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Commonly Used Electrosurgeries in Various Dermatological Disorders

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Commonly Used Electrosurgeries in Various Dermatological Disorders

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For treating numerous dermatological diseases and cosmetic aberrations, electrosurgery is used due to its low cost and ease of availability.

Written by

Dr. Suvash Sahu

Medically reviewed by

Dr. Preetha. J

Published At March 14, 2017
Reviewed AtMarch 13, 2024

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,

  • Cardiac pacemakers.

  • Infection at the site.

  • Bleeding disorders.

  • 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.

Frequently Asked Questions

1.

Name the Two Types of Electrosurgery.

The two variants of electrosurgery are electrocautery and high-frequency electrosurgery. High-frequency electrosurgery is done via four methods: electrocoagulation, electrodesiccation, electrofulguration, and electrosection. Whereas electrocautery uses thermals through alternating or direct current to remove unwanted tissues or seal off bleedings.

2.

Why Is Electrocautery Used?

Electrocautery is a procedure that uses an electric current that utilizes heat to destroy or excise abnormal tissues like tumors and other lesions. The method used thermal energy generated via alternating or direct current to effectively excise tissues or even stop bleeding by sealing off the injured vessels.

3.

How Is Electrocautery Different From Electrosurgery?

The basic difference in the types of electrical surgery is based on the nature of the current used. Electrocautery uses direct current (unidirectional electron flow), whereas electrosurgery utilizes alternating current, which is a waveform (hence, the frequency can be modulated).

4.

How to Perform Electrosurgery?

In electrosurgery, the patient completes the electrical circuit. A radiofrequency electric current heats the tissue. Radiofrequency induces intracellular oscillation of the ionized cell, which increases the temperature and causes instant cell death, desiccation, and protein coagulation; intracellular contents undergo a liquid-to-gas conversion, massive volumetric expansion, and explosive vaporization, which completes the procedure.

5.

Are Electrosurgery and Laser Surgery the Same?

Electrosurgery and laser surgery are complementary to one another and carry their own sets of advantages and disadvantages. Electrosurgery uses a high-frequency alternating current for tissue dissection, whereas laser surgery uses plasma pulses to evaporate the tissues.

6.

What Is the Use of Electrosurgery in Dentistry?

Electrosurgery is used in dentistry in surgeries including impaction, implant placement, periodontal surgeries, and procedures like gingivectomy, frenectomy, biopsy, hemorrhage control, bleaching, root canal sterilization, and pulpotomy.

7.

Define High-Frequency Electrosurgery.

High-frequency electrosurgery is a diathermic surgery that utilizes high-frequency electromagnetic current in a clinical setup with several surgical implications. The method uses high-frequency currents between 100 kHz to 5 MHz at 10,000 volts to coagulate, dissect, fulgurate, ablate and shrink the unwanted b tissue.

8.

What Are the Safety Norms Associated With Electrosurgery?

The safety precautions while dealing with electrosurgical units are:
- Familiarize yourself with the manual.
- Install a smoke evacuation system.
- Do not deviate from the provided indications and instructions.
- Test the equipment on a dummy before working on the patient.
- Avoid flammable substances in the vicinity.
- Avoid patients with electrical implants.
- Avoid contact with metals.
- Avoid additional contact with skin.
- Carefully manage the equipment to avoid any mishaps.

9.

What Are the Patient Risks Associated With Electrosurgery?

The patient risks associated with electrosurgery are:
- Burn injuries.
- Patients with electrical implants are at risk.
- Transmission of infection through the smoke.

10.

In What Situations Is Electrocautery Indicated?

Electrocautery can be utilized in certain conditions:
- Seborrheic keratoses.
- Acrochordons.
- Molluscum.
- Verrucae.
- Syringomas.
- Small angiomas.
- Vitiligo.
- Sebaceous hyperplasia.
- Pyogenic granulomas.
- Hemostasis of vessels in surgery.
- Vasectomy.
Punctual occlusion (for dry eye syndrome).

11.

Is Electrocautery Indicated During Pregnancy?

Electrocautery is considered harmless to the fetus if the mother undergoes procedures involving the technique. The method has been successfully used in performing caesareans (C-sections) after having multiple successes in general surgeries. C-sections with electrocautery aim at improving patient outcomes.

12.

What Are the Post-electrosurgery Precautions?

Post-surgical care of electrosurgery involves:
- Keep the dressing undisturbed.
- Avoid stretching or touching the surgical area.
- Avoid hot tubs and saunas for three days.
- Apply gentle pressure if the site bleeds.
- Gently wash the area twice a day.
- Apply prescribed ointments and take the pills.
- In case of inflammatory signs, seek immediate medical assistance.

13.

What Is the Healing Time for Electrosurgery?

The electrosurgical wound takes around six weeks to completely heal. The site may show some initial swelling and redness, gradually reducing over seven days. The healing time may extend if a large tissue or tumor is dissected during surgery. Patient care is very important post-surgery. Wound care and infection prevention are of utmost importance to hasten recovery.

14.

Is Electrosurgery a Scarring Procedure?

Electrosurgery leaves some amount of scarring. In case of any additional infection at the site, the scarring may become significant. The scarring is reduced by shave incision and electrosurgical smoothening of wound edges which produces a less noticeable scar and improves blending with the surrounding tissues.

15.

What Are the Surgical Field Complications Associated With Electrocautery?

The two major complications of electrosurgery in the surgical field are:
- Mechanical trauma. 
- Electrothermal injury.
Both these injuries occur due to the laparoscopic field of view. The injuries may result from unwanted energy transfer or unnoticed stray currents outside the laparoscopic view.
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Dr. Suvash Sahu
Dr. Suvash Sahu

Dermatology

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