Cauterization (or cauterisation, or cautery) is a medical practice or technique of burning a part of a body to remove or close off a part of it. It destroys some tissue in an attempt to mitigate bleeding and damage, remove an undesired growth, or minimize other potential medical harm, such as infections when antibiotics are unavailable.
The practice was once widespread for treatment of wounds. Its utility before the advent of antibiotics was said to be effective at more than one level:
Cautery was historically believed to prevent infection, but current research shows that cautery actually increases the risk for infection by causing more tissue damage and providing a more hospitable environment for bacterial growth.
The main forms of cauterization used today in the first world are electrocautery and chemical cautery—both are, for example, prevalent in the removal of unsightly warts and stopping nosebleeds. Cautery can also mean the branding of a human, either recreational or forced.
Cauterize is a Middle English word borrowed from the Old French cauteriser, from Late Latin cauterizare "to burn or brand with a hot iron", from Greek καυτηριάζειν > kauteriazein, from καυτήρ, kauter, "burning or branding iron", and καίειν, "to burn" (cf caustic).
Cauterization has been used to stop heavy bleeding since antiquity. The process was described in the Edwin Smith Papyrus and Hippocratic Corpus. It was primarily used to control hemorrhages, especially those resulting from surgery, in ancient Greece. Archigenes recommended cauterization in the event of hemorrhaging wounds, and Leonides of Alexandria described excising breast tumors and cauterizing the resulting wound in order to control bleeding. The Chinese Su wen recommends cauterization as a treatment for various ailments, including dog bites. Indigenous peoples of the Americas, ancient Arabs, and Persians also used the technique.
Tools used in the ancient cauterization process ranged from heated lances to cauterizing knives. The piece of metal was heated over fire and applied to the wound. This caused tissues and blood to heat rapidly to extreme temperatures, causing coagulation of the blood and thus controlling the bleeding, at the cost of extensive tissue damage. In rarer cases, cauterization was instead accomplished via the application of cauterizing chemicals like lye.
Cauterization continued to be used as a common treatment in medieval times. While mainly employed to stop blood loss, it was also used in cases of tooth extraction and as a treatment for mental illness. In the Arab world, scholars Al-Zahrawi and Avicenna wrote about techniques and instruments used for cauterization.
Electrocauterization is the process of destroying tissue (or cutting through soft tissue) using heat conduction from a metal probe heated by electric current. The procedure stops bleeding from small vessels (larger vessels being ligated). Electrocautery applies high frequency alternating current by a unipolar or bipolar method. It can be a continuous waveform to cut tissue, or intermittent to coagulate tissue.
The electrically produced heat in this process inherently can do numerous things to the tissue, depending on the waveform and power level, including cauterize, coagulate, cut, and dry (desiccate). Thus electrocautery, electrocoagulation, electrodesiccation, and electrocurettage are closely related and can co-occur in the same procedure when desired. Electrodesiccation and curettage is a common procedure.
In unipolar cauterization, the physician contacts the tissue with a single small electrode. The circuit's exit point is a large surface area, such as the buttocks, to prevent electrical burns. The amount of heat generated depends on the size of contact area, power setting or frequency of current, duration of application, and waveform. A constant waveform generates more heat than intermittent. The frequency used in cutting the tissue is higher than in coagulation mode.
Bipolar electrocautery passes the current between two tips of a forceps-like tool. It has the advantage of not disturbing other electrical body rhythms (such as the heart) and also coagulates tissue by pressure. Lateral thermal injury is greater in unipolar than bipolar devices.
Electrocauterization is preferable to chemical cauterization, because chemicals can leach into neighbouring tissue and cauterize outside of intended boundaries. Concern has also been raised regarding toxicity of the surgical smoke electrocautery produces. This contains chemicals that, through inhalation, may harm patients or medical staff.
Ultrasonic coagulation and ablation systems are also available.
Many chemical reactions can destroy tissue, and some are used routinely in medicine, most commonly to remove small skin lesions such as warts or necrotized tissue, or for hemostasis. Because chemicals can leach into areas not intended for cauterization, laser and electrical methods are preferable where practical. Some cauterizing agents are:
- Silver nitrate is the active ingredient of the lunar caustic, a stick that traditionally looks like a large match. It is dipped in water and pressed onto the lesion for a few moments.
- Trichloroacetic acid
- Cantharidin is an extract of the blister beetle that causes epidermal necrosis and blistering. It is used to treat warts.
Even if the nose is not bleeding at the time, a physician may cauterize it to prevent future bleeding. Cauterization methods include burning the affected area with acid, hot metal, or lasers. Such a procedure is naturally quite painful. Sometimes, a physician uses liquid nitrogen as a less painful alternative, though it is less effective. A physician may apply cocaine in the few countries that allow it for medical use. Cocaine is the only local anesthetic that also produces vasoconstriction, making it ideal for controlling nosebleeds.
More modern treatment applies silver nitrate after a local anesthetic. The procedure is generally painless, but after the anesthetic wears off, there may be pain for several days, and the nose may run for up to a week after this treatment.
Cauterization has been used for the circumcision of infants in the United States and Canada. The College of Physicians and Surgeons of Manitoba advises against its use in neonatal circumcision. This method of circumcision resulted in several infants having their penises severely burned, with at least seven male children being reassigned as female.
References and notes
- "Dictionary definition, retrieved: 2009-03-07".
- Soballe, Peter W; Nimbkar, Narayan V; Hayward, Isaac; Nielsen, Thor B; Drucker, William R (1998). "Electric Cautery Lowers the Contamination Threshold for Infection of Laparotomies". The American Journal of Surgery. 175 (4): 263–6. doi:10.1016/S0002-9610(98)00020-8. PMID 9568648.
- Robinson, Victor, ed. (1939). "Actual cautery". The Modern Home Physician, A New Encyclopedia of Medical Knowledge. WM. H. Wise & Company (New York)., page 16.
- Agnus Stevenson, ed. (2010). "cauterize". Oxford Dictionary of English. OUP. p. 277. ISBN 9780199571123.
- S. M. Alsanad, A. A. H. Asim, I. M. A. Gazzaffi and N. A. Qureshi (2018). "History of Cautery: The Impact of Ancient Cultures". Journal of Advances in Medicine and Medical Research. 25 (9): 1-17.
- "The Presocratic Influence upon Hippocratic Medicine". Archived from the original on 2001-11-04. Retrieved 2008-11-07.
- Niki Papavramidou, Theodossis Papavramidis, Thespis Demetriou (2010). "Ancient Greek and Greco–Roman Methods in Modern Surgical Treatment of Cancer". Annals of Surgical Oncology. 17 (3): 665-667.
- Unschuld, Paul U. (2003). "Survey of the contents of the Su wen". Huang Di Nei Jing Su Wen: Nature, Knowledge, Imagery in an Ancient Chinese Medical Text. University of California Press. p. 314. ISBN 9780520233225.
- Helaine Selin (ed.). Medicine Across Cultures. Springer. p. 212, 226. ISBN 9780306480942.
- Surgical Instruments from Ancient Rome
- Madeleine Pelner Cosman, Linda Gale Jones (2009). "Medicine, Science, and Technology". Handbook to Life in the Medieval World, 3-Volume Set, Volumes 1-3. Infobase. p. 497. ISBN 9781438109077.
- Sabiston textbook of surgery (19th ed.). 2012. p. 235. ISBN 978-1-4377-1560-6.
- See Mr. R. McElroy for details of various operations and the unintended effects of chemical cauterization
- Fitzgerald, J. Edward F.; Malik, Momin; Ahmed, Irfan (2011). "A single-blind controlled study of electrocautery and ultrasonic scalpel smoke plumes in laparoscopic surgery". Surgical Endoscopy. 26 (2): 337–42. doi:10.1007/s00464-011-1872-1. PMID 21898022.
- "3.08 Epistaxis (Nosebleed)". ncemi.org.
- College of Physicians and Surgeons of Manitoba. Neonatal Circumcision. Winnipeg: College of Physicians and Surgeons of Manitoba, 1997.[verification needed]
- "Family Is Awarded $850,000 For Circumcision Accident" The New York Times, New York, USA, Published November 2, 1975
- "David Reimer, 38, Subject of the John/Joan Case" The New York Times, New York, USA, Published May 12, 2004
- Charles Seabrook. $22.8 million in botched circumcision. Atlanta Constitution, Tuesday, March 12, 1991.
- Schmidt, William E (October 8, 1985). "A Circumcision Method Draws New Concern". The New York Times.
- Vincent Lupo. Family gets $2.75 million in wrongful surgery suit. Lake Charles American Press, Wednesday, May 28, 1986.
- Gearhart, JP; Rock, JA (1989). "Total ablation of the penis after circumcision with electrocautery: A method of management and long-term followup". The Journal of Urology. 142 (3): 799–801. doi:10.1016/S0022-5347(17)38893-6. PMID 2769863.
- Valleylab division of Covidien (no longer part of Tyco Healthcare) , explaining the basics of electrosurgery
- Examples of Cauterizing the Wound in Cinema - Daily Film Dose
- Villafane, Carlos (June 2009). Biomed: From the Student's Perspective (First ed.). [Techniciansfriend.com]. ISBN 978-1-61539-663-4.