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Introduction
CHAPTER 16 Electrosurgery and
Hemostasis
Michael Frank Anthony V. Benedetto
SUMMARY
Electrosurgery is a workhorse technique for dermatologic surgeons, with
electrocautery and electrodessication representing the most frequently used techniques.
Monoterminal units that function without a ground may be useful for many
applications, but generally cannot be used for high-power applications or electrosection.
Electrosurgery is a staple of dermatologic surgery practice, whether used for
hemostasis, treatment of nonmelanoma skin cancer, or benign lesion desiccation.
Beginner Tips
For most applications, electrocoagulation is the standard setting, and can be used with
a monoterminal unit.
Generally 40 watts is sufficient for small-vessel coagulation.
Expert Tips
Electrosection may be useful for wide undermining.
Do not use electrosection on any tissue that will be sent for histopathologic analysis in
order to minimize the risk of artifact.
Electrofulguration is an elegant technique in experienced hands to treat seborrheic
keratoses, but as no tissue will be available for pathology the diagnosis must be absolutely certain before proceeding.
Donโt Forget!
Biterminal units always require that patients be in contact with a grounding plate, and
most modern units are well isolated.
Monoterminal units should never be used on sedated patients.
Do not attempt to use ED&C to treat areas with a thin dermis, where full-thickness
wounds will result.
Pitfalls and Cautions
Larger electrosurgical units may generate significantly more power than smaller
hyfrecators used in many offices.
Never overreach by attempting to use electrosurgical approaches on a vessel that
should be ligated with suture.
Patient Education Points
Cure rates for low-risk nonmelanoma skin cancers with ED&C are very high, but are
also highly operator dependent.
Patients should realize that the tradeoff for a quick ED&C procedure is that the healing
time postoperatively may be significantly longer than seen for surgical excisions.
Billing Pearls
ED&C coding is based on the site and size of the entire skin cancer that was
destroyed.
Multiple sites treated in the same session would be added together for size, rather than
billed individually.
CHAPTER 16 Electrosurgery and