Week One - Electrosurgery and Cryotherapy Flashcards
Where is the electrode placed during electrofulgeration?
- It is held away from the skin, producing a spark and a shallow effect
Where is the electrode placed during electrodessication?
- It is touched to the skin (or inserted into the skin) to destroy tissue
Does the hyfrecation machine by Conmed produce electrofulgeration or electrodessication?
- Both
What are the advantages of a thermal pencil cautery (hot wire loop)?
- Disposable (battery-powered)
- Low cost ($15-20)
- Individual sterile packaging
- Safe around eyes
- Safe with pacemakers
- Drain subungual hematomas
- Control bleeding
- Cut off lesions
What are some of the advantages of electrosurgical devices?
- Simple to master
- Rapid technique
- Controls bleeding while cutting/destroying tissue
- Compact equipment
- Affordable (available used)
- Sterile conditions and sutures are not needed
- Infection rarely develops in wounds left open
What are some of the disadvantages of electrosurgical devices?
- Safety risk (electric shocks, burns, or fires)
- Risk of hypertrophic scars
- Risk of channeling of current down vessels and nerves
- Risk of smoke plume carrying viruses (eg from wart) into respiratory tract
- Delayed hemorrhage while healing
- Unsightly wound initially
- Slow healing vs scalpel shave excisions
- Produces electrosurgical artifact at margins, which obliterates the histology (do a shave biopsy first, if needed)
What are the advantages of cryotherapy over electrosurgery?
- Often treatment of choice for actinic keratosis and simple warts
- Faster and easier to perform
- Needs no anesthesia
- Tends to cause less scarring than electrosurgery
- No smoke plume
> No need for a smoke evacuator
> No risk of developing HPV, HIV, or other viral respiratory tract infections
What are the disadvantages of cryotherapy versus electrosurgery?
- More likely to cause hypopigmentation due to the cold killing melanocytes (varies with degree of skin pigmentation; may also cause hyperpigmentation)
- Less effective for large pedunculated lesions (eg condylomata)
- Final result is not immediately visible
> More guesswork in treating the lesion for the inexperienced physician
> May need to be repeated several times - Causes more postoperative swelling
- Causes more transient discomfort
What are the advantages of the scalpel versus electrosurgery?
- Best for shave biopsies and excisions
- Inexpensive
- Disposable
- Cleaner edge on the biopsy specimen
- No heat-induced tissue damage to obscure the borders of the biopsy specimen
- Dermablade can be easier for obtaining a shave biopsy
What are the disadvantages of the scalpel versus electrosurgery?
- Does not control bleeding by itself
- Small risk of accidentally cutting yourself
What are the advantages of electrosurgery over laser treatment?
- Less expensive
- Easier to use
> Non-specialists can perform most procedures
> Lasers require a subspecialist to determine and perform the best treatment modality for each case
What are the advantages of laser treatment over electrosurgery?
- Efficiently cut, coagulate, and destroy lesions
- Good for “resurfacing” (removing wrinkles)
- Pulsed dye lasers or yellow-light lasers are very good for treating large hemangiomas or port-wine stains (maximized cosmetic results)
- Visible-light lasers produce less scarring when treating angiomas and telangiectasias
What are the contraindications/cautions based on the patient for use of electrosurgery?
- Caution with patients who have a pacemaker
- Caution with metal plates, pins, or prosthetic joints near the operative site
- Patient should not touch any metal part of the treatment table to avoid current jump (“shock”)
Is electrosurgery an appropriate treatment modality for melanoma?
- No - never use electrosurgery as a destruction treatment modality
> Always do complete full-thickness excision for suspected melanomas
Is electrosurgery an appropriate treatment modality for a lesion around the eye?
- No
