Optimization of Thermocautery in Excisional Dermatologic Surgery

Abstract

The thermocautery unit examined is an effective and safe unit to achieve hemostasis. In addition, the temperature may be adjusted as opposed to hand-held units that operate at in vitro temperatures exceeding 1,400 degrees F. Hemostasis at approximately 100 to 400 degrees C provided optimal hemostasis.

Newer Hemostatic Agents Used in the Practice of Dermatologic Surgery

“…On physical exam, it is important to look for any indications of hemostatic abnormalities such as increased bruising or petechiae. For more details on how to manage a patient with a bleeding disorder, please see the section titled, “Approach to the Patient with a Bleeding Disorder.” It is also important to investigate the patient's cardiac history including the presence of a pacemaker or implantable cardiac defibrillator (estimated that 4% of Mohs patients are estimated to have one), because the use of certain electrosurgical agents used for hemostatic purposes may be prohibited in these patients [8]. Also, alcohol is a natural anticoagulant, and obtaining information regarding consumption could be beneficial as part of the preoperative evaluation.…”

“…The waveforms that are transmitted to the tissues can be categorized as damped or undamped. Damped waveforms provide the best hemostasis by generating heat to the tissues, leading to sealing of blood vessels; however these techniques can be more destructive [8]. …”

“…The most common types of electrosurgery used by dermatologic surgeons are electrodesiccation, electrosection, electrocoagulation, and electrocautery [8]. A unit such as the Bovie, capable of conducting electrosection and electrocoagulation, provides the physician the ability to cut through the tissues and simultaneously provide hemostasis in a biterminal fashion.…”

“…The unit produces high amplitude, low voltage currents that can be damped or undamped depending on the desire to cut or provide coagulation. Electrocoagulation produces damped waveforms providing excellent hemostasis, while electrosection produces mainly undamped waveforms that slice through tissue layers [8]. Because these methods generate an electrical current, they can alter implantable cardioverter defibrillators and pacemakers, potentially producing premature firing of the devices, generating arrhythmias, or causing asystole.…”

“…Because these methods generate an electrical current, they can alter implantable cardioverter defibrillators and pacemakers, potentially producing premature firing of the devices, generating arrhythmias, or causing asystole. A method called electrocautery can be used in this select group of patients, because it works by generating heat from a high resistance wire instead of producing electricity [8]. Less heat can be generated in areas of increased blood flow; therefore, electrocautery is generally only used for hemostasis of small cutaneous vessels.…”