BACKGROUND

Electrical devices are used in dermatologic procedures for tissue destruction and establishing hemostasis. These devices fall under two large categories: electrocautery and electrosurgery. "Electrocautery" devices are often chosen for procedures in which the goal is to destroy superficial layers of the tissue (Taheri et al., 2014a). During electrocautery, electric current does not flow through the patient's body; instead, only heat is transferred from the device to the patient to achieve a desired result. Thus, electrocautery may be suitable for dermatologic procedures in an area on top of or immediately adjacent to an implantable cardiac device, such as a pacemaker or defibrillator, to avoid any potential electrical interference (Taheri et al., 2014b). "Electrosurgical" devices differ from those of electrocautery because current does flow through the patient's body during the procedure. This current can be safely collected by a dispersive electrode, which is often seen in the form of a grounding pad that is attached to the patient (Taheri et al., 2014a).

The two forms of electricity used in electrosurgical devices include direct and alternating current. "Direct" current passes through a continuous circuit while traveling in one direction. Conversely, alternating current can change directions within a circuit. As a result, alternating current can travel through a circuit with "breaks" or capacitors. This enables alternating current to "leak" out of the circuit if its pathways are not well insulated. Electrosurgical devices must be engineered to reduce the risk of current leakage to protect the patient and provider from potential injury (Taheri et al., 2014a). Whereas direct current is only used in electrocautery devices, alternating current can be used for both electrocautery and electrosurgical devices.

Preprocedure screening to determine the presence of an implantable cardiac device is helpful in promoting patient safety. There are various suggested techniques to reduce the risk of interference with such devices, including using bursts of electricity that are less than 5 seconds, avoiding procedures directly on top of or immediately adjacent to the device, and using the lowest possible power setting (Bolognia, Schaffer, & Cerroni, 2017).

COMMON ELECTRICAL TERMS IN DERMATOLOGY

The following terms are commonly used in dermatologic surgery:

Electrocautery - Current passes through a metal wire to generate heat. In electrocautery, current does not pass through the patient (Taheri et al., 2014a).

Electrosurgery - High-frequency alternating current is used to produce a thermal effect in tissue. In electrosurgery, current does pass through the patient (Taheri et al., 2014a). The various subtypes include the following:

Electrocoagulation - two forms:

Referred to as "electrocoagulation" (or "contact coagulation")-thermal denaturation of the tissue when heated below the boiling point. This is most often used when creating thermal damage over a small area, such as a destruction of sebaceous hyperplasia (Taheri et al., 2014a).

Referred to as "electrofulguration" ("noncontact coagulation" or "spray mode")-Instead of directly contacting the tissue, the active electrode or probe is held millimeters away from the tissue surface where electricity creates a small spark. This spark enables transfer of the current to the tissue. This is most often used to achieve quick hemostasis or to cause thermal damage over a bigger area, such as a destruction of a large seborrheic keratosis (Taheri et al., 2014a).

Electrodessication - When electrocoagulation is complete, water in the superficial layers of the tissue vaporizes (Taheri et al., 2014a).

Electrosection - A method of cutting tissue that is an alternative to using a scalpel. Two forms include the following:

Pure cutting (cutting mode) - The tissue is quickly heated to a temperature above the boiling point using continuous current. This leads to tissue cutting, but with minimal coagulation and hemostasis on the edges of the incision (Taheri et al., 2014a).

Blend cutting (coagulation mode) - This employs the same mechanism as pure cutting. However, the use of interrupted current results in better coagulation and hemostasis on the walls of the incision (Taheri et al., 2014a).

Electrocution - A synonym for electrical injury, in which damage is caused by electric current running through the body (Dechent et al., 2019).

Hyfrecator - A common electrosurgical device among dermatology providers that utilizes alternating current. The hyfrecator is primarily used for either electrodessication or electrofulguration during procedures (Weyer, Siegle, & Eng, 2012).

SUMMARY

Electrical devices used within dermatology involve a unique vocabulary. We aim to provide the nursing community with a succinct review of the most commonly used electrical concepts and terms used in dermatology practice.

REFERENCES