TECHNICAL NOTE Safety and efficacy of electrocautery scalpel utilization for skin opening in neurosurgery B. SHEIKH Neurosurgery Department, King Faisal University, Saudi Arabia Abstract Diathermy is used widely in neurosurgical procedures, mainly for subcutaneous and deeper layers dissection. The use on scalp and skin of other body parts has been precluded by the fear of scar formation and wound dehiscence. One-hundred-and- seventy-seven skin incisions for neurosurgical procedures have been performed using the micro-needle electrocautery scalpel (MES) and the steel scalpel. The elements in this study included: electrocautery generator unit, cutting mode, power, waveform, size and shape of the MES, depth of the incision, the speed of the electrode movement through tissue, amount of blood loss, physical inspection of the wound edges and wound complication. Patients tolerated the procedures well, with no increased risk from the use of the MES. Only two incisions had wound infection and dehiscence. All other patients had usual wound healing. Time taken during skin opening was significantly shorter when using the MES. Blood loss during skin opening was three to five times less when the micro-needle electrocautery scalpel was used. The MES is both safe and useful in neurosurgical procedures. The findings of this study recommend the use of the MES in all neurosurgical procedures, especially when blood loss has significant importance, such as in paediatric cases. Key words: Electrocautery scalpel, monopolar, neurosurgery, scalp incision, skin incision. Introduction The use of electrocautery in surgery dates back to 1909 when it was used to fulgurate tumours. 1 Later, in 1926, Cushing introduced it for neuro- surgery use. 2 The general surgical use of electro- cautery had been mainly reserved for incising and dissecting the subcutaneous tissue and deeper layers. The use of the electrocautery scalpel to open the skin in substitution for the classical steel scalpel has been rejected in the past for the fear of delay wound healing and the risk of infection. 3 Several reports reflected the recent change in this concept. The electrocautery knife has been used widely by general surgeons to create abdominal and thoracic incisions, with excellent results. The need for a fast and more haemostatic method to create incisions is even more important in neuro- surgery, particularly for scalp incisions and in the paediatric age group. The present study evaluates the result of routine use of micro-needle electro- cautery scalpel to perform skin incision in neuro- surgical practice. Materials and methods The micro-needle electrocautery scalpel was used to perform 177 skin incisions during neurosurgical procedures. In each procedure, the proposed skin incision was marked and measured in millimetres. Each incision was then divided into two parts, one to be opened by the steel scalpel and the other half by the micro-needle electrocautery scalpel. The gen- erator unit (Valleylab electrosurgical generator unit, Force FX-8C) was set on cutting pure mode, power of 5 W, and 390 kHz sinusoid waveform. The micro- dissection needle tip (Colorado Biomedical, Inc.) was utilized as the electrocautery scalpel (Fig. 1). The size of the micro-dissection needle tip is 5 m. On completing total skin incision, the wound edges were inspected for physical differences be- tween the parts performed by the steel scalpel and the micro-needle electrocautery scalpel. The total length and time taken to complete the incision on each side was calculated separately. The speed of skin incision was calculated in mm/s from the start of incising till completing the incision, including 1 Received for publication 4 November 2003. Accepted 13 April 2004. Correspondence: B. Sheikh, Neurosurgery Department, King Fahd Hospital of the University, PO Box 40040, Al-Khobar 31952, Saudi Arabia. Fax: (966) 3- 858 7546. E-mail: bsheikh@helth.net.sa (T&F) CBJN180310 British Journal of Neurosurgery, June 2004; 18(3): 268 – 272 ISSN 0268-8697 print/ISSN 1360-046X online/04/030268–05 # The Neurosurgical Foundation DOI: 10.1080/02688690410001732715