AUTHORS’ REPLY the ESU and ABC are over 10 million particles per cubic foot. The data shown in Figure 1 should be considered to yield a relative qualitative comparison of the ESU and ABC since subsequent laboratory tests indicated that there was a loss of approximately 25% of the total number of particles in the relevant size ranges dure to particle set- tling and diffusion to the wall of the inlet probe of the op- tical particle counter. Since visibility is mainly related to smoke generation, the improvement with ABC is modest at best. However, higher argon flow rates tend to enhance visibility. In summary, the usefulness of ABC in plastic surgery seems limited because capillary and small-vessel bleeding as encountered in the liver is uncommon. The potential benefits weighed against the added inconvenience and ex- Fig. 1 Smoke particle concentrations vs. elapsed time of surgery pense do not seem worth the effort when compared to cur- rent standard electrosurgical units. The particulation pro- duced by the ESU and ABC are similar, and both units were measured eight feet from the point of smoke gener- present a potential health risk and nuisance associated ation. Previous studies have shown that smoke levels are with the smoke produced. It is also important to remem- essentially constant throughout the operating room except ber that ABC should not be utilized in patients with right for the transient fluctuations associated with the unsteady to left intracardiac shunts because of the rare but disas- flow field related to intermittent use of ESU or ABC. The trous consequences of gas embolism. present smoke data failed to demonstrate a significant dif- ference in particle density between ESU and ABC during V.L. Young ´ H.J. Brandon Washington University, St. Louis, Missouri, USA reduction mammoplasty. Peak particle densities for both Dr. Young is absolutely right in emphasizing the impor- pable of grabbing the vessel with pickups so that the sur- tance of not using the spray coagulation on larger vessels. geon can use the tip of the discussed ABC unit to apply This is in accordance with our own experience as reported current to these pickups and thus achieve ªconventionalº in the paper. However, we cannot follow the conclusion coagulation without having to switch instruments. We that the usefulness of ABC in plastic surgery is limited. think it is important to point out the different nature of Especially in procedures close to the body surface, bleed- the ABC devices routinely used for liver surgery that only ing from small vessels is commonly encountered and can use a plasma beam, as opposed to the device discussed easily and quickly be controlled by ABC. Although it is here. certainly necessary to use conventional coagulation when Finally we would like to thank Dr. Young for sharing encountering larger vessels while doing a reduction mam- his results concerning smoke particle densities with us. maplasty, we still feel that the use of the ABC is benefi- cial, since a lot of small bleeders can be controlled very W.G.N. Steinmetz ´ B.J. Bauer ´ P. Eckert effectively. However, it has to be admitted that in a teach- Plastic Surgery and Hand Surgery, University Hospital, ing hospital environment the assistant is usually quite ca- Josef-Schneider-Strasse 2, D-97078 Würzburg, Germany European Journal of Plastic Surgery Springer Journals


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Copyright © 1998 by Springer-Verlag Berlin Heidelberg
Medicine & Public Health; Plastic Surgery
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