Electrosurgery is a reliable, inexpensive, and simple choice for treating various dermatological disorders and cosmetic aberrations. Read the article to know more.
Electrosurgery is the process of removing skin lesions with the use of electric current. The electric current may be a direct or alternating high-frequency current. The electrosurgical unit is the most commonly used equipment in any dermatologist’s clinic. It provides a quick and cost-effective treatment modality for a wide range of cutaneous lesions, both benign and malignant. Electrosurgery includes electrocautery, electrofulguration, electrodesiccation, electrocoagulation, and electro section.
William Bovie first devised the first electrosurgical unit at Harvard medical school.
The contraindications of electrosurgery are as follows,
The presence of an active infection at the site.
Patient with a history of cardiac arrhythmias.
The types of equipment required for electrosurgery are a surgical diathermy unit (heat-generating electrode), a long cable with an insulated handle, a foot switch, and 220 volts of AC power.
When the electric current flows through the electrode and touches the tissue, the resistance created by the tissues to the electric waves is converted into heat and results in the desired action. When the heat is above the boiling point of the intracellular water, the tissue is sectioned, and if it is below the boiling point, bleeding control is achieved. The intracellular water can evaporate with slow continuous heating, and the tissues get dry and eliminated.
Prevention of bleeding (hemostasis) at the site of surgery is essential to keep the area dry, avoid blood loss, and for the easy manipulation of the surgical instruments. Electrocautery is an electrosurgical modality used to achieve hemostasis in a better way. Even patients with defibrillators and pacemakers can use electrocautery since there is no current flow through the patient.
This method uses minimal current, and no local anesthesia is usually required. The current is applied on top of the lesion for a short time without the electrode touching the skin, and the crust formed is removed with the needle. The surrounding skin should be protected. An antibacterial cream should be rubbed on this crust twice daily. The crust falls off after a few days, leaving healthy skin. The complications of this procedure are bleeding, skin burns, cardiac arrhythmias in predisposed patients, and scarring in the case of deep or excessive destruction.
This method also has the same effects as fulguration. Desiccation involves touching the lesions with the electrodes. In this tissue, destruction is more profound and includes superficial mummification and necrosis of cells. The advantages of this procedure are minimal scarring and adequate hemostasis. And the disadvantages are the depth cannot be well controlled, and surface damage is within the boundaries of the lesions; hence recurrence is common.
Coagulation is a part of hemostasis in which small fine needle electrodes are used for superficial coagulation, and the large electrodes with larger contact areas are used for deep coagulation.
The procedure where the electric energy is used to section the tissue instead of the scalpel is called the electrosection. Sharp, exact, and neat cuts can be done using minimum continuous power through fine electrodes with minimal peripheral tissue damage. At the same time, coagulation is achieved at the tip of the cut ends.
Clinical applications of electrosurgery are,
Curettage and Electrodesiccation:
Curettage and electrodesiccation are usually used to treat non-cancerous and superficial skin tumors and lesions by dermatologists. The tumor is excised using a curette (scraping surgical instrument), and the site is cleaned with electrosurgery. For non-cancerous superficial tumors, low-output power electrofulguration or desiccation may be used. Generally, the preferred power energy is low because of the low risk of tissue damage in excess. HIgh power mishandling can lead to color changes, scarring and keloid formation, wound site infection, and delay in healing of the wound. The electrosurgery softens the skin layers and transforms them into material that may be eliminated easily with surgical instruments. When these procedures are appropriately handled, one can avoid skin damage and scare. This process is continued till all the tumors or lesions are excised. Then, the curettage and desiccation can be repeated until there is a normal dermis. Inadequate treatment or removal of the lesion will have a risk of recurrence and infection. Therefore, appropriate lesions for electrosurgery treatment should be selected. The success rate depends on the site, size, and nature of the tumor or lesions.
Electrodesiccation or electrofulguration are used to char the epidermal layer and are often used by dermatologists for the hemostasis of superficial blood vessels. Coagulation electrosurgery is preferred in the hemostasis of small blood vessels during surgeries. The best result can be achieved by keeping the surgical bed and area dry and clean before the initiation and application of electrodes.
Coagulation can be completed in two ways. The direct method involves the application of surgical electrodes on the bleeding vessel, and in the indirect mode, the electrodes are placed over the forceps. The heat from the electrode results in the fusion of the coagulation materials (collagen and elastin fibers). If accidentally the power is in excess, electricity passes through the vessel wall, leading to vessel damage and increasing the risk of postoperative bleeding. Hence, it is of utmost importance to have the setting of minimum power that is effective. But the application time to fuse the required amount of tissue at the surgical site is necessary to stop bleeding.
In electrosurgery, side effects such as scarring can be minimized, and recurrences of dermatological illness can be prevented. Electrosurgery can be carried out in various ways and customized to bring about the desired clinical effects. Experience and instrumentation skills make electrosurgery the right tool in the art of medicine.
A person using the electrosurgical unit must know the fundamental principles of electrosurgery. Better knowledge of various techniques and apparatus skills, along with their benefits and risks, are the success formula for electrosurgery.
Last reviewed at:
15 Jun 2022 - 4 min read
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