Cauterization

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The medical practice or technique of cauterization c. 1400, from Old French cauterisier, from Late Latin cauterizare "to burn or brand with a hot iron," from Greek καυτηριάζειν > kauteriazein, from kauter "burning or branding iron," from kaiein "to burn" (see caustic). Related: Cauterized; cauterizing. is the burning of part of a body to remove or close off a part of it in a process called cautery, which 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.[1] The practice was once widespread for treatment of wounds. Its utility before the advent of antibiotics was said to be effective on several levels:

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.[2]

Actual cautery refers to the metal device, generally heated to a dull red glow, that a physician applies to produce blisters, to stop bleeding of a blood vessel, and other similar purposes.[3]

The main forms of cauterization used today in the first world are electrocautery and chemical cautery—where both are, for example, prevalent in the removal of unsightly warts. Cautery can also mean the branding of a human, either recreational or forced.

History[edit]

Hot cauters were applied to tissues or arteries to stop them from bleeding.

Cauterization was used to stop heavy bleeding, especially during amputation. This form of medical work was first discovered by Andreas Vesalius, Belgian Renaissance scientist. The procedure was simple: a piece of metal was heated over fire and applied to the wound. This would cause tissues and blood to heat rapidly to extreme temperatures in turn causing coagulation of the blood thus controlling the bleeding, at the cost of extensive tissue damage.

Cauterization was a common treatment in the Middle Ages, sometimes unintentionally as with Saint Hubert's Key.

Cautery is described in the Hippocratic Corpus.[4] The cautery was employed for almost every possible purpose in ancient times: as a counter-irritant, as a haemostatic, as a bloodless knife, as a means of destroying tumours, etc.[5] Later, special medical instruments called cauters were used to cauterize arteries. The technique of ligature of the arteries as an alternative to cauterization was later improved and used more effectively by Ambroise Paré.

Electrocauter 00.jpg

Electrocautery[edit]

Not to be confused with Electrosurgery.

Electrocauterization is the process of destroying tissue using heat conduction from a metal probe heated by electric current. The procedure stops bleeding from small vessels (larger vessels being ligated) or for cutting through soft tissue. 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.

Unipolar[edit]

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. Heat generated depends on size of contact area, power setting or frequency of current, duration of application, and waveform. Constant waveform generates more heat than intermittent. Frequency used in cutting the tissue is higher than in coagulation mode.

Bipolar[edit]

Bipolar electrocautery passes the circuit 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.[6]

Electrocauterization is preferable to chemical cauterization, because chemicals can leach into neighbouring tissue and cauterize outside of intended boundaries.[7] 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.[8]

Ultrasonic coagulation and ablation systems are also available.

Chemical cautery[edit]

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.

Nasal cauterization[edit]

Frequent nose bleeds are most likely caused by an exposed blood vessel in the nose. 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 if in one of the few countries that allow it for medical use. Cocaine is the only local anesthetic that also produces vasoconstriction,[9] making it ideal for controlling nosebleeds. More modern treatment applies silver nitrate after a local anesthetic—a procedure that is generally painless. The nose may run for up to a week after this treatment.

Amputational cauterization[edit]

Countries that practice amputation as part of their penal code may use cauterization to prevent death from severe loss of blood.

Infant circumcision[edit]

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.[10] This method of circumcision resulted in several infants losing their penises, with at least seven male children being reassigned as female.[11][12][13][14][15][16]

See also[edit]

References and notes[edit]

  1. ^ "Dictionary definition, retrieved: 2009-03-07.". 
  2. ^ 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. 
  3. ^ Robinson, Victor, Ph.C., M.D. (editor) (1939). "Actual cautery". The Modern Home Physician, A New Encyclopedia of Medical Knowledge. WM. H. Wise & Company (New York). , page 16.
  4. ^ The Presocratic Influence upon Hippocratic Medicine
  5. ^ Surgical Instruments from Ancient Rome
  6. ^ Sabiston textbook of surgery (19th ed ed.). 2012. p. 235. ISBN 978-1-4377-1560-6. 
  7. ^ See Mr. R. McElroy for details of various operations and the unintended effects of chemical cauterization
  8. ^ 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. 
  9. ^ http://www.ncemi.org/cse/cse0308.htm.  Missing or empty |title= (help)
  10. ^ College of Physicians and Surgeons of Manitoba. Neonatal Circumcision. Winnipeg: College of Physicians and Surgeons of Manitoba, 1997.[verification needed]
  11. ^ "Family Is Awarded $850,000 For Circumcision Accident" The New York Times, New York, USA, Published November 2, 1975
  12. ^ "David Reimer, 38, Subject of the John/Joan Case" The New York Times, New York, USA, Published May 12, 2004
  13. ^ Charles Seabrook. $22.8 million in botched circumcision. Atlanta Constitution, Tuesday, March 12, 1991.
  14. ^ Schmidt, William E (October 8, 1985). "A Circumcision Method Draws New Concern". The New York Times. 
  15. ^ Vincent Lupo. Family gets $2.75 million in wrongful surgery suit. Lake Charles American Press, Wednesday, May 28, 1986.
  16. ^ 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. PMID 2769863. 

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