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ELECTROSURGERY

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SUMMARY

  • Electrosurgery is a workhorse technique for dermatologic surgeons, with electrocautery and electrodessication representing the most frequently used techniques.

  • Monoterminal units that function without a ground may be useful for many applications, but generally cannot be used for high-power applications or electrosection.

  • Electrosurgery is a staple of dermatologic surgery practice, whether used for hemostasis, treatment of nonmelanoma skin cancer, or benign lesion desiccation.

image Beginner Tips

  • For most applications, electrocoagulation is the standard setting, and can be used with a monoterminal unit.

  • Generally 40 watts is sufficient for small-vessel coagulation.

image Expert Tips

  • Electrosection may be useful for wide undermining.

  • Do not use electrosection on any tissue that will be sent for histopathologic analysis in order to minimize the risk of artifact.

  • Electrofulguration is an elegant technique in experienced hands to treat seborrheic keratoses, but as no tissue will be available for pathology the diagnosis must be absolutely certain before proceeding.

image Don’t Forget!

  • Biterminal units always require that patients be in contact with a grounding plate, and most modern units are well isolated.

  • Monoterminal units should never be used on sedated patients.

  • Do not attempt to use ED&C to treat areas with a thin dermis, where full-thickness wounds will result.

image Pitfalls and Cautions

  • Larger electrosurgical units may generate significantly more power than smaller hyfrecators used in many offices.

  • Never overreach by attempting to use electrosurgical approaches on a vessel that should be ligated with suture.

image Patient Education Points

  • Cure rates for low-risk nonmelanoma skin cancers with ED&C are very high, but are also highly operator dependent.

  • Patients should realize that the tradeoff for a quick ED&C procedure is that the healing time postoperatively may be significantly longer than seen for surgical excisions.

image Billing Pearls

  • ED&C coding is based on the site and size of the entire skin cancer that was destroyed.

  • Multiple sites treated in the same session would be added together for size, rather than billed individually.

INTRODUCTION

For millennia, heat has been used to treat tissue and control bleeding. Over time, the methods used have evolved, with the first widely available commercial electrosurgical unit released in the 1920s. Since then, the units have been refined dramatically, though the basic concept behind electrosurgery has remained the same. Details regarding the physics underpinning electrosurgical devices have been explored at length.1–4

Terminology

Electrosurgery refers to the passage of high-frequency alternating electrical current through tissue to achieve a desired surgical effect, such as coagulation or cutting (Table 16-1). All true electrosurgical devices utilize a high-frequency electrical generator and two electrodes. Electric current flows from the active electrode through the patient’s body and returns to the electrosurgical generator via the dispersive (return or indifferent) electrode (Fig. 16-1). When current passes through tissue, the tissue’s ...

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