Outcomes of Craniotomy Scalp Incision Using Cutting Micro-Needle Diathermy versus Traditional Stainless-Steel Scalpel

Scalp incision bleeds profusely due to its high vascularity. In other regions of the body, studies have debunked the initial concern of poor wound outcomes thought to be associated with thermal skin injury if diathermy is used to make skin incision and found that skin incision with diathermy led to reduced incisional blood loss. Studies on cranial operations involving scalp incisions in which incisional blood loss is more likely are scarce.

The objective of this study was to compare the outcomes of scalp incisions using either cutting micro-needle diathermy (MND) or the traditional stainless-steel scalpel (TSSS) during craniotomy.

The study was a hospital-based, prospective, randomized comparative study. Consented adult patients who had craniotomy were randomized into either cutting MND or TSSS group. Outcome measures were volume of blood loss per wound length and incision duration per wound length during scalp incision, 30-day surgical site infection (SSI), and scar appearance at 3 months postoperatively.

The data were analyzed using SPSS version 23, and statistical significance was set at p -value <0.05.

A total of 56 patients were recruited for the study, with 28 patients in each group. The mean age of the patients was 36.21 ± 13.90 years. The mean volume of incisional blood loss per wound length was 3.21 ± 2.06 and 4.65 ± 3.25 mL/cm in MND and TSSS groups, respectively ( p  = 0.053). In the MND group, the mean incision duration per wound length was 0.39 ± 0.18 minutes/cm, while it was 0.35 ± 0.10 minutes/cm in the TSSS group ( p  = 0.364). Five patients (22.7%) and four patients (16.7%) developed SSI in the MND and TSSS groups, respectively ( p  = 0.885). At 3 months postoperatively, the mean scar score was 9.06 ± 0.94 in the MND group and 8.63 ± 1.26 in the TSSS group ( p  = 0.255).

The study revealed no significant difference in the outcomes of craniotomy scalp incision between the two methods of making scalp incision. The study concludes that the use of diathermy in making scalp incision is not inferior to the use of the traditional scalpel, and the method of scalp incision may be left to the discretion of the surgeon.