Search Results (106)

Introduction: Neurosurgery has evolved from an anatomy-driven analog discipline into a digitally augmented field supported by multimodal imaging, neuronavigation, intraoperative imaging, neurophysiological monitoring, robotics, augmented reality, and artificial intelligence. Objective: To examine how this transition has altered professional responsibility, informed consent, training, and medico-legal accountability in neurosurgical practice. Methods: We performed a structured narrative review of the literature on digital neurosurgery and its ethical and professional implications, focusing on publications from 1990 onward and supplemented by landmark historical papers. Sources were selected for relevance to cranial, spinal, skull base, stereotactic, and neuro-oncological neurosurgery, and then synthesized into thematic domains including brain shift, eloquent cortex preservation, stereotactic accuracy, intraoperative neurophysiology, workflow integration, equity, and liability. Results: Digital systems improve lesion localization, function-preserving surgery, stereotactic precision, documentation, and training, but they also introduce new vulnerabilities related to registration error, brain shift, platform dependence, data overload, cost, cybersecurity, deskilling, and diffuse accountability. Conclusions: Digital augmentation expands rather than diminishes the neurosurgeon’s responsibility. The neurosurgeon remains accountable for surgical indication, interpretation of technology-generated information, intraoperative override, and communication of technology-specific risks. The central ethical challenge is to integrate digital tools without weakening patient-centered judgment. Full article

Manual counting of surgical tools, known as surgical counting, is a time-consuming and error-prone task that increases the risk of retained surgical instruments and extends operating room (OR) time. Presently, in hospitals around the world, surgical counting is often performed manually with paper or tablet checklists, often leading to delays, increased infection risk, and financial cost. RFID, barcode-based, and computer vision solutions exist but are expensive and have challenges with sterilization and signal interference. This paper presents ToolSafe, a low-cost, portable system that classifies surgical tools by their acoustic signatures when dropped into a detection box. A pilot dataset of 4004 audio samples from four tool types (n = 996, tissue forceps; n = 1005, iris scissors; n = 1006, scalpel handle; n = 997, testing needle) was collected using ToolSafe. A convolutional neural network (CNN) was evaluated using stratified five-fold cross-validation on the laboratory dataset, with a k-nearest neighbors (KNN) classifier implemented as a control model. In each fold, both models were trained on 80% of the data and tested on the remaining 20%, ensuring that all samples were used for both training and evaluation. The CNN achieved a mean (±standard deviation) classification accuracy of 99.55% (±0.19%) across the validation folds, outperforming the KNN model, which achieved a mean accuracy of 97.28% (±0.50%). The difference was statistically significant according to a paired t-test across folds (p = 0.0003), indicating CNN’s superior performance on the dataset. For a run of 100 additional samples using the Raspberry Pi-based system, spectrogram generation averaged 0.121 s (±0.025 s), CNN inference averaged 0.180 s (±0.033 s), and total end-to-end latency averaged 1.851 s (±0.253 s) per tool. This pilot study proposes a possible technological solution for surgical counting that reduces human error and enhances patient safety. ToolSafe may be subsequently improved by increasing the number of surgical tools used in the training dataset, testing under more robust OR-like environments, and comparing to other classification algorithms. Further refinement and incorporation of ToolSafe in operating room workflows have the potential to reduce patient risks from extended surgical times and retained surgical instruments. Full article

Background/Objectives: Morphological alterations of the lingual frenulum may impair sucking, speech articulation, and tongue mobility. In such cases, frenectomy is considered the most effective therapeutic approach. High-power lasers have been increasingly adopted due to their precision and reduced surgical trauma. This study aimed to compare the effects of frenectomy performed with a cold scalpel, electric scalpel, and diode laser in Wistar rats. Methods: Forty-five female rats, approximately six months old and weighing 250–300 g, were randomly allocated into three experimental groups (n = 15) according to the surgical technique used. Each group was further divided into three subgroups (n = 5) based on postoperative evaluation periods of 1, 3, and 7 days. After surgery, animals were euthanized at the predetermined time points, and tissue samples from the operated area were collected for histological analysis. Specimens were processed histologically, and sections were analyzed descriptively and semi-quantitatively for inflammatory response. Results: All surgical techniques produced similar inflammatory responses across the evaluated periods, with no statistically significant differences among groups. The inflammatory infiltrate was predominantly acute, characterized by the presence of neutrophils, lymphocytes, and macrophages, with scarce plasma cells and no multinucleated giant cells. Although the cold scalpel group showed greater variability in macrophage response over time, the electric scalpel and diode groups exhibited more consistent inflammatory patterns. Conclusions: All evaluated techniques were biologically equivalent with respect to the initial inflammatory response, with the electric scalpel and high-power laser showing slightly greater temporal stability. Full article

Objective: This study compared the clinical and patient-reported outcomes of Er: YAG laser-assisted versus conventional scalpel frenectomy, while evaluating the adjunctive impact of postoperative antimicrobial mouthwashes on wound healing and periodontal parameters. Methods: A total of 102 patients who underwent labial frenectomy were included in this retrospective longitudinal cohort study. Participants were allocated into four groups based on the surgical approach (Er: YAG laser or conventional scalpel) and the postoperative mouthwash protocol (Kloroben^® or Klorhex Plus^®). Clinical assessments were performed at baseline and at 7, 14, and 28 days postoperatively. Wound healing, evaluated using the Wound Healing Index, was defined as the primary outcome. Secondary outcomes included periodontal clinical parameters, epithelialization status, postoperative pain, bleeding, and analgesic consumption. To control potential confounders, multivariable regression analysis was performed alongside standard parametric and nonparametric tests, with p < 0.05 considered statistically significant. Results: All treatment protocols resulted in significant improvements over time (p < 0.001). However, Er: YAG laser–assisted frenectomy was associated with significantly better periodontal indices, superior wound-healing scores, and more favorable patient-reported outcomes than the conventional scalpel technique at all postoperative evaluations (p < 0.001). On day 7, ‘Very Good’ healing was observed in 70.2% of the laser groups, compared with 14.4% in the CS groups (p = 0.001). Group 4 showed the lowest mean VAS scores (0.04 ± 0.20) and the lowest analgesic consumption by day 7. Multivariable analysis confirmed that the surgical technique was the strongest independent predictor of superior wound healing (p < 0.05), regardless of age, gender, smoking, or systemic disease. Notably, frenulum type was not significantly associated with wound healing or pain outcomes (p > 0.05). Conclusions: Within the limitations of this study, Er: YAG laser-assisted frenectomy was observed to provide favorable wound healing outcomes compared to the conventional technique. Furthermore, our findings show that anatomical variations in frenulum type do not significantly influence the quality or speed of recovery. These findings suggest that the choice of surgical modality and postoperative chemical support are more critical determinants of early clinical success than the anatomical variations of the frenulum. Full article

Background: Axillary lymph node dissection (ALND) remains necessary for selected patients with breast cancer but is associated with lymphatic morbidity, including seroma formation and breast cancer-related lymphedema (BCRL). The Total Sealing Technique (TST) is a technique-centered operative concept that emphasizes systematic sealing of lymphatic and vascular structures during ALND. Methods: This review integrates mechanistic rationale and clinical evidence derived from comparative cohort studies evaluating TST (using advanced bipolar vessel-sealing systems) versus conventional electrocautery (CONV). Key perioperative and long-term outcomes are summarized quantitatively. Results: In a comparative cohort of total mastectomy with ALND, TST significantly reduced total drainage volume (360.5 ± 187.9 vs. 820.6 ± 661.6 mL; p < 0.001) and shortened time to drain removal (4.8 ± 1.3 vs. 6.8 ± 2.1 days; p < 0.001). Postoperative hospital stay was reduced by 3.7 days on average (5.9 ± 1.3 vs. 9.6 ± 3.4 days; p < 0.001). The incidence of seroma decreased from 65.9% to 28.6% (p = 0.001), with fewer aspiration procedures (1.8 vs. 4.6 per patient; p = 0.022). Importantly, long-term follow-up demonstrated a statistically significant reduction in BCRL incidence (2.9% vs. 22.2%; p = 0.028). Operative time and blood loss were not increased. Conclusions: Current single-center data indicate that TST is associated with substantial reductions in postoperative lymphatic morbidity and a statistically significant decrease in BCRL incidence. While independent multicenter validation is warranted, TST represents a reproducible technique-centered approach with meaningful clinical impact in ALND. Full article

Objectives: Oral leukoplakia (OL) is the most prevalent oral potentially malignant disorder and requires accurate diagnosis, safe excision, and reliable margin evaluation to minimize recurrence and malignant transformation. Diode laser excision is increasingly adopted due to its precision and favorable clinical outcomes; however, laser-induced thermal effects at surgical margins raise concerns regarding tissue integrity and histopathological reliability. This study aimed to evaluate optical coherence tomography (OCT) as a real-time, high-resolution, non-invasive imaging modality for assessing peri-incisional thermal effects during diode laser excision of non-dysplastic OL. The primary objective was to validate OCT for ultrastructural and morphometric tissue analysis while ensuring preservation of diagnostic readability. Methods: A single-center observational case series was conducted at the University of Turin. Thirty patients with clinically and histopathologically confirmed oral leukoplakia without epithelial dysplasia were enrolled and allocated to two groups: 15 lesions excised using a 980 nm diode laser in continuous-wave contact mode (laser group) and 15 lesions removed by conventional scalpel biopsy (control group). Laser excisions were performed with standardized parameters and a circumferential safety margin of 5 mm. Immediately after excision, specimens underwent ex vivo spectral-domain OCT (SD-OCT) imaging to evaluate the epithelial and connective tissue microarchitecture at surgical margins and central lesion areas. OCT acquisition sites were precisely correlated with histological sections. Quantitative OCT measurements of epithelial thickness, lamina propria thickness, and laser-induced thermal alterations were compared with corresponding histological findings. Results: OCT consistently provided high-resolution visualization of oral mucosal microarchitecture in both groups, allowing clear identification of epithelial stratification, basement membrane continuity, and lamina propria organization. In the laser group, OCT detected superficial optical alterations at the surgical margins consistent with laser-induced thermal effects, while deeper tissue layers remained structurally readable. Histological analysis revealed mean epithelial and connective tissue thermal alterations of 288.9 μm and 430.3 μm, respectively. OCT-derived measurements showed high concordance with histology, with an overall agreement of 88.5% and no statistically significant differences between OCT and histological assessments. Importantly, laser-induced thermal effects did not impair definitive histopathological diagnosis in any specimen. Comparison with the control group confirmed preserved tissue architecture in scalpel-excised samples and highlighted OCT sensitivity in detecting laser-related structural remodeling. Conclusions: OCT proved to be a reliable, non-invasive imaging technique for real-time assessment of diode laser-induced thermal effects during OL excision. The technique accurately delineated tissue microstructure and surgical margins without compromising histopathological interpretation. Integration of OCT into the laser-assisted management of oral potentially malignant disorders may enhance surgical precision, optimize margin control, reduce diagnostic uncertainty, and support individualized follow-up strategies. Full article

Background: Low-level laser irradiation (LLLI) can promote wound healing. However, the biological effects of the erbium-doped yttrium aluminum garnet (Er:YAG) laser on gingival wound healing remain unclear. Objectives: To assess the effects of low-level Er:YAG laser irradiation on endothelial cell activity in vitro and on early phase gingival wound healing in vivo. Methods: In vitro, human umbilical vein endothelial cells were irradiated with a low-level Er:YAG laser (30 mJ/pulse, 10 Hz, 20 and 30 s, defocused, no water spray) and assessed for viability, cytotoxicity, and migration. Standardized bilateral wounds (4 × 1 mm) were created in the palatal gingiva of 14 male mice using a scalpel and curette. The wounds were irradiated for 20 s under the same irradiation settings, using a contact tip (diameter 800 μm) to induce superficial blood surface coagulation, while contralateral sites were assigned to controls in a split-mouth design. Postoperative wound area and mRNA expression of IL-6, TNF-α, VEGF, FGF-2, and TGF-β1 were analyzed after 48 h. Results: In vitro, LLLI significantly enhanced cell proliferation with/without increasing cytotoxicity. In the wound healing assay, the LLLI significantly promoted cell migration compared with the control. In vivo, the reduction in residual wound area in the laser group was comparable to that in the control group. IL-6 and TNF-α expressions were significantly downregulated, whereas VEGF was significantly upregulated in the laser group. Conclusions: Low-level Er:YAG laser irradiation enhances anti-inflammatory and pro-angiogenic effects, suggesting its potential in promoting gingival wound healing. Full article

Despite significant advances in neurosurgical and critical care, traumatic brain injury (TBI) remains a major cause of morbidity and mortality. Surgical treatment of intracranial hemorrhagic lesions can only target the primary mechanical injuries and their immediate consequences but fails to address the biochemical pathological cascade that unfolds during the second injury. This review synthesizes current knowledge regarding the use of several biomarkers in diagnosis and prognosis assessment. A structured literature search was conducted by querying the PubMed database. Articles evaluating diagnostic and prognostic biomarkers in adult TBI were screened according to Prisma guidelines, and data regarding biomarkers type, cut-off values, and correlations with the outcome were extracted and summarized. Among Central Nervous System (CNS)-Specific markers, S100 calcium-binding protein (S100B) emerged as a remarkably strong negative predictor for Computed Tomography (CT)-visible intracranial lesions (NPV = 97.3–100%), whereas glial fibrillary acidic protein (GFAP) yielded both high NPV and brain specificity. Coagulation parameters such as the international normalized ratio (INR) and fibrinogen were independently correlated with mortality and unfavorable outcomes. Fibrinogen displayed a bidirectional relationship with increased mortality risk at both low (<2 g/L) and high (>4.5 g/L) values. In conclusion, biomarkers quantify the otherwise invisible progression of secondary traumatic brain injury that persists even after successful surgery. Full article

The intelligent surgical knife (iKnife), based on rapid evaporative ionization mass spectrometry (REIMS), represents a transformative advance in intraoperative tissue characterization. By integrating mass spectrometry with electrosurgical dissection, the iKnife enables real-time differentiation between cancerous and healthy tissues through molecular fingerprinting of the aerosol generated during cutting. This innovation significantly shortens operative time by eliminating delays associated with conventional histopathological analysis and enhances surgical precision by providing continuous feedback on tissue composition. Since its inception by Zoltán Takáts and colleagues, the iKnife has demonstrated remarkable diagnostic accuracy across multiple cancer types, including breast, ovarian, and colorectal malignancies, with reported sensitivities and specificities > 90% in selected tumour types. Beyond oncology, REIMS technology also shows promise for microbial identification and metabolomic profiling. This review provides a comprehensive overview of the iKnife’s development, underlying principles, clinical validation, and emerging applications, as well as its integration into surgical workflows and the challenges remaining for widespread clinical adoption. Future perspectives include miniaturization, AI-driven spectral interpretation, and expansion into robotic and image-guided surgery. Full article

Background: Despite level-A evidence demonstrating superior long-term survival with bilateral internal mammary artery (BIMA) grafting, its global utilization remains dismally low (<10–15%), largely due to historical concerns over deep sternal wound infections (DSWI) and technical complexity. This underutilization persists even as multi-arterial grafting (MAG) adoption stagnates, with recent North American data showing only 16% of coronary artery bypass grafting CABG procedures utilize more than one arterial conduit. Objective: This review synthesizes contemporary evidence demonstrating that modern surgical refinements—particularly skeletonized “no-touch” harvesting—have effectively mitigated these concerns, enabling wider BIMA application. Methods & Results: Over two decades of institutional experience confirm that skeletonized harvesting preserves sternal perfusion and minimizes DSWI risk, even in high-risk patients. Propensity-matched analyses show significant survival benefits of BIMA grafting across age and comorbidity strata (8-year survival: 67.1% BIMA vs. 58.2% single internal mammary artery (SIMA), p < 0.05), rendering previous contraindications relative rather than absolute. Long-term outcomes demonstrate superior 10-year survival for in situ BIMA compared with SIMA (86.1% vs. 78.6%, p < 0.05). Advanced configurations such as sequential skeletonized grafting are safe and further enhance outcomes. In single-vessel left anterior descending artery (LAD) disease, skeletonized left internal mammary artery (LIMA) continues to outperform percutaneous coronary intervention (PCI), underscoring the unmatched durability of arterial conduits. Conclusions: The technical evolution of conduit harvesting has resolved the “BIMA paradox”. Contemporary evidence supports BIMA grafting as a standard of care for a broad CABG population, offering a durable, lifelong solution for coronary artery disease and warranting renewed guideline emphasis on multi-arterial revascularization. Full article

Amorphous cobalt-phosphorous (CoP) coatings are a candidate to replace hard chromium and other traditional coatings. Here, electrodeposition of both amorphous and crystalline CoP coatings was performed at room temperature and in an air environment. The bath composition and deposition conditions were optimized to offer a low cost, low maintenance, and safe process. The effects of various deposition variables such as solution composition, pH, duration, and mixing parameters were studied, and the reproducibility of the process was demonstrated. Selected coatings were then thoroughly characterized by a variety of techniques. The best amorphous/nanocrystalline coating contained ca. 6.4 wt.% P after 1.2 h of deposition, and 7.2 wt.% P after 4 h of deposition. The best crystalline coating contained ca. 2.7 wt.% P after 1.2 h of deposition and between 2.3 and 5.5 wt.% P after 4 h of deposition. The amorphous coating had excellent mechanical properties: a high hardness (7.8 ± 0.7 GPa), high Young’s modulus (153 ± 9 GPa), and surprisingly low coefficient of dry friction (between 0.11 ± 0.02 and 0.17 ± 0.01). The coating could not be scraped from the substrate using a diamond scalpel blade. In a standard adhesion test, the sample failed neither cohesively within the coating nor adhesively between the coating and the substrate. In the as-deposited conditions, the structure was uniform, nanocrystalline, or had nanocrystals embedded in an amorphous matrix. The crystallization temperature of the amorphous alloy was 284 °C, and the phase transformation occurred only between 300 and 400 °C. The coatings developed and comprehensively characterized herein may be considered for aerospace, magnetic storage, fuel cells, water splitting, and other applications. Full article

Background: Gingival recession (GR) is defined as the exposure of the root surface due to the gingival margin shifting apically from the cemento-enamel junction. Current effective management of defects related to GR relies on root coverage periodontal plastic surgery (RCPPS), using the Modified Coronally Advanced Flap (mCAF) with an envelope design. Recent literature also reported the association of different biomaterials to the mCAF procedure. In light of these considerations, a systematic review (SR) was conducted to determine and compare the efficacy of all mCAF adjunctive techniques for the treatment of multiple adjacent GR-type (MAGR) defects. Methods: An electronic search was conducted in 2025 on studies published between 2013 and 2025, using PubMed, Scopus, Web of Science, and Cinahl Complete, to address the focused question: “which is the efficacy of different mCAF adjunctive techniques for the treatment of multiple adjacent GR-type defects, in terms of root coverage (RC), esthetic outcomes, and keratinized tissue (KT) augmentation?”. Randomized controlled trials with a minimum follow-up of 6 months with ≥ 5 patients treated for coverage of MAGR were included. Risk of bias was assessed with RoB 2 Tool. A meta-analysis was performed using RevMan5.4 software and the level of evidence of included studies was analyzed with GRADEPro GDT. Results: A total of 17 studies were included in the SR, 9 of which evaluating mCAF + sCTG (subepithelial connective tissue graft) vs. mCAF adjunctive techniques [Collagen Matrix (CM), xenogeneic acellular dermal matrix (XADM), Platelet-Rich Fibrin (PRF), Enamel Matrix Derivatives (EMD), sCTG harvested double blade scalpel] were then included in the meta-analysis. The primary outcomes of complete root coverage (CRC) and keratinized tissue width variation (ΔKTW) were statistically significant ([CRC: Odds Ratio (OR) 1.70; 95% CI (confidence interval) 1.18, 2.44; p = 0.004]; [ΔKTW: SMD (standardized mean difference) 0.37; 95% CI 0.11, 0.63; p = 0.005]) in favor of mCAF + CTG. Meanwhile, no statistically significant difference was observed in terms of RES. The certainty assessment highlighted relevant results: despite the lack of evidence in the long-term, a high level of evidence showed that sCTG was more effective than XADM in terms of CRC (p = 0.002) and ΔKTW (p = 0.0001). A low level of evidence revealed that sCTG achieved a greater ΔKTW compared to CM (p = 0.0006). Although no significant differences were observed, a low level of evidence suggested that mCAF + EMD and mCAF + sCTG (DBS) may provide good results. To date, only one RCT showed long-term stable results of CTG in terms of RC. Conclusions: The association of sCTG to mCAF demonstrated better results in terms of RC and KTW augmentation in short- and medium-term follow-ups. Long-term studies are needed to confirm the efficacy of the other mCAF adjunctive techniques, considering limitations due to heterogeneity in follow-ups, distribution of techniques analyzed, and different study designs. Registration in PROSPERO (International prospective register of systematic reviews) was performed with ID CRD420251085823. Full article

Background and Clinical Significance: Thoracic dorsal arachnoid web (DAW) is a rare intradural extramedullary condition characterized by a thin band of arachnoid tissue compressing the dorsal spinal cord. A hallmark imaging feature is the “scalpel sign”, which refers to anterior displacement of the thoracic spinal cord with dorsal cerebrospinal fluid (CSF) accumulation, producing a sagittal profile resembling a surgical scalpel. Although highly specific for DAW, this sign may also appear in other intradural conditions such as idiopathic ventral spinal cord herniation and arachnoid cysts. The clinical presentation is typically progressive and nonspecific, including lower limb weakness, sensory changes, gait disturbances, and, less frequently, sphincter dysfunction. Diagnosis is often delayed due to the subtle nature of the lesion and limited resolution of conventional Magnetic Resonance Imaging (MRI). High-resolution Three-Dimensional Constructive Interference in Steady State (3D-CISS) sequences improve diagnostic accuracy by highlighting indirect signs such as spinal cord deformation and dorsal CSF flow obstruction. Case Presentation: We report the case of a 57-year-old woman presenting with chronic cervico-dorsalgia, bilateral lower limb weakness, paresthesia, and progressive gait instability. Neurological examination revealed spastic paraparesis and hyperreflexia. Conventional MRI was inconclusive. However, sagittal T2-weighted and 3D-CISS sequences demonstrated the scalpel sign at the T4–T5 level, with anterior cord displacement and dorsal subarachnoid space enlargement. Surgical exploration confirmed the presence of a dorsal arachnoid web, which was resected. Postoperative follow-up showed clear improvement in motor function and gait. Conclusions: DAW should be considered in cases of unexplained thoracic myelopathy or cervico-dorsalgia with neurological signs. Early recognition of the scalpel sign using advanced MRI sequences is critical for timely diagnosis and surgical planning, which may lead to significant clinical improvement. Full article

Dermal tissue samples are a rich source of germplasm because they can be readily collected, frozen as part of a genebank collection, digested and cultured, and used for a variety of purposes such as genotyping or other forms of genetic research. Derived fibroblasts can also be used for somatic cell nuclear transfer, and the remaining cells can be frozen for future use. However, collection of tissues with ear notchers, scalpels, or biopsy punches can be problematic because tissue handling and the tool surfaces can contaminate the samples. Therefore, the modification of the Allflex Tissue Sampling Unit (TSU) system was explored to determine if the technology can empower rapid collection of clean samples that are easily identifiable and portable. Results indicate that the TSU system was efficient, and samples that were collected and processed for tissue culture resulted in successful derivations of fibroblasts from 7 of 11 animals. Thus, the TSU system appears to be a viable option for collecting and preserving dermal tissue for genebanking and other applications where simple, rapid collection of large quantities of samples is required. Full article

Background and Objectives: Modified radical mastectomy (MRM) is a common surgical procedure, with outcomes that are influenced by the instruments used in the operation. This meta-analysis aimed to compare “cold cutting” or “traditional” techniques and monopolar or bipolar electrocautery. Materials and Methods: A comprehensive search of five databases was conducted, with only studies of adult patients undergoing MRM in clearly defined groups selected. Data from 12 RCTs and 3 cohort studies summarizing 1372 participants was extracted and then synthesized using random-effects models. Risk of Bias was assessed for each of the included studies using the RoB-2 or ROBINS-I tool. Results: Scalpel or scissor use in dissection and flap raising was associated with a significantly lower risk of seroma formation (LogOR = −0.90, 95% CI: −1.26 to −0.54, p < 0.01). Conversely, electrocautery demonstrated advantages including reduced operative time (MD = −13.14 min, 95% CI: −19.58 to −6.70, p < 0.01) and decreased intraoperative blood loss (MD = −171.60 mL, 95% CI: −259.35 to −84.41, p < 0.01). No statistically significant differences were observed in total drain output (MD = −16.45 mL, 95% CI: −170.96 to 138.06, p = 0.83) or duration of drainage (MD = 0.41 days, 95% CI: −0.41 to 1.23, p = 0.32). Similarly, rates of infection, ecchymosis, and flap necrosis did not differ significantly between techniques. Conclusions: Electrocautery should be employed in patients who benefit from a shorter operative time and lower blood loss, while patients in better clinical condition should benefit from cold cutting techniques. Data on patient-reported outcomes and wound cytokine levels were sparse and inconsistent. This meta-analysis was registered in PROSPERO (ID: CRD420251059886). Full article