Hyfrecator® 2000 Procedures
The list below shows a number of classic applications for the Hyfrecator® 2000.
Dermatology
BENIGN LESIONS
The HYFRECATOR® 2000 can remove a wide range of benign skin lesions. With its wide range of power settings, the HYFRECATOR® 2000 treats even the most sensitive lesions on the face as well as the thickest scaling lesions on the trunk. Examples of clinical applications:
• Acrochordon (skin proliferation): These lesions are quickly destroyed by electrode desiccation or fulguration. The remaining charring is removed with a gauze swab or curette.
•Actinic Keratoses: These pre-malignant lesions respond well to light electrofulguration. Since these lesions occur on exposed surfaces, a cosmetic result is essential. Using a low power setting will help you control the destruction and ensure a satisfactory cosmetic result.
• Adenoma Sebaceum: Treat each papule with desiccation using a low power setting.
• Angiokeratoma: Superficial desiccation is generally sufficient.
• Angiomas, Capillary: Superficial desiccation of fulguration is usually quite successful in treating these lesions. The remaining char may be wiped away with a gauze pad.
• Angiomas Cavernous: Electrodesiccation may satisfactorily treat small lesions. Multiple needle insertions are usually necessary.
• Angiomas, Spider: Electrodesiccation of the centrum, from which the telangiectatic vessels radiate cosmetically, removes the lesions.
• Condyloma Acuminatum (Venereal Wart): Condylomata respond quickly to electrofulguration. Anesthesia is generally required and care must be taken to avoid postoperative infection in the warm, moist genital area.
• Fibroma: Light electrodesiccation or fulguration easily destroys small pedunculated fibromas.
• Keratoacanthoma: After a deep shave or “scoop” biopsy for diagnosis, the base of this lesion should be electrofulgurated to achieve hemostasis and destroy any residual tumor.
• Lymphangioma: These uncommon tumors may respond to electrodesiccation or fulguration.
• Molluscum Contagiosum: These viral lesions 13 resolve quickly with electrodesiccation.
• Pyogenic Granuloma: This loose vascular tissue responds well to electrofulguration.
• Seborrheic Keratoses: These are perhaps the most common and most cosmetically annoying skin tumors in adults. Their presence is often associated with old age. Initial fulguration enables you to easily wipe away the charred remains with a gauze pad or gentle curette. The cosmetic result is usually excellent. Multiple small seborrheic keratoses of the face in young blacks (dermatosis papulosa nigra) may be treated without anesthesia using a low power setting. While excellent cosmetic results are achievable, it is prudent to initially treat one or two as a therapeutic cosmetic test.
• Sebaceous Papules: Seen in rosacia and older, oily-skinned patients, these lesions may be removed by light electrofulguration.
• Syringomas: Very light fulguration, followed by gentle curettage, may be curative. Test one or two lesions initially as a cosmetic trial.
• Telangiectasias: Facial telangiectasias respond well to gentle electrodesiccation. Use LOW terminal at low power settings at one or more sites along their length. This procedure has several advantages over more costly laser treatments and less controllable sclerosing injections. Leg lesions, however, are more recalcitrant to electrosurgery and more likely to recur.
• Common Warts (Verrucae Vulgaris): Most common warts respond to electrofulguration and curettage of the base. Special care must be given to warts that occur over specifically located nerves. Such sites include the digital nerves or those that occur on weight-bearing surfaces like the foot (Verruca Plantais). Care should be taken to avoid excessively deep tissue destruction which may result in painful scarring.
• Filiform Warts: Electrodestruction of the pedicle near its base yields a high cure rate with excellent cosmoses.
• Flat Warts (Verrucae Plana): Flat warts respond well to light electrofulguration.
MALIGNANT LESIONS
If malignancy is suspected take a biopsy before treatment by electrosurgery for histopathologic examination. The most common skin cancers are basal and squamous cell carcinomas. Appropriately selected ones may be treated easily, quickly and effectively with curettage and electrofulguration. You usually need to repeat the procedure once or twice at the same sitting to achieve a high cure rate. The tumors you wish to treat generally should be less than two centimeters in diameter, occurring on a sun-exposed site (face, arms, upper back, lower legs) and not involving a body fold (such as the alar groove or inner canthus of the eye). When lesions are chosen appropriately, as noted above, very acceptable cure rates for electrosurgery can be achieved. In addition, electrosurgery has the advantage of being easy to learn, simple to perform and costeffective. Cosmeses is quite acceptable and, in many cases, may be preferable to the cosmetic results of excisional surgery or radiotherapy.
• Basal Cell Carcinoma: Obtain a shave biopsy before electrosurgery. After initial tumor delineation with a curette, fulguration is performed and followed by thorough removal of the necrotic debris with additional curettage. Curettage and fulguration is typically repeated once or twice.
• Bowen’s Disease (Squamous Cell Carcinoma in Situ): These lesions respond to the same techniques for basal cell carcinomas. Since these lesions may extend further laterally than they clinically appear, anesthesia should extend one to two centimeters beyond the visible lesions.
• Bowenoid Papulosis: Occurring on the genitals, these papules respond to electrofulguration.
• Squamous Cell Carcinoma: The same techniques are again employed as with basal cell carcinoma. You should only treat lesions arising in sun-damaged areas. Squamous cell carcinomas arising in non-sun-exposed skin and in mucous membranes are more aggressive biologically.
Plastic Surgery
Many surgeons use the HYFRECATOR® 2000 for hemostasis in plastic and reconstructive surgery. It saves time and produces minimal tissue reaction compared to other methods. Coagulation occurs by touching each bleeding point with an electrodesiccating current. Because blood will dissipate the energy, a sponge should be used prior to application.
Gynecology
• Vaginal Cysts: Treat these cysts by first excising an oval strip and emptying the contents, then use a strong desiccating current to cauterize the interior. Gartner cysts extending near the vault and alongside the cervix respond to this method.
• Condylomata of the Vulva: You can effectively destroy these warts as you would destroy the various types of warts on the surface of the body. (see Venereal Warts under Dermatology and Urology).
• Cervical Polyps: Cervical polyps up to two centimeters in diameter respond to desiccation of the base without the need for a local anesthetic. If shallow, a fulgurating spark may blanch them thoroughly. Polyps extending into the cervical canal may require more than one treatment. Remember that endocervical and intrauterine polyps may be present. Dilation and curettage of the uterine cavity under general anesthesia may be indicated. As with all such lesions, preliminary biopsy is advisable.
• Pruritus Vulvae: By fulgurating the entire surface using a strong current, excellent results can be achieved. Take care to prevent urethral stenosis.
• Urethral Tumors: The majority of urethral tumors are benign and respond readily to desiccation. However, treatment should be thorough to avoid recurrence.
• Cervical Erosion: Many cervical erosions are asymptomatic and require no treatment. However, if the erosions produce symptoms such as increased discharge or pain, you should treat them effectively with desiccation, fulguration or coagulation. Typically, this is done without the need for a local anesthetic.
• Cervicitis: A strong desiccating current effectively destroys the entire infected mucosa, although more than one treatment is usually necessary.
• Bartholin’s Cysts or Abscesses: Aspiration alone may cure the condition, if this fails, incise the cyst or abscess, evacuate its contents and coagulate the cyst wall using a fulgurating spark. Recurrent cysts respond to marsupialization.
• Nabothian Cysts: Puncture these infected glands and cysts with a sharp needle point, then desiccate.
• Skene’s Glands: Insert a sharp point into the abscess or cyst, then desiccate using a strong current. The wound closes by granulation.
Dental and Oral Surgery
• Apicoectomy: To prepare for an apicoectomy, insert a fine desiccating needle electrode (Cat. No. 705A) slightly beyond the apex of the tooth, then apply the desiccating current to the infected area. The resulting coagulation reduces capillary bleeding and minimizes the spread of infection during later root resection.
• Buccal Gingival Caries: Soft, infected gingival tissue responds to desiccating currents.
• Cysts, Mucous: Small cysts of the mouth respond to epilation. An application of the desiccating current for a few seconds will boil out the mucous fluid and destroy the cyst lining. Results are excellent with minimal scarring.
• Dentin Desensitization: Fulguration desensitizes hypersensitive exposed dentin. Spray the area with a topical anesthetic before the first treatment, then fulgurate with a weak current. Only two treatments are usually required.
• Frenectomy: Intense fulguration of the superfluous tissue under local anesthesia reduces abnormal labial frenum.
• Hemostasis: To control bleeding after exodontia, desiccation or fulguration with a small ball electrode (Cat. No. 727) can be most effective.
• Gingivectomy: The removal of gingival tissue, such as the exposure of the gingival margin, the preparation for taking hydrocolloid impressions and papillectomies and the elimination of gum flaps, responds to both electrodesiccation and fulguration.
• Root Canal Sterilization: The dental electrode (Cat. No. 705A) can sterilize the pulp chamber after first removing the debris. Use one-second bursts of fulguration and gradually move the electrode deeper into the chamber and root canal.
Ophthalmology
• Chalazion (Meibomian Cysts): To treat these cysts, first anesthetize the area. Next, incise and evacuate the cysts.
• Entropion: Treat each nodule by inserting a very fine needle point electrode (Cat. No. 15 714). Use a low-powered desiccating current. Treat only a small portion at each session.
• Xanthelasma: These cholesterol deposits respond effectively to light desiccation or light fulguration. Several treatments are preferable to avoid any scarring.
• Burn Entropion: Light fulguration is recommended.
• Spastic Entropion: Following surgical incision and desiccation to separate it from the orbicularis oculi muscle, desiccate the muscle lightly until it is a light brownish-green color. Suture and dress the wound with antibiotic ointment.
Otolaryngology
• Adenoid - Hypertrophied Remnants: Coagulate small areas under local anesthesia and repeat the process until the hypertrophied areas are completely destroyed.
• Epistaxis: Electrodesiccation is very effective for hemostasis. Anesthetize the areas and carefully identify the vessels. Bring the electrode into direct contact with the ruptured arteriole and use a light current. Exercise care to avoid excessive tissue damage that could result in perforation of nasal septum. For that reason, it is inadvisable to treat both sides simultaneously.
• Granular Pharyngitis: Desiccate each point using a mild desiccating current.
• Nasal Polyps: Desiccate these polyps at the base.
• Hemostasis in Tonsilloadenoidectomy: Use either monoterminal or monopolar coagulation. The monoterminal technique uses the HIGH output. Bleeding is controlled with a sponge dampened with epinephrine (Adrenalin) 1:1,000 before activation of the electrode. Use a ball electrode (Cat. No. 727) as the active electrode.
• Tonsil Tag Destruction: Bipolar coagulation, using a specialized electrode (Cat. No. 789CC), can destroy tonsillar tissue. Insert the double needles into the tissue and destroy the tissue between them.
• Turbinate Shrinkage: Use either monoterminal or monopolar coagulation. The monoterminal mode uses a fine needle with a long, insulated sheath (Cat. No. 716). Monopolar coagulation uses the same electrodes along with the Dispersive Patient Plate (Cat. No. 7-900-7) to complete the circuit.
Proctology
• Fissure-in-ano: Spray a fairly strong fulgurating current over the involved tissue. Healing is prompt, but there is some discomfort during the first three days. Do not destroy the tissue too deeply. Instruct your patient to keep the area clean and to apply an antiseptic ointment.
• Hemorrhoids: Some authorities advocate bipolar coagulation for office management of hemorrhoids. Individually distend the hemorrhoids with a fluid solution and then coagulate.
• Ischiorectal: Incise and drain these lesions, then desiccate the wall with strong current.
• Papilloma: Small papillomas readily respond by inserting a fine needle electrode, but a fairly strong current is needed. Larger polyps within the bowel are better treated with snares and an electrosurgical cutting current.
Urology
• Bladder: Desiccation or fulguration of various growths within the bladder are well established urological techniques. Use a cystoscope and a continuous flow of water. (Check with the manufacturer of your cystoscope to determine compatibility with the HYFRECATOR® 2000).
• Vasectomy: After your patient has been anesthetized, the lumen of the vas deferens can easily be desiccated, minimizing any peripheral damage to the surrounding muscle layers.
• Venereal Warts: Venereal warts and other small polypoid tumors respond to desiccation. Insert the sharp, fine needle point electrode into the base of the growth, intermittently applying the current until the tissue mildly blanches. It is not necessary to remove the desiccated tissue, as epithelization occurs beneath it.