๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Electrosection
Electrosection
Electrosection is the cutting of tissue with current rather than a scalpel. The goal in electrosection is for the cutting of tissue to be brisk, with the lowest effective power setting.8,9 If the power is too low, the cutting process will be slow, resulting in a prolonged contact time with greater heating of the incision walls and therefore higher collateral tissue damage. In order to determine the correct output power for a clean incision, start low and increase the power until the maximum cutting speed is achieved. If the power is insufficient, the electrode will not easily glide through the tissue but rather will โstick.โ10 If there is arcing or sparking across the tissue surface, the voltage is too high and needs to be reduced. Once the optimal power setting is determined, the same setting can be used for all subsequent patients with only mild fine-tuning required.
Electrosection is infrequently used in dermatologic surgery due to histologic distortion and a lack of evidence that it is superior to scalpel-based surgery. Electrosurgery causes greater collateral tissue damage, and therefore histologic distortion of surgical margins, compared to scalpel surgery. Thermal damage causes carbonization at the excision margin, collagen denaturation, and vessel thrombosis.11,12 It can cause vacuolar degeneration, along with shriveled and shrunken cell outlines with condensation and elongation of the nuclei and fusion of cells into structureless, homogenized masses with a hyalinized appearance.13 All of these factors may result in false positives due to normal structures mimicking tumor.14 Therefore, when electrosection is used in the context of dermatologic surgery, it is usually performed as a
wide undermining technique for large excisions.
When electrosection units first came to market, reports of impaired wound healing and increased postoperative infection rates discouraged their adoption by dermatologic surgeons. As such, there is very little data comparing electrosection to conventional scalpel surgery with respect to incisional speed, postoperative pain and infection, wound healing, or scar cosmesis. The few randomized control trials that do exist are found in the general surgery literature. Not surprisingly, electrosection is associated with significantly less blood loss and shorter incisional time, though it is unclear whether it is associated with any statistically significant difference in postoperative pain, infection, wound healing, or scar cosmesis.15,16