Procedures

Question 1

Cryotherapy
Histofreeze Device

Answer 1

Use clean technique
No anesthesia necessary
Charge, invert, apply
Hold the lesion for approximately 30 secs. (to tolerance)
Remove & allow lesion to warm
Re-freeze and thaw a total of (at least) 3 cycles
No need to dress
Often need multiple sessions (weeks apart) for good results!

Question 2

Liquid nitrogen technique

Answer 2

Identify the lesions; position patient
Don non-sterile gloves.
Obtain a shave biopsy if needed.
Ladle sufficient quantity of liquid nitrogen out of the thermos into a double-layered Styrofoam cup.
Apply to each lesion using either a small cotton swab or a larger “scopette” (determined by lesion size).
Hold the applicator to each lesion for 3-15 seconds. An ice ball forms within the lesion and you note a surrounding “freeze ring” of ice that should lasts 3-5 seconds
Alternate Q-tips and repeat this process 2-4 times, allowing each lesion to completely thaw out between rounds – 5-10 seconds

Question 3

follow up cryotherapy

Answer 3

Blisters typically will form within 24 hours.
After several days, the blister dries and the skin containing the lesion peels off.

Question 4

excision types

Answer 4

Lift and Snip
Shave, Scoop, Punch Biopsy
Electrodesiccation (hyfrecation or radiosurgery) & Curettage
Elliptical (fusiform)Tissue Resection

Question 5

excision uses

Answer 5

SK
Nevi
Skin tags
Small lesions
Malignancy

Question 6

Lift & Snip

Answer 6

Apply alcohol to skin
Clean anesthesia bottle top with alcohol
Draw up anesthesia with an 18-22 g needle (controversial whether or not to inject air into the bottle!)
Switch to a ½-1 inch 27-30g needle
Inject Anesthesia: 0.2-0.4cc 1% lidocaine or 1% lido w/epi to create a cutaneous bleb (or use optional field block)
Grasp lesion with forceps and elevate a moderate amount
Snip off lesion with sterile iris scissors
Apply direct pressure and/or cautery (electro, silver nitrate, styptic) to oozing wound/bleeders
Dress with minor surgery tincture on Band-Aid

Question 7

Minor surgery advanatges/disadvantages

Answer 7

Advantages
* Cheaper
* Less anxiety for patient
* Cane return home immediately
* Decreased risk of complications seen in hospitals

Disadvantages
* Patient’s anxiety level may halt the procedure
* Anaphylactic shock due to anesthetic toxicity
* Unexpected bleeding both operative and post-op
* Malpractice insurance to cover practice
* The physician may need to sacrifice a room to keep it sterile
* Initial costs for a surgical theater are high
* Basic equipment and supplies are extensive and can be very elaborate
* Cost effectiveness should be considered (cost vs. cases)

Question 8

Who can get minor surgery

Answer 8

15-65
No Diabetes, Blood dyscrasias, Heart problems, Asthma, emphysema, COPD, and Anxiety
No Deficiencies in vitamin A, vitamin C, zinc, protein, Vitamin K or EFA’s can contribute to slower healing times.
No Blood thinners and Recreational drugs
Occupation that allows area to rest

Question 9

Shave Biopsy

Answer 9

Apply alcohol to skin
Clean anesthesia bottle top with alcohol
Draw up anesthesia with an 18-22 g needle (controversial whether or not to inject air into the bottle!)
Switch to a ½-1 inch 27-30g needle
Inject Anesthesia: 0.2-0.4cc 1% lidocaine or 1% lido w/epi to create a cutaneous bleb (or use optional field block) under the skin lesions at an angle, pull back on syringe then push it in as pull out
Test it they are numb
Put on gloves
3 iodine swabs from center outward
Open towel away from you, open up, place on patient and press down
Dab off iodine
Open up scalpel and forceps
If possible, grasp lesion with forceps and elevate
Shave off lesion with #15 or #10 scalpel or dermablade
Apply direct pressure and/or cautery (electro, silver nitrate, styptic) to oozing wound/bleeders from the outside to center, put pressure and see if oozes
Dress with minor surgery tincture and/or Vaseline on Band-Aid

Question 10

Cryotherapy pros/cons

Answer 10

Advantages:
No risk of infection
No sterile field required
No suture removals
No need for local anesthesia
Fast procedure
Little or no scarring
Less traumatic

Disadvantages
Can cause hypopigmentation
Blistering
Pain
Damage nerve or blood vessels

Question 11

cryotherapy uses

Answer 11

Warts
Porokeratosis
Seborrheic keratosis
Skin tags
Actinic keratosis
Solar lentigo
Basal cell carcinoma
Cherry angioma
Molluscum contagiosum
Benign nevi
Sebaceous hyperplasia

Question 12

mechanism of cryotherapy

Answer 12

Cooling starts
Extracellular fluid will form ice crystals
Ice will grow into the cell
Intracellular fluid will form ice crystals
Rupture of cell membrane
Destruction of cell function

Question 13

What temp dose Dimethylether/propane/butane (Histofreezer) get too?

Answer 13

-50C

Question 14

what temp dose N2O get too?

Answer 14

• 127°C

Question 15

what temp dose N2 get to?

Answer 15

• 196°C

Question 16

How long do you hold the cryotherapy on the skin

Answer 16

1 mm per 5 seconds
3-90 seconds with 1-2 mm rim of frozen tissue with a 5-60 second thaw before refreezing repeat 2-4 cycles

Question 17

How long dose cryotherapy take to heal

Answer 17

7-10 days

Question 18

what can patients expec from cryotherapy

Answer 18

Expect pain and tenderness with erythema or hemorrhagic blister in 24 hrs.
After several days, the blister dries and the skin peels off.

Question 19

What are the types of cryotherapy

Answer 19

cryoprobe
cryospray with N2
Histofreeze
liquid nitrogen on swab

Question 20

Cryoprobe

Answer 20

application of liquefied N2O spray directly on the skin will bring temperature fully under control (nitrous oxide always evaporates at -127°C)
Most accurate and effective