Optimization of Thermocautery in Excisional Dermatologic Surgery

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Abstract

PURPOSE

Electrosurgery is routinely used in cutaneous surgery for hemostasis. Thermocautery can be used in patients with implantable cardiac devices. This technique relies on heat without electrical current passing through the patient to produce hemostasis. The temperatures and utility of a commercially available, adjustable thermocautery unit are examined.

METHODOLOGY

Tip temperature of the commercially available thermocautery unit (Geiger model 150, Geiger Medical Technologies, Council Bluffs, IA, USA) was measured in air and tissue via a type E thermocouple (0.002 in. diameter) around the unit's tip. Time intervals of 20 to 30 seconds were recorded at device settings 1 to 9 in air and 3 to 8 on surgical patients (Institutional Review Board approval obtained).

RESULTS

In vitro analysis demonstrated predictable temperatures at increasing settings in air: 350 to 900°C. Analysis in vivo during surgery demonstrated similar findings. Tissue contact decreased tip temperature by approximately 50% from in vitro values, and use in a bloody field caused a further decrease in the tip temperature.

CONCLUSION

The thermocautery unit examined is an effective and safe unit to achieve hemostasis. In addition, the temperature may be adjusted as opposed to hand-held units that operate at in vitro temperatures exceeding 1,400°F. Hemostasis at approximately 100 to 400°C provided optimal hemostasis.

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