Introduction:
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 benign and malignant cutaneous lesions. Electrosurgery includes electrocautery, electrofulguration, electrodesiccation, electrocoagulation, and electrocution. William Bovie first devised the first electrosurgical unit at Harvard Medical School.
What Are Dermatological Disorders?
Skin disorders are illnesses that affect the skin. These illnesses can bring on rashes, inflammation, itching, and other skin abnormalities. Dermatologists are specialists in the skin, hair, and nails. Dermatologists determine the severity of the skin disorder and give an appropriate treatment for it. Among the most common dermatological conditions are:
Acne - Formation of oil buildup in the hair follicles present in the skin causes pimples.
Alopecia Areata - Alopecia areata causes the loss of hair and it is a rare autoimmune disease.
Atopic Dermatitis - It produces itching, dryness, and inflammation of the skin.
Psoriasis - When the immune system is activated, it causes multiple cells to grow and cause a scaly appearance on the skin, and inflammation also occurs.
Chromhidrosis - It produces colored sweat on the skin, underarms, and face.
Epidermolysis Bullosa - It is a rare disease that produces blisters on the skin.
What Are the Indications for Electrosurgery?
Electrosurgery is indicated for lesions like plane warts, verruca vulgaris, subungual warts, papillomas, skin tags, molluscum contagiosum, seborrhoeic keratosis, fibromas, etc.
What Are the Contraindications of Electrosurgery?
The contraindications of electrosurgery are as follows,
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Cardiac pacemakers.
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Infection at the site.
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Bleeding disorders.
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Patient with a history of cardiac arrhythmias.
What Are the Types of Equipment Required for Electrosurgery?
The equipment required for electrosurgery is a surgical diathermy unit (heat-generating electrode), a long cable with an insulated handle, a foot switch, and 220 volts of AC power.
When an electric current passes through the electrode and reaches the tissue, the tissue's resistance to the electric waves is converted into heat, resulting 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.
What Is the Procedure Involved in Electrosurgery?
Electrocautery:
Preventing bleeding (hemostasis) at the surgery site is essential to keep the area dry, avoid blood loss, and facilitate 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.
Electrofulguration:
This method uses minimal current, and no local anesthesia is usually required. The current is applied briefly on top of the lesion 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.
Electrodesiccation:
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. The disadvantages are that the depth cannot be well controlled, and surface damage is within the boundaries of the lesions; hence, recurrence is common.
Electrocoagulation:
Coagulation is a part of hemostasis in which small, fine-needle electrodes are used for superficial coagulation, and large electrodes with larger contact areas are used for deep coagulation.
Electrosection:
The procedure where electric energy is used to section the tissue instead of the scalpel is called electroreception. 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 tips of the cut ends.
What Are the Clinical Applications of Electrosurgery?
Clinical applications of electrosurgery are,
Curettage and Electrodesiccation:
Dermatologists use curettage and electrodesiccation to treat non-cancerous and superficial skin tumors and lesions. 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 delayed wound healing.
Electrosurgery softens the skin layers and transforms them into material that surgical instruments may easily eliminate. When these procedures are appropriately handled, skin damage and scarring can be avoided. This process is continued until 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 increase the risk of recurrence and infection. Therefore, appropriate lesions for electrosurgery treatment should be selected. The success rate depends on the tumor or lesions' site, size, and nature.
Hemostasis:
Electrodesiccation, or electrofulguration, is used to char the epidermal layer and is often used by dermatologists for the hemostasis of superficial blood vessels. Coagulation electrosurgery is preferred for 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 initiating and applying 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 the power is accidentally 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 a minimum power setting that is effective. However, the application time to fuse the required tissue at the surgical site is necessary to stop bleeding.
Conclusion:
In electrosurgery, side effects such as scarring can be minimized, and recurrences of dermatological illness can be prevented. Electrosurgery can be performed in various ways and customized to achieve the desired clinical effects. Experience and instrumentation skills make electrosurgery the right tool in 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, is the success formula for electrosurgery.