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Surgical Pearl: The insulated Hyfrecator needle: A no-cost surgical safety tip
Pearls 689
J AM ACAD DERMATOL VOLUME 52, NUMBER 4
Fig 3. Insertion of the diamond fraise into the partial cleft earlobe.
Fig 4. Appearance immediately after operation.
Fig 5. Appearance 1 year after surgery.
REFERENCES 1. Blanco-A´vila F, Va´sconez HC. The cleft earlobe: A review of methods of treatment. Ann Plast Surg 1994;33:677-80. 2. Watson D. Torn earlobe repair. Otolaryngol Clin North Am 2002;35:187-205. 3. Hochberg J, Ardenghy M. Repair of incomplete earlobe. Ann Plast Surg 1996;37:170-2. 4. Niamtu J III. Eleven pearls for cosmetic earlobe repair. Dermatol Surg 2002;28:180-8. 5. Tan EC. Punch technique—an alternative approach to the repair of pierced earlobe deformities. J Dermatol Surg Oncol 1989;15:270-2.
Surgical Pearl: The insulated Hyfrecator needle: A no-cost surgical safety tip Capt Christopher R. Gorman, USAF, MC, FS,a and Stephen W. White, MDb United States Air Force Academy, Colorado, and Bethesda, Maryland
A
ccidental cutaneous burns are unfortunate yet preventable complications of electrosurgery. The Hyfrecator (ConMed Corp, Utica, NY), an instrument that delivers a high-frequency electrical current, is frequently utilized for electrodessication, coagulation, and fulguration. We often perform electrosurgery where there is danger of harm to adjacent
From the United States Air Force Academy,a and the Department of Dermatology, George Washington University, and private practice,b Bethesda. Funding sources: None. Conflicts of interest: None identified. Reprints not available from the authors. The opinions expressed herein are those of the authors and should not be construed as official or representing those of the US Department of the Air Force or the Department of Defense. J Am Acad Dermatol 2005;52:689-90. doi:10.1016/j.jaad.2004.11.030
tissue. Commercially available insulated needles and tips are relatively expensive. The metal tip of the Hyfrecator electrode is more than one centimeter long. Unintentional cutaneous burns may occur when the surgeon’s attention is focused on the tip of the electrode. With this loss of situational awareness, the more proximal aspects of the metal electrode may accidentally contact nearby skin, resulting in tissue damage. In the oral surgery literature, Abubaker1 described insulating the electrosurgical tip with Vessel Paws, a rubber-shod tubing used in vascular surgery and typically available in a general operating room. However, Vessel Paws are not typically found in a dermatology clinic.
TECHNIQUE Although there are a variety of commercially available insulated tips, the precise tip may not be
690 Pearls
J AM ACAD DERMATOL APRIL 2005
Fig 1. A, The Hyfrecator cautery electrode sheathed in a plastic tube. B, Cutting the distal portion of the plastic tube creates a proximal cylindrical protective casing. C, The tip of the electrode is exposed for use with the proximal portion covered to prevent accidental burns.
obtainable during a procedure, especially for a solo operator. Hyfrecator cautery tips are available in sterile and non-sterile versions with the exposed metal part sheathed in a plastic tube (Fig 1, A). The plastic tube can be cut and shortened to accommodate the need for insulation, depending on the length of exposed needle required (Fig 1, B and C). If one cuts the plastic tube during a procedure which is clean, yet not sterile, any scissors or razorblade may be used to trim the plastic tube. For a sterile procedure, trimming of the tube is performed while gloved and with sterile instruments. Cutaneous electrosurgical burns are a preventable complication. Certain high-risk areas such as the ear canal, inside the nose or mouth, or within a
confined delicate area, such as around the eye, may require only a millimeter of exposed tip. An insulated Hyfrecator needle is quickly produced from the disposable protective sheath. This readily available insulation, conjoined with standard, excellent surgical technique, can prevent accidental electrosurgical burns of adjacent tissue. These benefits are available with minimal time commitment and without additional supplies or cost, yet they may avoid a permanent complication.
REFERENCE 1. Abubaker AO. Insulation for the electrosurgical tip. J Oral Maxillofac Surg 1985;43:393.
IOTADERMA #135 What disease of infants mimics neonatal lupus in both its dermatologic and serologic findings? Robert I. Rudolph, MD Answer will appear in the May issue of the Journal.
MARCH IOTADERMA (#134) ‘‘Hanging groins’’ is a manifestation of what disease? Answer: Onchocerciasis. This dramatic physical finding consists of large masses (often containing bowel and lymph nodes) on the lower abdomen and inguinal areas which sag pendulously, and which is secondary to a chronic inflammation which has induced skin atrophy and fibrotic changes. It is a sign of chronic and massive infestation by microfilariae. REFERENCES Somo RM, Enyong PA, Fobi G, Dinga JS, Lafleur C, Agnamey P, et al. A study of onchocerciasis with severe skin and eye lesions in a hyperendemic zone in the forest of southwestern Cameroon: clinical, parasitologic, and entomologic findings. Am J Trop Med Hyg 1993;48:14-9. Keeling JH. Tropical parasitic infections. In: James WD, editor. Textbook of military medicine. Falls Church (VA): Office of the Surgeon General; 1994. pp. 278-9.
Robert I. Rudolph, MD
J AM ACAD DERMATOL VOLUME 52, NUMBER 4
Fig 3. Insertion of the diamond fraise into the partial cleft earlobe.
Fig 4. Appearance immediately after operation.
Fig 5. Appearance 1 year after surgery.
REFERENCES 1. Blanco-A´vila F, Va´sconez HC. The cleft earlobe: A review of methods of treatment. Ann Plast Surg 1994;33:677-80. 2. Watson D. Torn earlobe repair. Otolaryngol Clin North Am 2002;35:187-205. 3. Hochberg J, Ardenghy M. Repair of incomplete earlobe. Ann Plast Surg 1996;37:170-2. 4. Niamtu J III. Eleven pearls for cosmetic earlobe repair. Dermatol Surg 2002;28:180-8. 5. Tan EC. Punch technique—an alternative approach to the repair of pierced earlobe deformities. J Dermatol Surg Oncol 1989;15:270-2.
Surgical Pearl: The insulated Hyfrecator needle: A no-cost surgical safety tip Capt Christopher R. Gorman, USAF, MC, FS,a and Stephen W. White, MDb United States Air Force Academy, Colorado, and Bethesda, Maryland
A
ccidental cutaneous burns are unfortunate yet preventable complications of electrosurgery. The Hyfrecator (ConMed Corp, Utica, NY), an instrument that delivers a high-frequency electrical current, is frequently utilized for electrodessication, coagulation, and fulguration. We often perform electrosurgery where there is danger of harm to adjacent
From the United States Air Force Academy,a and the Department of Dermatology, George Washington University, and private practice,b Bethesda. Funding sources: None. Conflicts of interest: None identified. Reprints not available from the authors. The opinions expressed herein are those of the authors and should not be construed as official or representing those of the US Department of the Air Force or the Department of Defense. J Am Acad Dermatol 2005;52:689-90. doi:10.1016/j.jaad.2004.11.030
tissue. Commercially available insulated needles and tips are relatively expensive. The metal tip of the Hyfrecator electrode is more than one centimeter long. Unintentional cutaneous burns may occur when the surgeon’s attention is focused on the tip of the electrode. With this loss of situational awareness, the more proximal aspects of the metal electrode may accidentally contact nearby skin, resulting in tissue damage. In the oral surgery literature, Abubaker1 described insulating the electrosurgical tip with Vessel Paws, a rubber-shod tubing used in vascular surgery and typically available in a general operating room. However, Vessel Paws are not typically found in a dermatology clinic.
TECHNIQUE Although there are a variety of commercially available insulated tips, the precise tip may not be
690 Pearls
J AM ACAD DERMATOL APRIL 2005
Fig 1. A, The Hyfrecator cautery electrode sheathed in a plastic tube. B, Cutting the distal portion of the plastic tube creates a proximal cylindrical protective casing. C, The tip of the electrode is exposed for use with the proximal portion covered to prevent accidental burns.
obtainable during a procedure, especially for a solo operator. Hyfrecator cautery tips are available in sterile and non-sterile versions with the exposed metal part sheathed in a plastic tube (Fig 1, A). The plastic tube can be cut and shortened to accommodate the need for insulation, depending on the length of exposed needle required (Fig 1, B and C). If one cuts the plastic tube during a procedure which is clean, yet not sterile, any scissors or razorblade may be used to trim the plastic tube. For a sterile procedure, trimming of the tube is performed while gloved and with sterile instruments. Cutaneous electrosurgical burns are a preventable complication. Certain high-risk areas such as the ear canal, inside the nose or mouth, or within a
confined delicate area, such as around the eye, may require only a millimeter of exposed tip. An insulated Hyfrecator needle is quickly produced from the disposable protective sheath. This readily available insulation, conjoined with standard, excellent surgical technique, can prevent accidental electrosurgical burns of adjacent tissue. These benefits are available with minimal time commitment and without additional supplies or cost, yet they may avoid a permanent complication.
REFERENCE 1. Abubaker AO. Insulation for the electrosurgical tip. J Oral Maxillofac Surg 1985;43:393.
IOTADERMA #135 What disease of infants mimics neonatal lupus in both its dermatologic and serologic findings? Robert I. Rudolph, MD Answer will appear in the May issue of the Journal.
MARCH IOTADERMA (#134) ‘‘Hanging groins’’ is a manifestation of what disease? Answer: Onchocerciasis. This dramatic physical finding consists of large masses (often containing bowel and lymph nodes) on the lower abdomen and inguinal areas which sag pendulously, and which is secondary to a chronic inflammation which has induced skin atrophy and fibrotic changes. It is a sign of chronic and massive infestation by microfilariae. REFERENCES Somo RM, Enyong PA, Fobi G, Dinga JS, Lafleur C, Agnamey P, et al. A study of onchocerciasis with severe skin and eye lesions in a hyperendemic zone in the forest of southwestern Cameroon: clinical, parasitologic, and entomologic findings. Am J Trop Med Hyg 1993;48:14-9. Keeling JH. Tropical parasitic infections. In: James WD, editor. Textbook of military medicine. Falls Church (VA): Office of the Surgeon General; 1994. pp. 278-9.
Robert I. Rudolph, MD