Modifications of electrosurgery electrodes.

Dermatologists often find that electrosurgical electrodes that are commercially available do not always suit their specific clinical requirements. Some physicians modify electrodes to achieve specific electrosurgical effects. The more popular modifications have given rise to new varieties of commercially available electrodes.

Current issues in the performance of Mohs micrographic surgery.

Recently, a survey was sent to all members of the American College of Mohs Micrographic Surgery and Cutaneous Oncology concerning their performance of Mohs micrographic surgery. Responses to numerous questions regarding the daily practice of this technique revealed that many useful modifications have evolved over the years that serve to enhance the efficacy and the efficiency of the original Mohs surgical procedure. The results of this survey are presented and discussed.

Fire hazards and electrosurgery.

Combustion is a rare hazard of electrosurgery, but every office should be equipped to deal with such emergencies. This article discusses the methods to minimize fire hazard and reviews the choices of fire extinguishing systems.

Blood vessel coagulation for incisional surgery.

Blood vessel electrocoagulation allows the cutaneous surgeon rapid and reliable bleeder control for incisional wounds. The following article discusses the various instruments and techniques used for blood vessel electrocoagulation.

Electrodes for high-frequency electrosurgery.

Among the varied types of electrosurgical electrodes available, many dermatologists find a tapered or needle-shaped electrodesiccation electrode most useful. Cutting current procedures are best accomplished with fine needle or wire electrodes. Both monopolar and bipolar forceps are useful for pinpoint coagulation of small blood vessels. Because of increasing concerns about electrode contamination, several kinds of disposable electrodes are now available.

Monopolar and bipolar treatment.

Monopolar and bipolar electrosurgical treatments are markedly different in principle, but the terms are often confused. The following article explains the differences between these two popular modalities.

The accessory tragus--no ordinary skin tag.

An accessory tragus can easily be treated by surgical excision. The results are quite satisfactory if care is taken to remove any protuberant portion of underlying cartilage. This lesion is rarely associated with other developmental defects of the first branchial arch.

Sterile technique and the prevention of wound infection in office surgery--Part II.

Surgical infection and associated complications are minimized by a combination of appropriate sterile technique and careful surgical technique. This review covers the essential elements of infection control for the office-based surgical practice. Recommendations are made concerning operating room facilities, instrument sterilization, and tray set-up (Part I, J Dermatol Surg Oncol 14:1364-1371, 1988). Part II addresses surgical prepping, surgical technique, and prophylactic antibiotics.

Sclerotherapy for telangiectasia of the lower extremity.

Telangiectatic blood vessels of the legs are insignificant in terms of medical complications but can be a major affliction in many patients' eyes. Therefore, therapeutic aggressiveness must be tailored to the needs of the patient. Today, techniques exist that successfully decrease the intensity of these unsightly lesions on the legs.

Sterile technique and the prevention of wound infection in office surgery--Part I.

Surgical infection and associated complications are minimized by a combination of appropriate sterile technique and careful surgical technique. This review covers the essential elements of infection control for the office-based surgical practice. Recommendations are made concerning operating room facilities, instrument sterilization, and tray setup (Part I). Part II addresses surgical prepping, surgical technique, and prophylactic antibiotics.

Patient "grounding".

Dispersive electrodes are often neglected or misused in electrosurgery. A dispersive electrode can increase electrosurgical safety and effectiveness. If misused, however, it can become the source of patient injury. The following article summarizes the proper use of dispersive electrodes and differentiates them from actual grounding.

The status of electrosurgery in dermatologic practice.

A survey was made of the electrosurgical practices of the members of the American Society of Dermatologic Surgery. Results showed that the majority prefer the traditional electrosurgical units, with the Hyfrecator (Birtcher Corp.) being by far the most popular. The most common forms of high-frequency electrosurgery are electrocoagulation and electrodesiccation. Very few dermatologists use cutting current, although many own machines with this capability. The majority do not use a strict sterile technic when performing electrosurgery. However, there appears to be an increasing awareness of contamination risks, and many dermatologists have started using disposable or sterilizable treatment electrodes. High-frequency electrosurgery is by far the most common method of electrosurgery. Electrocautery and surgical galvanism are very rarely used.

Survey of sterile technique used by dermatologic surgeons.

A survey was made of the sterile technique practices of dermatologists interested in dermatologic surgery. The steam autoclave is the most popular method for sterilizing surgical instruments. Dry heat sterilization is often used, as is cold, chemical sterilization. The most popular agent for chemical sterilization continues to be quaternary ammonium compounds despite warnings to the contrary. Gas sterilization is rarely used. Alcohol is the most popular agent for prepping the skin and iodophors are also quite popular. Dermatologists are now wearing gloves for most procedures. Prophylactic antibiotics are used minimally in surgical cases, as is recommended by established standards.

Electrosurgery: high-frequency modalities.

The most popular form of electrosurgery used in cutaneous surgery involves the application of high voltage electromagnetic energy in the form of a damped sine wave. This form of current may be applied by electrofulguration, electrodesiccation, or electrocoagulation. The principles involved in the application of these three forms of electrosurgery are discussed.

Electrosurgery principles: cutting current and cutaneous surgery--Part II.

The use of cutting current for electrosurgical excision is a valuable procedure for the cutaneous surgeon. Last month, the basic principles of cutting current were reviewed (J Dermatol Surg Oncol 14:29-31, 1988). This month, Part II will cover the technical aspects of cutting current administration.

Electrosurgery principles: cutting current and cutaneous surgery--Part I.

Cutting current is a valuable tool in the office surgical practice due to its speed, efficiency, and economy. Most electrosurgical generators produce a blended wave form that coagulates the tissue as it is cut. Care should be taken to see that the patient is adequately grounded with a dispersive electrode to prevent cutaneous burns. The cutting of the tissue should be brisk and with the smallest electrode and power setting possible. By using careful electrosurgical technique, the surgeon can produce an incised wound that heals as well as one created by cold steel excision.