Biomedical subjects
Publications and source records attributed to J E Sebben.
Dispersive electrodes are often neglected or misused in electrosurgery. A dispersive electrode can increase electrosurgical safety and effectiveness. If misused, however, it can become the source of patient injury. The following article summarizes the proper use of dispersive electrodes and differentiates them from actual grounding.
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The basics of wedge resection of the lower lip are reviewed. The use of an intraoral mental nerve block greatly decreases the pain for the patient. The procedure is simplified by the isolation and ligation of the labial artery prior to excision of the wedge. The best cosmetic results are obtained when the orbicularis oris muscle and vermillion border are carefully repaired.
Antibiotics can reduce the incidence of wound infection in some cutaneous surgical cases. In clean, uncomplicated surgical wounds, antibiotics have no effect on the incidence of infection. There is a reduction in infection rate when prophylaxis is used in clean-contaminated and contaminated surgical wounds. To achieve the maximum effect, the drug should be present in the tissue at the time of wounding. The antibiotic should be given for 24 to 48 hours. Longer treatment provides no greater protection from infection. A cephalosporin or erythromycin by the oral route is usually satisfactory for outpatient cutaneous surgery.
Adequate instrument handling and sterilization are important aspects of office surgery. Heat sterilization is the most reliable choice. The steam autoclave is highly recommended. Dry heat is effective but can pose some storage problems. Gas sterilization is useful for heat-sensitive materials but not practical for the private office. Cold "sterilization" is not reliable for incisional surgery. In addition to proper sterilization modality selection, the surgeon must observe important standards of instrument care, packing, and storage.
A useful technique for the electrocoagulation of bleeders while maintaining a sterile surgical field is outlined. The method is fast and efficient, and no special equipment is required.
There are two basic types of cardiac pacemakers: (1) Fixed-rate pacemakers stimulate the heart at a regular rate independent of the intrinsic heart rate. (2) Demand pacemakers sense the heart's spontaneous rhythm. They are more commonly used because they are noncompetitive with the heart. There are two varieties of demand pacemakers: ventricular-inhibited and ventricular-triggered. Their responses to electrical interference are quite different. Potential pacemaker interference is a consideration with high-frequency electrosurgery. The problems with electrosurgical interference have occurred primarily with early pacemaker models. Recent improvements in electrical shielding and filtering systems have made pacemakers very resistant to outside electrical influence. Simple electrodesiccation of small lesions on relatively healthy pacemaker patients poses negligible risks. Caution is advised for marginal patients undergoing extensive electrosurgical procedures. The potential risks are further minimized by proper attention to patient history, monitoring, proper grounding, the avoidance of cutting current, and the use of proper technic.
The skin cannot be sterilized because approximately 20% of the resident flora are beyond the reach of surgical scrubs and antiseptics. The goal of surgical preparation of the skin with antiseptics is to remove transient and pathogenic microorganisms on the skin surface and to reduce the resident flora to a low level. Four antiseptics which have been popular over the past two decades are discussed. Benzalkonium chloride is somewhat unstable on the skin and is too prone to contamination to be in general use. Hexachlorophene is not recommended due to narrow spectrum and risks secondary to percutaneous absorption. The iodophors are excellent antiseptics, but recent studies raise questions about effectiveness and contamination. Chlorhexidine is a very safe and effective antiseptic. Comparison studies with chlorhexidine, hexachlorophene, and iodophors show chlorhexidine to be the most effective agent. Chlorhexidine can be toxic to the middle ear and irritating to the eyes with direct contact. Caution should be used in these areas with chlorhexidine and other antiseptics.
This article reviews the special considerations necessary for adequate photography in a surgical practice. The selection of film, camera, lens, and flash is discussed. Major emphasis is on proper framing and composition of the subject matter. Recommendations are made concerning consent forms and filing of slides.
Office instruments should be steam autoclaved. This has the advantage of greatest effectiveness and reliability with reasonable cost and time. The iodophors and chlorhexidine are excellent surgical skin preparations. Chlorhexidine suppresses regrowth of bacteria much better than iodophors. Antibiotic prophylaxis may be beneficial for clean-contaminated and contaminated wounds. The antibiotic should be administered before surgery and continued no longer than 24 hours after surgery.
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A method for reconstruction of a sideburn is described in detail. Rotated flaps provide coverage with hair at once in a single surgical procedure.
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