02. Electroshaving of a verrucous epidermal nevus on the face
KEYWORDS: timedsurgical electroshaving, verrucous epidermal nevus
All small benign facial lesions, like this verrucous nevus, can be ablated by means of timedsurgical electroshaving carried out through slow pulsed timedsurgical cutting. The patient may also undergo a mini-facelift without blunt dissection, in which an elastic Elasticum® thread and a two-tipped Jano Needle® are used. Before excision of the verrucous nevus, local anaesthesia with carbocaine and epinephrine is performed. By using a magnifying lens, the operator can ablate the nevus while sparing the surrounding healthy tissue. The programme data of this timedsurgical slow cutting procedure are: Direct Pulsed 0.5/24.5 hundredths of a second, Coag – 38 Watt - EM10 Green. The slow pulsed timedsurgical incision does not burn around the edges. Following ablation, the tissue remains almost completely intact and is ready for immediate and spontaneous reconstruction. Indeed, electroshaving exploits the reconstructive capacity of the organism. Ablation triggers the onset of endogenous currents, which in turn stimulate the production of epidermal, connective, vascular and nerve growth factors. Endogenous currents are active until such time as the skin has completely reformed. In this patient, the medication used was a collagenase cream, which does not inhibit endogenous currents. During ablation, some bleeding from small vessels occurs; these vessels are vaporized by means of timedsurgical resurfacing. Programme data: Direct Pulsed 0.3/5.3 hundredths of a second, Coag, 50 Watt, EM 15.
Electroshaving of a benign neoformation by means of slow pulsed cutting. Local anaesthesia with epinephrine; excision of the neoformation from the healthy tissue; the same needle used to inject the anaesthetic is now used as a hook; haemostasis by means of resurfacing. When the crust drops off, only a slight introflexion remains, which will disappear with time (nature abhors a vacuum). A little nourishment (collagen or hyaluronic acid) helps to speed up restitutio ad integrum.
Timedsurgical resurfacing does not heat the tissues. Resurfacing is also used to vaporize small areas where lesion can still be seen. The results of facial electroshaving are always excellent. Electroshaving is the technique of choice for ablating benign facial lesion, especially if they are not located on the cristae cutis. The advantage of timedsurgical electroshaving over surgical excision is that, unlike a sutured surgical wound, it does not leave any visible scar.
Capurro S. (2000) Electroshaving of a verrucous epidermal nevus on the face. CRPUB Medical Video Journal. Timedsurgery section. http://www.crpub.org
Electroshaving by means of slow pulsed timedsurgical cutting enables small benign neoformations of the face and body to be removed and yields an aesthetic result. What precautions need to be taken?
Magnifying lens must be used; only the neoformation is removed, without burning the edges. In this way, healing can begin immediately. The patient has to apply a small amount of collagenase and chloamphenicol gel (Iruxol) every two days until the crust forms. If there is a lot of exudation and a crust has not formed after 3 or 4 days, an antiseptic powder (Ektogan) is applied. Once the crust has formed, it must be allowed to detach spontaneously; the patient must take care not to rub it off. When the crust is about to drop off, the patient should cover it with a sticking plaster before going to bed, so as to avoid rubbing against the pillow or sheets. When electroshaving is carried out on the body, it is advisable to add a drop of triamcinolone acetate (Kenacort A) to the anaesthetic solution in order to reduce the risk of slightly hypertrophic scarring, especially in young patients.
How much triamcinolone acetate should be added?
Small amount of triamcinolone acetate is drawn up into the syringe and then emptied back into the vial; immediately afterwards, the anaesthetic solution is drawn into the syringe. The small amount of triamcinolone that remains in the extremity of the syringe and in the needle is enough to prevent hypertrophic scarring.
How is the antiseptic powder applied?
Wad of cotton-wool is used to dab a small amount of powder onto the wound, in the same way as face powder is applied. After a minute, the same wad is used to remove all excess powder that does not adhere to the wound. In this way, the wound “breathes” and does not become infected.
Should the powder be applied several times a day?
It is advisable to do so.
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