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Electrosurgery is a technique often used in surgery to control bleeding and to rapidly dissect soft tissue in surgery. The electrical resistance of these soft tissues to an electromagnetic current generates heat. The endpoints of electrosurgery vary based on the waveform, power used, and surgical technique. This results in a variety of effects on the target tissue. This activity reviews the applications and considerations of safe electrosurgery and highlights the importance of a well-informed interprofessional team in ensuring patient safety. Objectives: Describe the biophysical foundations of electrosurgery. Review appropriate patient preparation required for electrosurgery. Summarize the safety considerations of unique patient populations when implementing electrosurgery. Outline interprofessional team strategies for enhancing care coordination and communication to advance the safe use of electrosurgery and improve patient outcomes. Access free multiple choice questions on this topic.

Electrosurgery is a technique often used in dermatologic surgery to provide superficial or deep coagulation or cutting of the skin. The skin has poor conducting properties for the electrical flow of energy. Therefore, this energy builds up and is converted into heat. The endpoints of electrosurgery vary based on the waveform and result in either desiccation, coagulation, or sectioning of the skin. Harvard physicist William Bovie made one of the most important contributions to electrosurgery. His device offered both coagulation and cutting currents. This was used in the 1920s by a neurosurgeon to cut through tissues and control bleeding during surgical procedures. [1] The term “bovie” is still used to refer to an electrosurgery device or even the act of performing electrosurgery in general. The main types of electrical hemostasis used in dermatologic practice include electrocautery, electrofulguration, electrodesiccation, and biterminal electrocoagulation. Electrolysis and electrosection are other types of electrosurgery that may be utilized in the field of dermatology.[2]

The main complications to consider when treating a patient with electrosurgery are the possibility of delayed bleeding and scarring with hypopigmentation. Patients can be reassured that delayed bleeding can be controlled with 20 minutes of constant direct pressure over the wound.[6][7][8] Other potential complications of electrosurgery include fire, thermoelectric burns, infectious transmission from the electrode, or smoke plume inhalation. Fire risk is greatest in the presence of alcohol, oxygen, or bowel gases. Aluminum chloride used commonly in hemostasis may contain 90% alcohol; therefore, clinicians must be sure the surgery site has dried completely before using electrosurgery. Also, care should be taken when using electrosurgical devices in the perianal area due to highly flammable bowel methane gas. Research studies have confirmed surgical smoke by-products contain toxic gases and vapors, including benzene, cyanide, cellular material, and viruses. These contaminants can be controlled by using smoke evacuators.

Electrosurgery is often used in dermatologic surgery to provide superficial or deep coagulation or cutting of the skin. This provides a review of the complications, indications, and contraindications of different types of electrosurgery, explains how these techniques are performed, and highlights the role of the interprofessional team in ensuring patient safety to produce better outcomes.