ELECTRIC CAUTERY LOWERS THE CONTAMINATION THRESHOLD FOR INFECTION OF LAPAROTOMIES

BACKGROUND: Interplay between wound resistance factors and bacterial i nnoculum determines the risk of surgical infection. Since cautery caus es more damage than the scalpel, our hypothesis is that lower numbers of bacteria are required to infect wounds made by electric cautery tha n to infect wounds made with a scalpel. METHODS: Abdominal fascia was incised in 375 rats by cold knife, cutting current, or coagulation cur rent. Wounds were innoculated with increasing numbers of bacteria and histologically scored at 7 days for necrosis, inflammation, and absces s. RESULTS: Coagulation current causes more inflammation, necrosis, an d abscesses than the scalpel at all bacterial levels. Electric cutting current is intermediate, causing more damage than the scalpel only af ter contamination reached 10(5). Above this threshold most wounds were infected in all groups. CONCLUSIONS: Electric coagulation current sho uld be used only when the need for meticulous hemostasis outweighs the considerably increased risk of infection. Electric cutting current is less destructive but also less hemostatic; indications for its use ar e difficult to identify. (C) 1998 by Excerpta Medica, Inc.