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 Electrosurgery:

 use of electricity to cause thermal tissue


destruction, most commonly in the form of
tissue
Dehydration
coagulation
vaporization.
 Electrodurgical procedures:
 Electrolysis : direct current induces tissue
damage through a chemical reaction at the
electrode tip
 Coblation: high-frequency alternating current

ionizes an electrically conductive medium,


usually
isotonic saline solution, which transmits heat to
cause superficial epidermal and dermal
damage with minimal collateral tissue
destruction.
 High-frequency electrosurgery: in which tissue
resistance to the passage of high-frequency
alternating current converts electrical energy to
heat, resulting in thermal tissue damage.
 High Frequency Electodurgery :
Heat generation occurs within the tissue, while
the treatment electrode remains 'cold'.
This method includes :
electrodesiccation,
Electrofulguration
electrocoagulation
electrosection.
 Electrocautery: in which direct or high-
frequency alternating current heats an element,
which causes thermal injury by direct heat
transference.
 Unlike electrosurgery, the element in
electrocautery is hot
 Electrical current :the net flow of electrons
through a conductor per second, and is
measured in amperes

 Current Density: the amount of current per


cross sectional area (J=I/A)
 The thinner the electrosurgical tip (i.e.
decreasing the cross-sectional area of the
conductor, A), the greater the current density, j,
at the point of electrode contact.
 High current density
results in greater
tissue injury, and is
the basis of surgical
diathermy
 increasing the cross-
sectional area of the
electrode by a
sufficient amount 
decrease current
density to a level of
nondestructive tissue
warming.
 Resistance : the ability of a conductor
to impede the passage of an electric current, and
is measured in ohms.
PREOPERATIVE
PREPARATION
 Notice risk factors of the procedure:
 excessive blood loss, such as bleeding diathesis,
 poor healing, such as vasculopathy,
 malnutrition, diabetes mellitus
 or poor general medical condition.
 Identify : cardiac pacemakers or implantable
cardiodefibrillators

May dysfunction in the presence of


electromagnetic radiations
 All Jewelry should be removed  Risk of
burning

 For Prep use: nonalcohol prep solution


(risk of ignite)
 Use chlorhexidine or povidone-Iodine
 If work in the perianal Region:

Use moist packing over anus


to prevent ignition of
methane
 Monopolar v.s Bipolar is not correct for
electrosurgery because we use alternating
current :
It is correct for electrolysis that use direct
current
 'mono-' and 'bi-' terminal : the number of
treatment electrodes used in electrosurgery.
 Monoterminal indicates that only one electrode
delivers current to the patien
 Biterminal indicates that two

electrodes are used for this purpose.


 Second electrode: an indifferent electrode,
serving to complete an electrical circuit that
begins in the electrosurgical unit, flows
through the patient, and then returns to the
unit.
 electrodesiccation and electrofulguration, are
monoterminal: electrons are
dispersed randomly to the environment,

 electrocoagulation or electrosection, are


biterminal.
 Superficial: electrodesiccation and
electrofulguration
 Deeper Tissue: Electrocoagulation
 Tissue Cutting: electrosection.
 Electrofulguration and electrodesiccation:
use markedly damped, high-voltage, low-amperage
current in a monoterminal
fashion to produce superficial tissue destruction
 Electrodesiccation: the electrode contacts the
skin and superficial skin dehydration occurs as
a result of Ohmic heating
 Low power setting:
 Most damage is epidermal
 minimal risk of scarring
 Higher power settings:
 increasing dermal coagulation
 superficial scarring
 hypopigmentation.
 variation of electrodesiccationin
 electrode is held 1-2 mm from the skin surface
 causes tissue dehydration by sparks
 cause superficial epidermal carbonization.
 This carbon layer has an insulating effect and
minimizes further damage to the underlying
dermis.
 lesions treated by electrofulguration

usually heal rapidly with minimal scarring


 Because of their low amperage,
electrodesiccation and electro fulguration are
best suited for superficial and relatively
avascular lesions, such as verrucae and
seborrheic keratosis.

 Are not suitable for very vascular lesions


 uses low-voltage, moderately damped
 or partially rectified, high-amperage current
in a biterminal fashion to cause deeper tissue
destruction and hemostasis with minimal
carbonization
 High amperage causes deep tissue destruction

and hemostasis.
 In electrocoagulation, one applies and slowly
moves the electrode across the lesion until
slightly pink to pale coagulation occurs.
 A curette may then be used to remove the
coagulum.
 avoid damaging tissue to the extent that a
friable, charred coagulum results because this
eschar may easily dislodge and result in
delayed bleeding.
 deep destruction provided by
electrocoagulation results in scarring, and this
should be noted when discussing therapeutic
alternatives with the patient.
 achieve hemostasis by touching the electrode
directly to the bleeding vessel, or by using
biterminal forceps.
With either method, the heat generated seals the
vessel by fusion of its collagen and elastic
fibers, and the operative field must be dry for
maximal efficacy.
It is useful for vascular lesions such as PG
 Electrosection uses undamped or slightly
damped, low voltage, high-amperage current
in a biterminal fashion to vaporize tissue with
minimal peripheral heat damage.

 Undampedcurrent yields cutting without


coagulation, whereas slightly damped current
provides some coagulation.
 electrosection requires almost no manual
pressure from the operator because the
electrode glides through tissue with minimal
resistance.
 If sparking occurs, the power setting is

likely too high.


 If the electrode drags, the power setting is

likely too low.


 Advantages of electrosection are its speed
 and its ability to simultaneously cut and seal
bleedin vessels, for instance, in the excision of
large, relatively vascular lesions, such as acne
keloidalis nuchae and rhinophyma.
 uses low-voltage, high-amperage, direct or
alternating current to heat a surgical tip to cause
tissue desiccation, coagulation, or necrosis by
direct heat transference to tissue.
 is excellent for pinpoint hemostasis and is
compatible with patients who may not tolerate
current flow (e.g. pacemaker patients).
 Choice depends on the:
 understanding of the nature of the destructive
modality,
 lesional histology
 anticipated consequences, including
pigmentary change and scarring
 use the minimum power setting necessary to
achieve the desired effect
 Excessive power causes disproportionate tissue
damage, and is associated with complications
such as increased fibrosis, susceptibility to
wound infection, and delayed wound healing.
 treatment electrode should always be clean of
carbonized tissue, which decreases current
density and insulates against current flow,
thereby reducing cutting and coagulation
effect.
 If carbon build-up seems rapid and excessive,
the power setting may be too high, or the
procedure rate too slow.
 often useful to combine routine electrosurgery
with other surgical modalities (e.g. use of a
scalpel, curette or scissors to remove the bulk
of a large lesion before use of electrosurgery to
treat the base).
 Hemostasis should be reserved for vessels < 1
mm in diameter;
 larger vessels or arterioles have a greater
chance of delayed bleeding and should be
ligated with a dissolvable suture.
 the operative field should be dry because
current flowing from the electrode is diffused
by blood.
 apply the minimum amount of time and
power, as well as to clamp only the minimum
amount of tissue necessary to seal the vessel
 Another problem during electrocoagulation is
an apparently sudden decrease in power.
Instead of increasing the power setting:
confirm good contact between the indifferent
electrode and the patient to ensure adequate
current drainoff,
 and that the electrosurgical tip is clean.
 Incisions made with electrocoagulation should
be avoided because animal
 studies demonstrate:

they are associated with higher postoperative


infection rates than incisions made with a
scalpel or with electrosection
 a needle electrode often provides the most
precise cutting effect.
 Larger electrodes, such as blades and loops,
require greater electrical energy to produce the
same cutting effect, causing greater peripheral
tissue destruction, which may impair wound
healing.
 For debulking procedures, such as rhinophyma
excision, however, wire loop electrodes may be
used to remove tissue efficiently
 For specimens requiring histopathologic
analysis, cutting without coagulation should be
used.
 Reports of impaired wound healing and
increased postoperative infection rates
associated with early model electrosection
units have discouraged the widespread use of
electrosection for skin incision.
 modern electrosection units provide
 superior speed

 hemostasis

 cosmetic outcome, and

decreased postoperative pain


than conventional scalpel surgery, while
providing
comparable postoperative wound healing and
infection rates.
 Superficial electrosurgical wounds heal well by
second intention with basic wound care
principles-specifically, cleansing with
hydrogen peroxide or saline daily followed by
application of an antibiotic ointment and
protective dressing.