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Electrosurgery on a Keloid pt

Discussion in 'Foot Surgery' started by megmad, Jul 26, 2016.

  1. megmad

    megmad Member

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    Soooo... being very green, i need some advice, as there is not very much literature out there regarding this issue:

    I have a patient with a very painful VP planter 2-3MTPJ.
    This patient mentioned that he has a few keloid scars...
    (none plantar - but i dont want to be the first)

    Is it safe to continue with electrosurgery?

    Many thanks
  2. I remember electrosurgery being performed by someone on a patient such as the one you mention when I was a clinical teacher at the Birmingham School- created no end of problems- wouldn't recommend it.
  3. Rob Kidd

    Rob Kidd Well-Known Member

    I did hundreds, possibly thousands of "hyfrecations" of plantar warts in the middle to late 70's. The vast majority were entirely successful. However, I stopped doing them in a realisation that most were unnecessary. While I do not practice any longer, have not for very many years, I could find you a case for the odd hyfrecation. Not many though.
  4. megmad

    megmad Member

    mmmmm thank you Simon. sounds like night mare i am imagining of a worst case scenario.

    Rob, that is interesting... tell me more about why you think hyfrecation is unnecessary...
  5. Rob Kidd

    Rob Kidd Well-Known Member

    Well, ok, since you drag me that way. I have to ask the question, why are you routinely treating warts? Yes, I know some hurt, yes I know about the immuno-supressed, and all the other fiddly bits. But routine treatment of warts - is surely an unneeded thing? I know that Blinda will jump up and down (and I hold her in the highest regard) - but no one has ever explained to me, in words that I understand, why routine treatment of warts is clinically desirable.
  6. megmad

    megmad Member

    mmmmmm definitely something for me to ponder over!!!!! thank you for making me think.... again and again
  7. blinda

    blinda MVP

    Difficult to hold me anywhere when I`m jumping up and down.....

    For you Rob, I do declare; Routine treatment of warts is NOT clinically desirable. We should be reassuring our patients of the benign nature of the Human Papilloma Virus associated with verrucae/plantar warts, particularly where lesions are aymptomatic. You can quote me on that, if you like.

    MM, I agree with Simon. Any VP tx comes with risk of scarring and that risk is increased with electrosurgery and cautery as the dermis is often cut, so has to heal with a scar. For a plantar lesion that will spontaneously resolve (eventually) and has a risk of developing unsightly - and most probably more painful than the original VP as it would be WB - keloid scarring, I would avoid electrosurgery. Maybe offloading and a Tincture of Time (Kidd,19something) would be best course of action.
  8. Ian Drakard

    Ian Drakard Active Member

    Hi MM

    As an observation, if it's bad enough to consider electrosurgery, why not needling?

    Less healing time, less infection risk while healing and less risk of scarring? I've never done one on a keloid prone patient though so I'd see if anyone else has before you get stuck in.

    And as Rob points out- does it actually need doing?
  9. blinda

    blinda MVP

    Question: Does this fella have tattoos? If so, did they heal appropriately?
  10. Lab Guy

    Lab Guy Well-Known Member

    If a patient has keloids (not hypertrophic scars), you want to avoid penetrating the dermis at all costs. Off-load it with inserts and treat conservatively. Avoid all invasive treatments, including needling.

  11. megmad

    megmad Member

    Thanks Ian, I have no experience in needling. very keen to do it but unfortunately i am limited at the practice i currently work at.
    And yes it needs doing, it is huge and extremely painful, made worse my OTC salicylic acid products (corn plasters and drops), and i am afraid it also has a secondary infection from him having fiddled with it... (a newbie's worst nightmare). i am suspecting an abscess below the surface....

    i want to die from my inexperience, but i suppose this is the best way to learn!

    thanks for all your advice everyone! i will take some of your opinions and challenge my boss! i will ponder all of it too, of course!

    again, many thanks :drinks

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