Histopathological comparison of incision methods in transconjunctival blepharoplasty: a rat model study

Year 2025, Volume: 2 Issue: 1, 26 - 31, 15.02.2025

Engin Selamioğlu , İlker Altundağ , Mustafa Sertaç Ocak , Mehmet Berke Göztepe , Ahmet Demir

https://doi.org/10.70058/cjm.1566344

Abstract

Objective: The choice of incision method is critical in transconjunctival blepharoplasty, affecting both the wound healing process and aesthetic outcomes. This study aimed to compare the histopathological effects of four different incision methods: scalpel, electrocautery, radiocautery, and laser, on wound healing in an animal model.

Methods: A total of 54 female Sprague-Dawley rats were divided into nine groups, each subjected to different incision methods on their palpebral conjunctiva. Specimens were collected immediately after the incision and at 1- and 2-week intervals to evaluate wound width, depth, vascular proliferation, inflammation, and fibrosis.

Results: Analysis revealed that scalpel and laser incisions resulted in narrower and shallower defects immediately post-operation, while electrocautery and radiocautery produced the most pronounced tissue trauma. By the first week, electrocautery showed the least vascular proliferation, inflammation, and fibrosis, while radiocautery exhibited the most pronounced effects. At the second week, scalpel incisions showed the least inflammation and vascular proliferation, while fibrosis was least observed in radiocautery incisions. Interestingly, despite the initial trauma caused by electrocautery, this method showed less fibrosis over time, suggesting reduced long-term scarring compared to radiocautery. Laser incisions also showed favorable healing outcomes, but with more moderate results compared to the scalpel group. Overall, the study highlights the varying impacts of each incision method on the healing process, indicating that scalpel and laser offer advantages in the early stages of healing, while electrocautery, despite initial trauma, may result in less long-term scarring.

Conclusion: The results highlight the importance of selecting the appropriate incision method to minimize complications and optimize healing in transconjunctival blepharoplasty.

Keywords

Scalpel, Electrocautery, Laser, Transconjunctival Blepharoplasty, Wound Healing

Ethical Statement

yes

Supporting Institution

no

Thanks

Thanks

Transkonjunktival blefaroplastideki insizyon yöntemlerinin histopatolojik karşılaştırması: bir sıçan modeli çalışması

Abstract

References

• Kothari NA, Avashia YJ, Lemelman BT, Mir HS, Thaller SR. Incisions for orbital floor exploration. J Craniofac Surg. 2012;23(7 Suppl 1):1985-1989. doi:10.1097/SCS.0b013e31825aaa03
• Pruksapong C, Jankajorn S, Burusapat C, Wanichjaroen N, Wongprakob N, Techasatian P. Comparison of Colorado Needle Electrocautery and Traditional Scalpel for Upper Eyelid Blepharoplasty Incision: A Randomized Controlled Trial and Systematic Review. Plast Reconstr Surg Glob Open. 2023;11(6):e5045. Published 2023 Jun 9. doi:10.1097/ GOX.0000000000005045
• Bähr W, Bagambisa FB, Schlegel G, Schilli W. Comparison of transcutaneous incisions used for exposure of the infraorbital rim and orbital floor: a retrospective study. Plast Reconstr Surg. 1992;90(4):585-591. doi:10.1097/00006534-199210000-00006.
• Wesley RE. Transconjunctival approaches to the lower lid and orbit. J Oral Maxillofac Surg. 1998;56(1):66-69. doi:10.1016/ s0278-2391(98)90918-1
• Patel PC, Sobota BT, Patel NM, Greene JS, Millman B. Comparison of transconjunctival versus subciliary approaches for orbital fractures: a review of 60 cases. J Craniomaxillofac Trauma. 1998;4(1):17-21.
• Appling WD, Patrinely JR, Salzer TA. Transconjunctival approach vs subciliary skin-muscle flap approach for orbital fracture repair. Arch Otolaryngol Head Neck Surg. 1993;119(9):1000- 1007. doi:10.1001/archotol.1993.01880210090012
• Rohrich RJ, Janis JE, Adams WP Jr. Subciliary versus subtarsal approaches to orbitozygomatic fractures. Plast Reconstr Surg. 2003;111(5):1708-1714. doi:10.1097/01. PRS.0000054209.18400.4E
• Mullins JB, Holds JB, Branham GH, Thomas JR. Complications of the transconjunctival approach. A review of 400 cases. Arch Otolaryngol Head Neck Surg. 1997;123(4):385-388. doi:10.1001/ archoto.123.4.385
• Baumann A, Ewers R. Use of the preseptal transconjunctival approach in orbit reconstruction surgery. J Oral Maxillofac Surg. 2001;59(3):287-292. doi:10.1053/joms.2001.20997
• Suga H, Sugawara Y, Uda H, Kobayashi N. The transconjunctival approach for orbital bony surgery: in which cases should it be used?. J Craniofac Surg. 2004;15(3):454-457. doi:10.1097/00001665-200405000-00022
• Lorenz HP, Longaker MT, Kawamoto HK Jr. Primary and secondary orbit surgery: the transconjunctival approach. Plast Reconstr Surg. 1999;103(4):1124-1128. doi:10.1097/00006534- 199904040-00003
• Wray RC, Holtmann B, Ribaudo JM, Keiter J, Weeks PM. A comparison of conjunctival and subciliary incisions for orbital fractures. Br J Plast Surg. 1977;30(2):142-145. doi:10.1016/0007-1226(77)90009-1
• Kelley P, Crawford M, Higuera S, Hollier LH. Two hundred ninety-four consecutive facial fractures in an urban trauma center: lessons learned. Plast Reconstr Surg. 2005;116(3):42e-49e. doi:10.1097/01.prs.0000177687.83247.27
• Westfall CT, Shore JW, Nunery WR, Hawes MJ, Yaremchuk MJ. Operative complications of the transconjunctival inferior fornix approach. Ophthalmology. 1991;98(10):1525-1528. doi:10.1016/ s0161-6420(91)32094-3
• Arung W, Meurisse M, Detry O. Pathophysiology and prevention of postoperative peritoneal adhesions. World J Gastroenterol. 2011;17(41):4545-4553. doi:10.3748/wjg.v17.i41.4545
• Grover R, Sanders R. Clinical review Recent advances Plastic surgery [Internet]. Available from: www.bmj.com
• Kim SH, Roh SG, Lee NH, Yang KM. Radiofrequency ablation and excision of multiple cutaneous lesions in neurofibromatosis type 1. Arch Plast Surg. 2013;40(1):57-61. doi:10.5999/ aps.2013.40.1.57
• David L. M., Sanders G. CO2 laser blepharoplasty: a comparison to cold steel and electrocautery. Dermatologic Surgery 13.2 (1987): 110-114.
• Rokhsar CK, Ciocon DH, Detweiler S, Fitzpatrick RE. The short pulse carbon dioxide laser versus the colorado needle tip with electrocautery for upper and lower eyelid blepharoplasty. Lasers Surg Med. 2008;40(2):159-164. doi:10.1002/lsm.20604
• Carqueville JC, Chesnut C. Histologic Comparison of Upper Blepharoplasty Skin Excision Using Scalpel Incision Versus Microdissection Electrocautery Needle Tip Versus Continuous Wave CO2 Laser. Dermatol Surg. 2021;47(10):1376-1378. doi:10.1097/DSS.0000000000003178
• Liboon J, Funkhouser W, Terris DJ. A comparison of mucosal incisions made by scalpel, CO2 laser, electrocautery, and constant-voltage electrocautery. Otolaryngol Head Neck Surg. 1997;116(3):379-385. doi:10.1016/S0194-59989770277-8
• Fisher SE, Frame JW, Browne RM, Tranter RM. A comparative histological study of wound healing following CO2 laser and conventional surgical excision of canine buccal mucosa.Arch Oral Biol. 1983;28(4):287-291. doi:10.1016/0003-9969(83)90069-9
• Sinha UK, Gallagher LA. Effects of steel scalpel, ultrasonic scalpel, CO2 laser, and monopolar and bipolar electrosurgery on wound healing in guinea pig oral mucosa. Laryngoscope. 2003;113(2):228-236. doi:10.1097/00005537-200302000-00007
• Kashkouli MB, Kaghazkanai R, Mirzaie AZ, Hashemi M, Parvaresh MM, Sasanii L. Clinicopathologic comparison of radiofrequency versus scalpel incision for upper blepharoplasty. Ophthalmic Plast Reconstr Surg. 2008;24(6):450- 453. doi:10.1097/IOP.0b013e31818acfce