Assessing the quality of scars from incisions made by a Colorado needle or a scalpel
Reviewed by James Hsuan

Traditional teaching has held the best scars are achieved with cold steel although no previous study has formally investigated this hypothesis in oculoplastic surgery. This paper describes a non-randomised cross-sectional study comparing the scar quality achieved from cold steel with a Colorado needle, in patients undergoing lateral tarsal strip, DCR or ptosis surgery. They found no significant difference between the two methods using two independent observer grading systems and a patient self-reported system. There was a significant age difference between the two groups, and although the authors state this was corrected for the analysis, how this was done is not clear. A further major weakness of the study was that there were two different surgeons, one of whom used only the Colorado needle and the other only cold steel, which could introduce a major bias from differences in technique and skill. As a retrospective study it therefore has significant limitations, but despite this provides some useful evidence that a Colorado needle may not be inferior to a scalpel in scar quality. Interestingly an incidental finding of the study was significantly better scar formation after DCR surgery than either ptosis or 
lateral tarsal strip surgery in terms of pigmentation and scar elevation. 

Long-term cicatrization analysis in periocular incisions for oculoplastic surgery performed with cold blade and Colorado needle.
González-López JJ, González-García FJ, Sales-Sanz M, et al.
OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY
2014;30:225-8.