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Abstract
This study investigated the inflammatory and histopathological outcomes of scalpel versus electrocautery skin excisions with adjunct topical metronidazole in mice. Group A underwent scalpel excision, Group B electrocautery excision, and Group C served as the control. All wounds received topical metronidazole. Systemic levels of interleukin‑6 (IL‑6) and interleukin‑1β (IL‑1β) were assayed by ELISA at multiple time points, and histopathological analysis of wound tissues was performed. Significant differences in inflammatory response and tissue healing were observed between groups. Group A exhibited a significant but transient increase in IL‑6 at 48 hours that resolved rapidly, suggesting a controlled inflammatory profile. In contrast, Group B showed a significant and sustained increase in IL‑1β, indicating a more intense and prolonged inflammatory reaction. Histological analysis confirmed that scalpel incisions resulted in superior tissue repair with enhanced collagen deposition and epithelialization, whereas electrocautery caused greater tissue disruption consistent with thermal damage. Topical metronidazole supported healing in both groups but did not fully mitigate the heightened inflammatory response triggered by electrocautery. Further investigation is warranted to elucidate the immunomodulatory role of metronidazole in surgical wound healing. In conclusion, the choice of surgical instrument significantly impacts the biological pathway of healing. Scalpel incisions promote a more favorable, self‑limiting inflammatory response with superior tissue regeneration, whereas electrocautery incisions induce a stronger pro‑inflammatory state and delayed repair. These findings suggest that scalpel incisions may facilitate a more advantageous healing response when reducing inflammation is essential.
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References
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- Vahabi, S., Karimi, A., Beiranvand, S., Moradkhani, M. and Hassanvand, K. (2020a). Comparison of the Effect of Different Dosages of Celecoxib on Reducing Pain after Cystocele and Rectocele Repair Surgery. The Open Anesthesia Journal, 14 (1): 30-34 DOI: 10.2174/2589645802014010030.
- Vahabi, S., Veiskarami, P., Roozbahani, M., Lashani, S. and Farzan, B. (2020b). Cross-sectional study on hearing loss and auditory reaction time before and after spinal anesthesia with marcaine 0.5% in patients undergoing elective surgery. Annals of Medicine and Surgery, 60 236-240 DOI: 10.1016/j.amsu.2020.10.046.
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References
Abdelaal, N., Ellakwa, H., Elhalaby, A., Shaheen, A. and Aish, A. (2019). Scalpel versus diathermy skin incisions in cesarean sections. Menoufia Medical Journal, 32 453.
Albeniz, G., Akıncı, O. and Tosun, Y. (2024). Comparison of the Results of Electrocautery and Scalpel Use in Abdominal Midline Incisions. Akdeniz Tıp Dergisi, 10 (1): 53-57.
Ali, M., Murtaza, M., Aleem-Ud-Din, M., Ud Din, M. B., Sarwar, A. and Aslam, A. (2020). Comparison of Harmonic Scalpel versus conventional hemostasis in Thyroid surgery in terms of per-operative and postoperative outcome. The Professional Medical Journal, 27 (01): 68-73 DOI: 10.29309/tpmj/2019.27.01.3278.
Ammar, I., Abdelrahman Ibrahim, A., Ahmed, E., Amr, M., Esraa, M., Mahmoud, I., Esraa, S., Anas, K., Hagar, Z., Abdelrahman, E.-T. and Esraa, G. (2017). Cutting electrocautery versus scalpel for surgical incisions: a systematic review and meta-analysis. Journal of Surgical Research, 220 147-163 DOI: https://doi.org/10.1016/j.jss.2017.06.093.
Ann, B. Z., Yu, B., John, B. H. and John, R. H. 2019. 40 - Hemorrhage Control and Thrombosis Following Severe Injury. In: Craig, S. K., Craig, M. K., Barbara, A. K., Michael, B. S. and David, A. G. (eds.) Consultative Hemostasis and Thrombosis (Fourth Edition). Fourth Edition ed. Philadelphia: Elsevier.
Cavaillon, J.-M. (2001). Pro- versus anti-inflammatory cytokines: Myth or reality. Cellular and molecular biology, 47 (4): 1-8.
Coll, A., Mahgoob, N., Tahir, E., Alsaffar, S., Muna, M. and Ahmed, M. (2013). Harmonic versus electrocautery in the dissection of gall bladder in laparoscopic cholecystectomy. Annals of the College of Medicine, Mosul, 39 107-112 DOI: 10.33899/mmed.2013.81304.
Dinarello, C. A. (2011). Interleukin-1 in the pathogenesis and treatment of inflammatory diseases. Blood, The Journal of the American Society of Hematology, 117 (14): 3720-3732.
Jeschke, M. G., Van Baar, M. E., Choudhry, M. A., Chung, K. K., Gibran, N. S. and Logsetty, S. (2020). Burn injury. Nat Rev Dis Primers, 6 (1): 11 DOI: 10.1038/s41572-020-0145-5.
Johnson, B. Z., Stevenson, A. W., Prêle, C. M., Fear, M. W. and Wood, F. M. (2020). The Role of IL-6 in Skin Fibrosis and Cutaneous Wound Healing. Biomedicines, 8 (5): DOI: 10.3390/biomedicines8050101.
Lacina, L., Kolář, M., Pfeiferová, L., Gal, P. and Smetana Jr, K. (2024). Wound healing: insights into autoimmunity, ageing, and cancer ecosystems through inflammation and IL-6 modulation. Frontiers in Immunology, 15 1403570.
Leong Tan, A. K., Hsu, P. P., Eng, S. P., Ng, Y. H., Sun Lu, P. K., Tan, S. M., Say, J. H. and Chan, Y. H. (2006). Coblation vs electrocautery tonsillectomy: Postoperative recovery in adults. Otolaryngology–Head and Neck Surgery, 135 (5): 699-703 DOI: 10.1016/j.otohns.2006.03.008.
Medzhitov, R. (2010). Inflammation 2010: new adventures of an old flame. Cell, 140 (6): 771-776.
Medzhitov, R. (2021). The spectrum of inflammatory responses. Science, 374 (6571): 1070-1075, doi:10.1126/science.abi5200.
Miller, E. D., Song, F., Smith, J. D., Ayan, A. S., Mo, X., Weldon, M., Lu, L., Campbell, P. G., Bhatt, A. D. and Chakravarti, A. (2019). Plasma‐based biomaterials for the treatment of cutaneous radiation injury. Wound Repair and Regeneration, 27 (2): 139-149.
Reinke, J. M. and Sorg, H. (2012). Wound Repair and Regeneration. European Surgical Research, 49 (1): 35-43 DOI: 10.1159/000339613.
Salgado, R. M., Alcántara, L., Mendoza-Rodríguez, C. A., Cerbón, M., Hidalgo-González, C., Mercadillo, P., Moreno, L. M., Álvarez-Jiménez, R. and Krötzsch, E. (2012). Post-burn hypertrophic scars are characterized by high levels of IL-1β mRNA and protein and TNF-α type I receptors. Burns, 38 (5): 668-676.
Sampaio, C. P. P., Biondo-Simões, M. D. L. P., Trindade, L. C. T., Farias, R. E., Pierin, R. J. and Martins, R. C. (2009). Inflammatory alterations provoked by metronidazole in wounds: an experimental study in rats. Jornal Vascular Brasileiro, 8 232-237.
Seaton, M., Hocking, A. and Gibran, N. S. (2015). Porcine Models of Cutaneous Wound Healing. ILAR Journal, 56 (1): 127-138 DOI: 10.1093/ilar/ilv016.
Shahmoradi, M. K., Mehri, J. and Taheri, H. R. (2020). Comparison of hemorrhoidectomy using harmonic scalpel and electrocautery: A randomized controlled trial. International Journal of Surgery Open, 27 39-42 DOI: 10.1016/j.ijso.2020.10.006.
Trindade, L. C. T., Biondo-Simões, M. D. L. P., Sampaio, C. P. P., Farias, R. E., Pierin, R. J. and Netto, M. C. (2010). Evaluation of topical metronidazole in the healing wounds process: an experimental study. Revista do Colégio Brasileiro de Cirurgiões, 37 358-363.
Vahabi, S., Karimi, A., Beiranvand, S., Moradkhani, M. and Hassanvand, K. (2020a). Comparison of the Effect of Different Dosages of Celecoxib on Reducing Pain after Cystocele and Rectocele Repair Surgery. The Open Anesthesia Journal, 14 (1): 30-34 DOI: 10.2174/2589645802014010030.
Vahabi, S., Veiskarami, P., Roozbahani, M., Lashani, S. and Farzan, B. (2020b). Cross-sectional study on hearing loss and auditory reaction time before and after spinal anesthesia with marcaine 0.5% in patients undergoing elective surgery. Annals of Medicine and Surgery, 60 236-240 DOI: 10.1016/j.amsu.2020.10.046.
Yameny, A. A. (2025). IL-6, TNF-α, IL-1β, and IFN-γ Cytokines as Core Inflammatory Biomarkers: Biological Roles, Diagnostic Utility, and Clinical Applications. Journal of Bioscience and Applied Research, 11 (3): 1055-1061.
Zhu, Z., Ding, J. and Tredget, E. E. (2016). The molecular basis of hypertrophic scars. Burns Trauma, 4 2 DOI: 10.1186/s41038-015-0026-4.