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ELECTROSURGICAL DESICCATION & HYFRECATION

What is Electrosurgical Desiccation & Hyfrecation?

The technique involves the application of extreme heat to produce very precise tissue destruction. The heat is transferred into the tissue via a tipped electrode.

Essentially, Electrosurgical Desiccation and Hyfrecation is the use of a high frequency alternating electrical current (of above 0.1MHz) to treat cutaneous lesions. In the field of Podiatric medicine such treatment is mainly undertaken on resistant verrucae, vascular and neurovascular corns (corns with blood vessels and nerve endings in), long-term resistant corns (particularly fibrous corns) and can also be used to help resolve a sinus (narrow opening) beneath corns.

The foot is numbed with a local anaesthetic agent being injected behind the ankle (tibial nerve block/ankle block). Prior to this injection the skin into which the local anaesthetic is to be injected is frozen with a very cold spray in order to minimise any discomfort from the injection.

Provided that the local anaesthetic is administered by a practitioner with a good technique and ample experience, then patients with a particular dislike of injections can be reassured that there is no discomfort at all from this injection.

When the foot has become numb the procedure can begin. Firstly, any excess hard skin is shaved from the surface of the corn or verrucae. Then the outer layer of skin is desiccated (dried). This involves applying heat by means of a relatively large ball electrode. When the area has been desiccated, a typical white colouration will appear. The epidermis (outer layer of skin) is then ‘peeled away’, exposing the lower layer of skin (dermis). This is the area where the verrucae-causing virus infection is active.

During the treatment of corns the exposed dermis is then hyfrecated very lightly. For resistant verrucae this is done more aggressively. Hyfrecation differs from Desiccation since hyfrecation delivers the same amount of energy into a smaller surface area. This is achieved by using a smaller tipped electrode and usually produces smoke and a smell similar to singed hair.

In effect the whole procedure ‘burns’ a controlled ulcer (hole) into the skin, as shown in figures A and B below. After the procedure no stitches are required and a dry dressing is applied. Patients are advised to avoid unnecessary weight-bearing for the duration of the day. Sensation returns to the foot after two/three hours.

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.Post-operative discomfort is normally quite modest, however a small percentage of patients may experience more pronounced discomfort. It is interesting to note that considering Electrosurgical Desiccation and hyfrecation is an invasive surgical procedure the levels of reported post-operative discomfort are significantly less than for cryotherapy and acid/caustic treatments which are not as invasive.

Depending on the size of the lesion treated the wound will take between three-seven weeks to heal. During this time patients attend the surgery on a weekly basis for post-operative dressings and reviews.

One advantage of Electrosurgical Desiccation and Hyfrecation is that unlike other invasive surgical skin procedures the levels of post-operative scarring are very low. This is important since significant scarring on the weight-bearing parts of the foot can cause long term corn and callus formation.

a. Using Electrosugery to treat corns

Before the treatment is considered for the treatment of corns the patient would normally have received prolonged conservative treatment by means of routine debridement and a sustained effort to reduce the pressures and stresses active over the corn. If this has not prevented the corn from constantly reappearing then Electrosurgical Desiccation and hyfrecation can be considered.

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The results for such corns are very good indeed. Patients with vascular and neurovascular corns report excellent results. Any nerve filament or small blood vessel within a neurovascular corn will be completely destroyed and although the corn may reappear at a later date the improvement in symptoms is exceptional.

For patients with non-vascular and non-neurovascular corns the results are generally very good, although not as marked as for vascular and neurovascular corns. Approximately 50% of corns will reappear at some stage after Electrosurgical Desiccation and hyfrecation, however very few of these patients will fail to report pronounced improvements in symptoms.

b. Using Electrosugery to treat verrucae

Electrosurgical Desiccation and Hyfrecation rarely fails to cure warts and verrucae. Occasionally the procedure may have to be repeated in which case fees for any further treatments do not apply.

Obviously there is a maximum size of lesion that can be treated at any one time. This is approximately 3cm squared.

It would normally be advisable for patients with verrucae and hand warts to attempt a less invasive treatment regime (Cryotherapy or possibly caustic) before consideration is given to undertake Electrosurgical Desiccation and hyfrecation. Usually this treatment is undertaken when other treatment regimes have failed and the patient is keen to obtain cure, in which case Electrosurgical Desiccation and hyfrecation is an ideal choice.

For further information and access to a video of the procedure do not hesitate to call and make a consultation appointment with Mark, who will advise you on the most appropriate treatment regime.

Broadband users can view a five minute video of Electrosurgical Desiccation and Hyfrecation treatment being performed. Please note that the quality of the video has been reduced in order to be streamed across the internet. Should you wish to view the original video on DVD, please feel free to ask at the surgery and we will be happy to loan you a copy.

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