slide1 n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Electrosurgery , Electrocoagulation , Electrofulguration , Electrodesiccation , Electrosection , Electrocautery PowerPoint Presentation
Download Presentation
Electrosurgery , Electrocoagulation , Electrofulguration , Electrodesiccation , Electrosection , Electrocautery

Loading in 2 Seconds...

play fullscreen
1 / 75

Electrosurgery , Electrocoagulation , Electrofulguration , Electrodesiccation , Electrosection , Electrocautery - PowerPoint PPT Presentation


  • 798 Views
  • Uploaded on

Electrosurgery , Electrocoagulation , Electrofulguration , Electrodesiccation , Electrosection , Electrocautery. Electrosurgery: use of electricity to cause thermal tissue destruction, most commonly in the form of tissue Dehydration coagulation vaporization .

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Electrosurgery , Electrocoagulation , Electrofulguration , Electrodesiccation , Electrosection , Electrocautery' - elata


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide2

Electrosurgery:

  • use of electricity to cause thermal tissue destruction, most commonly in the form of

tissue

Dehydration

coagulation

vaporization.

slide3

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.

slide4

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.

slide5

High Frequency Electodurgery :

Heat generation occurs within the tissue, while the treatment electrode remains 'cold'.

This method includes :

electrodesiccation,

Electrofulguration

electrocoagulation

electrosection.

slide6

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
principles of electricity
Principles of Electricity:
  • 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)
slide8

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.

slide10

increasing the cross-sectional area of the electrode by a

sufficient amount  decrease current density to a level of

nondestructive tissue warming.

slide11

Resistance : the ability of a conductor

to impede the passage of an electric current, and is measured in ohms.

history and ph exam
History and ph.exam
  • 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.
slide14

Identify: cardiac pacemakers or implantable cardiodefibrillators

May dysfunction in the presence of electromagnetic radiations

slide15

All Jewelry should be removed  Risk of burning

  • For Prep use: nonalcohol prep solution

(risk of ignite)

  • Use chlorhexidine or povidone-Iodine
slide16

If work in the perianal Region:

Use moist packing over anus to prevent ignition of methane

slide18

Monopolar v.s Bipolar is not correct for electrosurgery because we use alternating current :

It is correct for electrolysis that use direct current

slide19

'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.

slide20

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.

slide21

electrodesiccation and electrofulguration, are monoterminal:electrons are

dispersed randomly to the environment,

  • electrocoagulation or electrosection, are

biterminal.

degree of tissue destruction
Degree of tissue destruction:
  • Superficial: electrodesiccation and electrofulguration
  • Deeper Tissue: Electrocoagulation
  • Tissue Cutting: electrosection.
slide25

Electrofulguration and electrodesiccation:

use markedly damped, high-voltage, low-amperage current in a monoterminal

fashion to produce superficial tissue destruction

slide26

Electrodesiccation: the electrode contacts the skin and superficial skin dehydration occurs as

a result of Ohmic heating

electrodesication
Electrodesication
  • Low power setting:
  • Most damage is epidermal
  • minimal risk of scarring
  • Higher power settings:
  • increasing dermal coagulation
  • superficial scarring
  • hypopigmentation.
electrofulguration
Electrofulguration
  • variation of electrodesiccationin
  • electrode is held 1-2 mm from the skin surface
  • causes tissue dehydration by sparks
slide31

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

slide32

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
electrocoagulation
Electrocoagulation:
  • 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.

slide35

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.
slide36

deep destruction provided by electrocoagulation results in scarring, and this should be noted when discussing therapeutic alternatives with the patient.

slide37

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
ElectroSection:
  • 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.
slide39

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.

slide40

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.
electrocautery
Electrocautery
  • 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).
optimizing outcomes
OPTIMIZING OUTCOMES
  • Choice depends on the:
  • understanding of the nature of the destructive modality,
  • lesional histology
  • anticipated consequences, including pigmentary change and scarring
slide44

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.
slide45

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.
slide46

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).

outcome of electrocoagulation
Outcome of electrocoagulation:
  • 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.
slide48

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

slide49

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.
slide50

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

elecrtosection
Elecrtosection:
  • 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.
slide52

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.
slide53

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.

slide54

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.

slide55

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.