluate their scars. Wound infections within 30 days were recorded, and incision pain scores were measured on the first 5 days after operation.
  
  
  RESULTS
  A total of 66 patients were randomized to cutting diathermy (31) or scalpel (35). At 6 months, there was no significant difference between the diathermy and scalpel groups in mean(s.d.) VSS scores (4·9(2·6) versus 5·0(1·9); P = 0·837), mean POSAS total scores (19·2(8·0) versus 20·0(7·4); P = 0·684) or subjective POSAS total scores (20·2(12·1) versus 21·3(10·4); P = 0·725). Neither were there significant differences in wound infection rates between the groups (5 of 30 versus 5 of 32; P = 1·000). Pain scores on day 1 after operation were significantly lower in the diathermy group (mean 1·68 versus 3·13; P = 0·018), but were not significantly different on days 2-5.
  
  
  CONCLUSIONS
  Cutting diathermy is a cosmetically acceptable technique for abdominal skin incisions. There is no increased risk of wound infection, and diathermy may convey benefit in terms of early postoperative wound pain.
  
  
  BACKGROUND
  NCT01496404 ( http://www.clinicaltrials.gov).
authors.affiliation: Divisions of General Surgery, University of British Columbia, British Columbia, Canada.
authors.forename: L N F
authors.initials: LN
authors.lastname: Aird
authors.forename: S G
authors.initials: SG
authors.lastname: Bristol
authors.forename: P T
authors.initials: PT
authors.lastname: Phang
authors.forename: M J
authors.initials: MJ
authors.lastname: Raval
authors.forename: C J
authors.initials: CJ
authors.lastname: Brown
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D002921:Cicatrix / Q000209:etiology*; D003357:Cosmetic Techniques; D062109:Dermatologic Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D003972:Diathermy / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007422:Intestines / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D013525:Surgical Instruments / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology