For citation: Inkina A.V., Pryanikov P.D. The Search for Optimal Cutting Instruments in Reconstructive Surgery of the Larynx and Trachea. Head and neck. Russian Journal. 2023;11(1):21–27
The authors are responsible for the originality of the data presented and the possibility of publishing illustrative material – tables, drawings, photographs of patients.
The aim of the study was a comparative analysis of wound healing after tissue exposure to a conventional scalpel, an ultrasound scalpel, and a radiowave surgery device during reconstructive plastic surgery on hollow neck organs. Material and methods. A total of 55 patients with chronic cicatricial stenosis of the larynx and trachea were treated, who underwent laryngotracheoplasty and laryngotracheal defect suturing. We compared wound healing after staged reconstructive plastic surgery on the hollow neck organs with different methods of tissue treatment. The following types of surgical exposure on tissues were used: conventional scalpel; ultrasonic scalpel (ultrasound surgical device “LORA-DON”, Russia), and radiowave surgery device «Сuris» (Sutter, Germany). Two groups of patients were identified: 1 – after laryngotracheoplasty (n=26), 2 – after the laryngotracheal defect suturing (n=37). Postoperative wound healing was assessed with dynamic visual observation of the postoperative area, and several healing outcomes were identified: primary healing, partial surgical wound dehiscence, and complete wound dehiscence followed by secondary healing.
Results. Primary wound healing after laryngotracheoplasty was significantly more frequent with a radio knife (p<0.001) than with a scalpel (75.0% and 43.3%, respectively). At the same time, in the case of using a scalpel, partial wound dehiscence occurred after almost half of the operations (43.3%). Of all the methods used for cutting tissues, partial wound dehiscence occured least often when using a radio knife (25.0%). After using a scalpel, partial wound dehiscence (43.3%) was noted significantly more often (p<0.001) than with a radio knife. Conclusion. Complete wound dehiscence, the most unfavorable outcome of healing, was rarely observed in all cases. Primary wound healing after plasty of a defect of the larynx and/or trachea most often occurred when using a radio knife and an ultrasonic scalpel (77.2% and 66.6%). When using a conventional scalpel, the skin wound healed primarily in 60% of cases. Partial wound dehiscence and the formation of fistula was observed in 22.8% when using a radio knife. Complete wound dehiscence (11.1%) most often occurred when using USS, which was significantly more common (p<0.05) than in the conventional scalpel group. The best results in wound healing were obtained with a radio knife. Primary healing occurs significantly more often in the radio knife group compared with scalpel and USS, (p<0.001 and p<0.010, respectively). Key words: laryngeal stenosis, tracheal stenosis, staged reconstructive plastic surgery, ultrasonic scalpel, radiowave surgery Conflicts of interest. The authors have no conflicts of interest to declare. Funding. There was no funding for this study