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Cautery dissection in levator surgery.

This report describes a new technique that facilitates dissection of tissue planes and essentially eliminates intraoperative bleeding, two of the most frequently encountered problems during levator surgery. The described technique has been used in more than 450 consecutive eyelids with congenital and acquired ptosis requiring levator surgery. Disinsertion or dehiscence of the aponeurosis was found in less than 5% of the cases of involutional ptosis.

Blepharoptosis↗

Topical anaesthesia with local anaesthetic (lidocaine and prilocaine, EMLA) cream for cautery of genital warts.

Removal of genital warts by thermocautery was performed in 108 patients (57 men and 51 women) under topical anaesthesia with a local anaesthetic cream, lidocaine and prilocaine (EMLA). Most men had warts in the preputial cavity, most women had warts situated on the mucous membranes of the vulva, and warts at multiple sites were common. About 1 ml of cream per lesion was applied to the warts for 20 to 105 minutes before the operation. Plastic film (Glad, Union Carbide) was applied over the cream when natural occlusion, such as under the prepuce or on the introitus, was not present. Local pallor was seen in 30% of the patients, redness in 53%, and oedema in 15%, but did not cause any discomfort and were clinically insignificant. Analgesia was sufficient in 96% of the men and in 40% of the women. Additional local infiltration was given to 60% of the women, but was not as painful as injections generally are in the genital area. The analgesic efficacy on women may be further improved by optimising the application time on the genital mucosa.

Adolescent↗