Radio-wave surgery has many benefits

Conway McLEAN, DPM

Like many denizens of the modern world, I find myself enamored of the toys we have available to us, the products of modern technology. Look at the excitement generated by the release of the latest cell phone. As a surgeon, this is especially true, with all manner of electronic gadgets at our disposal. How many of these actually have the abilities advertised…..that’s another story. Yet, if you wait until a new technology is “tried-and-true”, you will forever be behind the times.

The history of surgery is replete with advances in technology changing the nature of what we can do. With no pain control and the risk of infection, surgery used to be painful, horrific and dangerous in roughly equal measure. Many people died on the operating table in the early days. Anesthetic gases such as ether and then chloroform allowed the patient to undergo surgical intervention without experiencing the pain previously necessary, and was thus a tremendous advance.

More recently, the development of internal fixation was a milestone in orthopedic surgery. The use of bone screws and metal plates for securing two bones together allowed us to move bones around, yet still be confident the bones would fuse as desired. Shattered bones could be repositioned, and able to heal appropriately because of this technology. Various deformities could be corrected, with an excellent chance of success, since the cut bones would be held rigidly in place.

The development of minimally invasive joint surgery was due primarily to advances in the equipment, especially the devices called arthroscopes. In essence, these are telescopic microscopes (or would it be microscopic telescopes?), which allow us to evaluate the inside of a joint, without opening it up. This led, in turn, to endoscopy, whereby a person’s “innards” could be explored, and altered, various structures moved, or even removed, with the introduction of tiny instruments into the abdomen for these manipulations.

One particular development that does not receive the accolades of, for example, lasers is that of radio-wave surgical technology. Equipment that generates controlled and precise amounts of energy are used for all manner of procedures. These are popular with a variety of surgical disciplines, including plastic surgeons, dermatologists, as well as ear, nose and throat doctors (oto-rhino-laryngologists). The atraumatic nature of radio-waves provides some noteworthy advantages. The lack of trauma results in tissue healing without stiffened scar tissue forming, which is a predictable characteristic of wounds created by manual cutting. The radiofrequency generator instrument has the ability to control bleeding by closing shut the blood vessels (known as coagulation). We can produce coagulation of blood vessels where it is needed, without significant adjacent tissue destruction. Naturally, the result is less pain post-operatively, as well as faster healing.

Radio-wave surgery clearly has many practical uses in various soft tissue procedures. All these characteristics benefit the health of the traumatized tissues. As a result of these advantages, radiosurgery facilitates, accelerates, and improves surgical procedures tremendously.

Hundreds of different electrodes are available for the multitude of procedures performed with this apparatus. One of my favorite examples of this technology involves the use of an electrode placed in the handpiece, which is attached to the radio-wave device. This particular item is a thin wire, roughly the thickness of a thick hair. But, when activated, this barely visible piece of metal goes through skin and soft tissue like “a not knife through butter,” the skin and deeper tissues melting away, providing a very dramatic demonstration of its capabilities.

A key element of the many benefits of radio-wave surgery is the mechanism by which the radio-waves act on the cells of the target tissue. Unlike other forms of electrical surgery, there is minimal amounts of char, which is burned tissue. This amazing gadget causes the cells to vaporize, just like a science fiction ray gun. Burned tissue is dead tissue, with no likelihood of healing. But since the radio-wave device produces little of this, and also helps to seal blood vessels, we can minimize blood loss afterwards, reduce pain, etc. You get the idea.

In my practice, one especially problematic condition is the dreaded ingrown nail. Not a particularly debilitating malady, but common. The chronicity of a buried nail edge detracts from one’s quality of life. When the toe becomes infected, and is left untreated, it is possible for the bacteria to get to the bone and start a bone infection. Obviously, this is a more complex problem, a “horse of a different color.” Quite often, the culprit causing recurrent ingrown nail pain is the shape of the nail, in combination with the configuration of the toe. Removing the edge of nail (by a doctor!), provides relief, but this is generally a temporary solution.

The answer is obvious: remove the nail root growing that edge. Permanent relief is accomplished when this supposedly simple goal is achieved. But is this truly a simple thing? Ask the millions of people who have had this procedure performed, and had the nail edge grow back, unfortunately a common occurrence with several methods that are in current use.

To this end, the application of an acid to the nail root has been performed for decades. Unfortunately, healing up from this procedure tends to be lengthy since the surgeon is creating a chemical burn. These burns heal slowly, are painful for weeks, and, worst of all, this approach has a very poor success rate. One national study put the rate of recurrence at about 60 percent. Almost half the time, the edge, or some distorted semblance of the nail edge, grows back, and the pain of the procedure, and the time required , another wonderful facet of radio-wave surgery for healing, all go for naught.

This is certainly one example where radio-wave surgery provides exemplary benefits. The healing time is a fraction of that of the acid technique, because of the lack of burned tissue. This application leaves the surrounding tissues unharmed. Additionally, the radio-wave technology allows the surgeon to be very precise, very controlled. Very importantly, post-operative pain is minimized. Soaking of the toe is not necessary, in contrast to the repeated, consistent, daily soaks required with the acid technique. Best of all, the success rate with this procedure is fantastic. Regrowth of the removed edge is an extreme rarity.

Why does any doctor still use the acid method? Doctors tend to be creatures of habit, and often won’t adopt new techniques, and/or purchase new equipment, unless they are intimately familiar with the alternative. Too many doctors are still taught only this primitive method of nail root destruction.

Radio-wave devices have become popular for a whole host of procedures, from cosmetic surgery, to a minimally invasive technique for resolving the (heel) pain of plantar fasciitis, as well as a lasting solution to Achilles tendonitis. But to my way of thinking, the benefits of radio-wave surgery for treatment of the very common ingrown nail problem is one of the most obvious. We have come to think of surgery as a safe, painless and reliable method to cure us from illness, but it’s often not the case. With the radio-wave device, treatment of a recurrent ingrown nail can be all these things and more.

Editor’s note: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at