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Diathermy in Surgery

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Diathermy in Surgery

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This topic has been introduced in the new edition of Bailey & Love - 26th. This topic covers the types, uses & special uses as well as complications of Diathermy.

This topic has been introduced in the new edition of Bailey & Love - 26th. This topic covers the types, uses & special uses as well as complications of Diathermy.

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Diathermy in Surgery

  1. 1. Introduction Forms of diathermy Surgical uses & Types of diathermy Complications
  2. 2.  Diathermy, form of physical therapy in which deep heating of tissues is accomplished by the use of high-frequency electrical current.  The term diathermy is derived from the Greek words “Therma”, meaning heat, and “Dia”, meaning through.  Diathermy literally means “Heating through”.  Carl France Nagelschmidt, a German physician, in 1909 coined the term diathermy.
  3. 3.  Depending on the amount of heat generated, diathermy can be used to merely warm or to destroy tissue.  In the first instance, it is particularly beneficial in relieving muscle soreness and sprain.  In the second, as an adjunct to surgery, diathermy is used to coagulate, prevent excessive bleeding, and seal off traumatized tissues.  It is particularly effective in eye surgery, neurosurgery & dermatology.
  4. 4. 3 forms of diathermy - wide use in hospitals : Shortwave Ultrasound Microwave
  5. 5.  In shortwave diathermy, the part to be treated is placed between two condenser plates, and the highest temperature is concentrated in the subcutaneous tissues.  It is usually prescribed as treatment for deep muscles and joints and is sometimes used to localize deep inflammatory disease.
  6. 6.  It uses high-frequency acoustic vibrations; their heating effect ↑ circulation and metabolism and speeds up the rate of ion diffusion across cellular membranes.  During treatment the apparatus is moved slowly across the surface of the area to be affected.  Ultrasound is used to heat selected muscles that are too deep to be significantly affected by surface heating.
  7. 7.  Microwave diathermy uses radiation of very high frequency & short wavelength similar to radar waves.  All physiologic responses are due to its heating effect.  Microwave diathermy is used in the management of superficial tumours with conventional RT & CT.
  8. 8.  Surgical diathermy is usually better known as "electrosurgery". (It is also referred to occasionally as "electrocautery“)  Electrosurgery and surgical diathermy involve the use of high frequency A.C. electrical current in surgery.
  9. 9. Diathermy can be used for 3 purposes : Coagulation – Sealing of blood vessels. Fulguration – the destructive coagulation of tissues with charring. Cutting – used to divide tissues during bloodless surgery.
  10. 10.  MONOPOLAR  BIPOLAR
  11. 11.  Where electrical current passes from one electrode near the tissue to be treated to other fixed electrode (indifferent electrode) elsewhere in the body.  Usually this type of electrode is placed in contact with buttocks or around the leg.
  12. 12.  Active electrode in surgical site.  Patient return electrode – electrical plate – attached elsewhere.  Current flows through patient.  Localised heating at tip of instrument.  Minimal heating on plate as more surface area.
  13. 13.  Bipolar, where both electrodes are mounted on same pen-like device and electrical current passes only through the tissue being treated.  Advantage of bipolar electrosurgery is that it prevents the flow of current through other tissues of the body and focuses only on the tissue in contact.  This is useful in microsurgery and in patients with cardiac pacemaker.
  14. 14.  Explosion  Burns  Lap.surgery
  15. 15.  Sparks from diathermy can ignite any volatile or gases or fluid within the theatre.  Alcohol based skin preparation can catch fire if they are allowed to pool or around the patient.
  16. 16.  Faulty application of the indifferent electrode with inadequate contact area.  Patient being earthed by touching any metal object.  Faulty insulation of diathermy leads.  Inadvertent activity such as accidental activation of foot pedal.
  17. 17.  Diathermy of wrong structure becoz of lack of clarity of vision.  Faulty insulation of any lap instrument.  Intraperitoneal contact of diathermy with another metal instrument.  Inadvertent activity while tip is out of vision of the camera.  Retained heat in the tip – touching the bowel.
  18. 18.  Short circuit instances leading to electrocution  Interfere with pacemaker function  Channeling effects if used on viscus with narrow pedicle (e.g. penis or testis)

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