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Chapter
Electrosurgery
Oliver J. Wisco and Paula S. Vogel
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102 Dermatologic Surgery
Tissue effect
Table 7-2 Waveform factors Continuous, undamped
Discontinuous, damped
Surgical approach (Box 7-2)
Key Points Desiccation and
coagulation
• Multiple conditions can be treated with
electrosurgery. The most common are those with
a superficial process.
• Electrodessication and curettage is an effective Figure 7-1 Types of waveform. Adapted from Robinson
option for superficial cutaneous malignancies. et al (2005) with permission from Mosby Publishing
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7
Chapter
Electrosurgery 103
Epidermis Epidermis
Dermis Dermis
Adapted from Robinson et al (2005) with permission from Mosby Publishing Company.
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104 Dermatologic Surgery
Epidermis Epidermis
Dermis Dermis
Adapted from Robinson et al (2005) with permission from Mosby Publishing Company.
B ox 7 - 1
Burns • The surgeon should not make or break contact with the
patient during current delivery.
• Use a nonflammable cleanser such as chlorhexidine or
povidone–iodine.
Transmission of infection
• Avoid alcohol cleanser, ethyl chloride anesthesia, and flowing
oxygen. • Use a smoke evacuator with the intake nozzle 2 cm from the
operative site.
• Ensure that the indifferent electrode has broad contact with
skin and is not placed over a bony prominence, scar tissue, or • Wear a surgical mask and eye protection when working with
implanted metal. human papillomavirus-related lesions.
• Ensure the patient is not touching grounded metal objects. Eye injuries
• Place the indifferent electrode away from vital structures to • Avoid using treatment electrode close to the eye, if
decrease the risk of current channeling into a substance that is possible.
more conductive than skin (e.g. nerve or vessel), especially if
it leads to an isolated region such as the penis or finger. • Use plastic corneal shields if working close to the eye.
• Use a three-pronged receptacle that is not overloaded. • See discussion in the Controversies section.
Adapted from Robinson et al (2005) with permission from Mosby Publishing Company.
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7
Chapter
Electrosurgery 105
B ox 7 - 2 B ox 7 - 3
Dermatologic electrosurgery
interference with pacemakers
and defibrillators
The use of electrosurgery in dermatologic sur-
gery may cause interference with pacemakers
or defibrillators (Box 7-3). It is recommended to
discuss with the patient’s cardiologist the need
for preoperative/postoperative evaluation and/or
intraoperative monitoring.
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