EXPERIMENTAL Comparative Healing of Human Cutaneous Surgical Incisions Created by the PEAK PlasmaBlade, Conventional Electrosurgery, and a Standard Scalpel Manuel E. Ruidiaz, M.S. Davorka Messmer, Ph.D. Dominique Y. Atmodjo, B.A. Joshua G. Vose, M.D. Eric J. Huang, M.D., Ph.D. Andrew C. Kummel, Ph.D. Howard L. Rosenberg, M.D. Geoffrey C. Gurtner, M.D. La Jolla, Palo Alto, San Francisco, and Stanford, Calif. Background: The authors investigated thermal injury depth, inflammation, and scar- ring in human abdominal skin by comparing the histology of incisions made with a standard “cold” scalpel blade, conventional electrosurgery, and the PEAK PlasmaBlade, a novel, low-thermal-injury electrosurgical instrument. Methods: Approximately 6 and 3 weeks before abdominoplasty, full-thickness in- cisions were created in the abdominal pannus skin of 20 women, using a scalpel (scalpel), the PlasmaBlade, and a conventional electrosurgical instrument. Fresh (0-week) incisions were made immediately before surgery. After abdominoplasty, harvested incisions were analyzed for scar width, thermal injury depth, burst strength, and inflammatory response. Results: Acute thermal injury depth was reduced 74 percent in PlasmaBlade in- cisions compared with conventional electrosurgical instrument (p  0.001). Sig- nificant differences in inflammatory response were observed at 3 weeks, with mean CD3 + response (T-lymphocytes) 40 percent (p = 0.01) and 21 percent (p  0.12) higher for the conventional electrosurgical instrument and PlasmaBlade, respec- tively, compared with the scalpel. CD68 + response (monocytes/macrophages) was 52 percent (p = 0.05) and 16 percent (p  0.35) greater for a conventional electrosurgical instrument and the PlasmaBlade, respectively. PlasmaBlade inci- sions demonstrated 65 percent (p  0.001) and 42 percent (p  0.001) stronger burst strength than a conventional electrosurgical instrument, with equivalence to the scalpel at the 3- and 6-week time points, respectively. Scar width was equivalent for the PlasmaBlade and the scalpel at both time points, and 25 percent (p = 0.01) and 12 percent (p = 0.15) less than for electrosurgery, respectively. Conclusions: PlasmaBlade incisions demonstrated reduced thermal injury depth, inflammatory response, and scar width in healing skin compared with electrosur- gery. These results suggest that the PlasmaBlade may provide clinically meaningful advantages over conventional electrosurgery during human cutaneous wound healing. (Plast. Reconstr. Surg. 128: 104, 2011.) CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II. From the Department of Bioengineering, Moores Cancer Center, and the Department of Chemistry and Biochemistry, Nanoen- gineering, Bioengineering, University of California San Diego; the Department of Clinical Affairs, PEAK Surgical, Inc.; the Department of Pathology, University of California San Fran- cisco; the Pathology Service 113B, Veterans Affairs Medical Center; and the Department of Plastic and Reconstructive Sur- gery, Stanford University Medical Center. Received for publication September 8, 2010; accepted Janu- ary 7, 2011. Clinical Trial Registry Information: clinicaltrials. gov, a service of the U.S. National Institutes of Health; regis- tration no. NCT00943150 (http://clinicaltrials.gov/ ct2/show/NCT00943150). Copyright ©2011 by the American Society of Plastic Sur- geons DOI: 10.1097/PRS.0b013e31821741ed Disclosure: This study was funded by PEAK Surgical, Inc. Dominique Y. Atmodjo and Joshua G. Vose are employees of PEAK; Eric J. Huang and Howard L. Rosenberg are consultants to PEAK. Geoffrey C. Gurtner received an unrestricted research grant provided by PEAK. None of the other authors has any relevant disclosures. www.PRSJournal.com 104