Treatment Reference

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Surgical Treatments: Electrosurgery
The following videos illustrate how to perform electrosurgery:

Safety Issues
Power Settings
Example: seborrheic keratosis
Example: viral warts and skin tags
Example: telangiectasias
Example: pyogenic granuloma
Example: cherry angiomas

Advantages
  1. Simple to use
  2. Easy to master
  3. Useful for a wide variety of skin lesions, especially for:
    • Superficial lesions
    • Tiny lesions (may not need anesthesia)
    • Vascular lesions
    • Basal cell carcinomas
  4. Rapid technique
  5. Controls bleeding while cutting or destroying tissue
  6. Equipment compact and affordable
  7. When used for tissue destruction, sterile conditions or sutures are not needed
  8. Infection rarely develops in wounds left open
Disadvantages
  • Safety risk (electric shocks, burns, or fires)
  • Hypertrophic scars, especially with poor technique
  • Risk of "channeling" of current down vessels and nerves
  • Smoke may carry viral particles
  • Delayed hemorrhage
  • Unsightly wound
  • Slow healing, especially if large area treated (healing can be slower than scalpel shave excision)
  • Obliteration of histology because of tissue destruction
  • Electrosurgical artifact at margins if used for biopsy
  • Electrosurgery is used in skin surgery to destroy benign and malignant lesions, control bleeding, and cut or excise tissue. There are many types of electrosurgical units available for use in the office setting. Modern electrosurgery units transfer current to the patient through cold electrodes. The term electrocautery implies that a hot electrode is being used; electrocautery is just one type of electrosurgery. Electrocautery is useful for some patients with pacemakers, for whom the use of modern electrosurgical current may be contraindicated.

    The major techniques used in electrosurgery are electrodesiccation, fulguration, electrocoagulation, and electrosection. In fulguration, the electrode is held away from the skin so that there is a sparking to the surface (such as happens with lightning). In fact, the term fulguration comes from the Latin term fulgur, which means lightning. Fulguration produces a more shallow level of tissue destruction (Fig. 12-1, A). With electrodesiccation, the active electrode touches or is inserted into skin to produce tissue destruction (Fig. 12-1, B). Epilation is a type of desiccation in which a fine-wire electrode is inserted into a hair follicle. Electrocoagulation is used to stop bleeding in deep and superficial surgery. In electrosection, the electrode is used to cut tissue.

    Usatine R, Moy R, Tobinick E, Siegel D. Skin Surgery: A Practical Guide. Mosby-Year Book, Inc., St. Louis, 1998
    Slides

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