Cutting current is a valuable tool in the office surgical practice due to its speed, efficiency, and economy. Most electrosurgical generators produce a blended wave form that coagulates the tissue as it is cut. Care should be taken to see that the patient is adequately grounded with a dispersive electrode to prevent cutaneous burns. The cutting of the tissue should be brisk and with the smallest electrode and power setting possible. By using careful electrosurgical technique, the surgeon can produce an incised wound that heals as well as one created by cold steel excision.

An accessory tragus can easily be treated by surgical excision. The results are quite satisfactory if care is taken to remove any protuberant portion of underlying cartilage. This lesion is rarely associated with other developmental defects of the first branchial arch.

The skin cannot be sterilized because approximately 20% of the resident flora are beyond the reach of surgical scrubs and antiseptics. The goal of surgical preparation of the skin with antiseptics is to remove transient and pathogenic microorganisms on the skin surface and to reduce the resident flora to a low level. Four antiseptics which have been popular over the past two decades are discussed. Benzalkonium chloride is somewhat unstable on the skin and is too prone to contamination to be in general use. Hexachlorophene is not recommended due to narrow spectrum and risks secondary to percutaneous absorption. The iodophors are excellent antiseptics, but recent studies raise questions about effectiveness and contamination. Chlorhexidine is a very safe and effective antiseptic. Comparison studies with chlorhexidine, hexachlorophene, and iodophors show chlorhexidine to be the most effective agent. Chlorhexidine can be toxic to the middle ear and irritating to the eyes with direct contact. Caution should be used in these areas with chlorhexidine and other antiseptics.

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