Approach Considerations
In addition to hemostasis, achieved by direct contact of the electrode tip to the damaged vessel, electrocautery can be used in various procedures. Detailed descriptions of a few electrocautery procedures are described below.
Pinpoint Cautery
Spider angiomas are superficial vascular lesions composed of small veins that radiate from a central dilated arteriole. The pinpoint cautery technique can be used to treat superficial telangiectasias such as this.
The lesion is cleaned with nonalcohol antiseptic solution.
Anesthetic is not necessary for this procedure.
A glass slide is placed on the lesion with pressure to locate the feeding vessel.
A fine needle electrode tip is used in the electrocautery device.
The cold needle is placed into the lesion and current is applied for less than 1 second.
The scab that develops will fall off within 10 days.
Removal of Small Benign Lesions
Small benign lesions such as acrochordons, seborrheic keratoses, and molluscum can be removed in the manner below.
The lesion is cleaned and area anesthetized (see Periprocedural Care).
A pinpoint or ballpoint electrode tip is touched directly to the lesion.
The electrode should be inactivated once the lesion appears to become necrotic or separates from the dermis.
The lesion will fall off within 10 days, or a curette or gauze may be used to remove abnormal tissue.
Larger, more exophytic lesions can be shaved flat prior to electrocautery of the base.
Benign lesions can be removed until the surface of the skin appears flat with normal contours to avoid scarring and ensure good cosmesis.
For highly vascular lesions such as pyogenic granuloma, the lesion is injected using 1% lidocaine with epinephrine 15 minutes prior to the start of the procedure, allowing vasoconstriction to take full effect.
Surgical Punctal Occlusion
Punctal occlusion surgery is used in patients with severe dry eye disease who experience recurrent punctual plug extrusions or punctual plug complications.
The area is cleaned and anesthetized using an infratrochlear nerve block with lidocaine.
A high-temperature electrocautery device with a fine tip is inserted cold into the lacrimal punctum, the vertical portion of lacrimal canaliculus, and the horizontal portion of lacrimal canaliculus.
The device is then turned on until the surrounding punctual tissue becomes white (10-14 seconds).
The device is then removed slowly and antibiotic ointment is applied.
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Electrocautery device
