The use of electrosurgery is one of the tools that combines experience and craftsmanship with the art of medicine. Just as a carpenter uses the appropriate tool for the appropriate purpose and work, those dedicated to the discipline of healing must choose the appropriate tool for the intended purpose.
Electropuluration and electrodesiccation are single-line electrosurgical procedures that carbonize and destroy superficial tissue using high-voltage, low-amperage, and high-attenuation currents. A high voltage is necessary to maintain the current, because the current flowing from the processing electrodes does not return to the generator.
Weak and extinct currents cause more tissue to clot than to amputate, allowing normal tissue destruction. Electrodesiccation causes tissue dehydration by direct contact with the electrode. During this time, a 1- to 2-mm lead electrode passes over the skin, and sparks occur on the skin to ablate the superficial tissue. Thus, fulgurance is characterized by
- During fulgurance, the active electrode is held at a small distance from the tissue.
- The sparks pass over the fabric.
- Only an active electrode is used.
- The patient serves himself as a counter-electrode by being grounded.
- High voltage and low current are used.
- A limited superficial burn occurs.
When should fulgurance be used?
Suitable for destruction of superficial tissues. Low-potency electrotherapy units are used to treat benign superficial malignant tumors such as seborrheic keratosis and wart. Dermatologists typically use curettage and electrodesiccation to treat superficial benign and malignant skin tumors. The tumor is first removed by curettage of the skin, followed by electrovulgarization or electrodesiccation at the site of the tumor.
For benign superficial tumors such as seborrheic keratosis and melanocytic papulosis, low-potency electrofulguration or desiccation may be done. Low potency is usually preferred because there is less risk of excessive tissue damage, which causes pigment changes, scarring, wound infection, and delayed healing.
These methods use the epidermis and papillary dermis, turning them into soft material. Liquefied areas can be easily removed with curettage or gauze after coagulation; if done correctly, desiccation and curettage can prevent damage to the reticular dermis and subsequent scarring. This procedure is repeated until all residual epidermal lesions have been cleared.
What are the indications of this technique?
The appropriate type of electrosurgery depends on the clinical condition. If only the epidermis needs to be treated, electrode ablation is appropriate and leaves virtually no scarring. Electrotherapy damages the most superficial tissues by drying the skin to be treated. A high voltage current passes through a single terminal, producing a highly damped current.
When the surgeon moves the electrode slightly away from the skin, sparks form between the skin and the electrode. This is called electrofulguration. This method also results in a very superficial degradation since the carbonization of the surface isolates the underlying tissue from the diffusion of heat. Both of these techniques are widely used by dermatologists.
In dermatology, acrodermatism, actinic keratoses, small hemangiomas, new epidermis, seborrheic keratoses, flat warts, and hemostasis with capillary hemorrhage are common indications for electrotherapy and electrode curettage in epidermectomy.
Application of the fulgurance technique with a Kalstein electrosurgical generator
The application of this technique requires reliable equipment, which controls the amount of current supplied for the electrosurgical process. The generators developed by the manufacturer Kalstein meet this requirement perfectly; to know all their technical specifications, you can consult the link HERE