Cauterization

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.[1]

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.[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 for other similar purposes.[3]

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

Etymology

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).[4]

History

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

Cauterization has been used to stop heavy bleeding since antiquity. The process was described in the Edwin Smith Papyrus[5] and Hippocratic Corpus.[6] 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.[7] The Chinese Su wen recommends cauterization as a treatment for various ailments, including dog bites.[8] Indigenous peoples of the Americas, ancient Arabs, and Persians also used the technique.[9]

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.[10] 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.[11]

The technique of ligature of the arteries as an alternative to cauterization was later improved and used more effectively by Ambroise Paré.

Electrocautery

Electrocauter

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.

Unipolar

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

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.[12]

Electrocauterization is preferable to chemical cauterization, because chemicals can leach into neighbouring tissue and cauterize outside of intended boundaries.[13] 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.[14]

Ultrasonic coagulation and ablation systems are also available.

Chemical cautery

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.[15] Because chemicals can leach into areas not intended for cauterization, laser and electrical methods are preferable where practical.[16] 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.[17]
  • Trichloroacetic acid[18]
  • Cantharidin is an extract of the blister beetle that causes epidermal necrosis and blistering.[19] It is used to treat warts.[20]

Nasal cauterization

Frequent nosebleeds are most likely caused by an exposed blood vessel in the nose, usually one in Kiesselbach's plexus.

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,[21] 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.

Nasal cauterization can cause empty nose syndrome.[22][23][24]

Amputational cauterization

Countries that practice amputation as part of their penal code, such as Iran,[25] may use cauterization to prevent death from severe loss of blood.

In popular culture, cauterizing is demonstrated as a reliable means of treating an amputated limb whilst ignoring the substantial risk of infection the burn would likely induce.

Infant circumcision

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.[26] This method of circumcision resulted in several infants having their penises severely burned, with at least seven male children being reassigned as female.[27][28][29][30][31][32]

See also

References

  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, ed. (1939). "Actual cautery". The Modern Home Physician, A New Encyclopedia of Medical Knowledge. WM. H. Wise & Company (New York)., page 16.
  4. ↑ Agnus Stevenson, ed. (2010). "cauterize". Oxford Dictionary of English. OUP. p. 277. ISBN 9780199571123.
  5. ↑ Sullivan, Richard (August 1996). "The identity and work of the ancient Egyptian surgeon". Journal of the Royal Society of Medicine. 89 (8): 472. doi:10.1177/014107689608900813.
  6. ↑ "The Presocratic Influence upon Hippocratic Medicine". Archived from the original on 2001-11-04. Retrieved 2008-11-07.
  7. ↑ Papavramidou, Niki; Papavramidis, Theodossis; Demetriou, Thespis (2010). "Ancient Greek and Greco–Roman Methods in Modern Surgical Treatment of Cancer". Annals of Surgical Oncology. 17 (3): 665–7. doi:10.1245/s10434-009-0886-6. PMC 2820670. PMID 20049643.
  8. ↑ 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.
  9. ↑ Helaine Selin, ed. (2006-04-11). Medicine Across Cultures. Springer. pp. 212, 226. ISBN 9780306480942.
  10. ↑ "Surgical Instruments from Ancient Rome". Archived from the original on 2009-09-18. Retrieved 2008-11-07.
  11. ↑ 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.
  12. ↑ Sabiston, David C. (2012). Sabiston textbook of surgery (19th ed.). p. 235. ISBN 978-1-4377-1560-6.
  13. ↑ See Mr. R. McElroy for details of various operations and the unintended effects of chemical cauterization
  14. ↑ 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. S2CID 10211847.
  15. ↑ Jangra, Ravi Shankar; Gupta, Sanjeev; Gupta, Somesh; Dr, Anu (2020-06-01). "Chemical cautery pen". Journal of the American Academy of Dermatology. 82 (6): e193–e194. doi:10.1016/j.jaad.2019.03.032. ISSN 0190-9622. PMID 31653459.
  16. ↑ Toner, J. G.; Walby, A. P. (1990). "Comparison of electro and chemical cautery in the treatment of anterior epistaxis". The Journal of Laryngology and Otology. 104 (8): 617–618. doi:10.1017/s0022215100113398. ISSN 0022-2151. PMID 2230555.
  17. ↑ Ho, Chuong; Argáez, Charlene (2018). Topical Silver Nitrate for the Management of Hemostasis: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines. CADTH Rapid Response Reports. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health. PMID 30817105.
  18. ↑ Satpute, Satish S.; Joshi, Samir V.; Arora, Ripudaman; Prabha, Neel; Keche, Prashant; Nagarkar, Nitin M. (2020). "Cryosurgery Vs Trichloroacetic Acid Chemical Cautery for the Treatment of Hypertrophied Nasal Turbinate: A Comparative Study". Iranian Journal of Otorhinolaryngology. 32 (112): 303–309. doi:10.22038/ijorl.2019.39039.2293. ISSN 2251-7251. PMC 7515624. PMID 33014907.
  19. ↑ Lipke, Michelle M. (2006). "An Armamentarium of Wart Treatments". Clinical Medicine and Research. 4 (4): 273–293. doi:10.3121/cmr.4.4.273. ISSN 1539-4182. PMC 1764803. PMID 17210977.
  20. ↑ Recanati, Maurice A.; Kramer, Katherine J.; Maggio, John J.; Chao, Conrad R. (2018). "Cantharidin is Superior to Trichloroacetic Acid for the Treatment of Non-mucosal Genital Warts: A Pilot Randomized Controlled Trial". Clinical and Experimental Obstetrics & Gynecology. 45 (3): 383–386. doi:10.12891/ceog4112.2018. ISSN 0390-6663. PMC 6075835. PMID 30078935.
  21. ↑ "3.08 Epistaxis (Nosebleed)". ncemi.org. Archived from the original on 2014-09-04. Retrieved 2014-11-11.
  22. ↑ Houser, Steven M. (2007-09-01). "Surgical Treatment for Empty Nose Syndrome". Archives of Otolaryngology–Head & Neck Surgery. 133 (9): 858–863. doi:10.1001/archotol.133.9.858. ISSN 0886-4470. PMID 17875850. Although total turbinate excision is most frequently the cause of ENS, lesser procedures (eg, submucosal cautery, submucosal resection, cryosurgery) to reduce the turbinates may cause problems as well if performed in an overly aggressive manner.
  23. ↑ "FFAAIR | Syndrome du Nez Vide (SNV)". www.ffaair.org (in French). Retrieved 2019-09-11. à la suite d’interventions endonasales diverses (turbinectomie, turbinoplastie, cautérisation…
  24. ↑ Saafan. "Empty nose syndrome: etiopathogenesis and management". www.ejo.eg.net. Retrieved 2019-09-11. ENS is a complication of middle and/or inferior turbinate surgery, most frequently total turbinate excision, but also with minor procedures such as submucosal cautery, submucosal resection, laser therapy, and cryosurgery if performed in an aggressive manner
  25. ↑ "Amputations Continue in Iranian Prisons".
  26. ↑ College of Physicians and Surgeons of Manitoba. Neonatal Circumcision. Winnipeg: College of Physicians and Surgeons of Manitoba, 1997.
  27. ↑ "Family Is Awarded $850,000 For Circumcision Accident" The New York Times, New York, USA, Published November 2, 1975
  28. ↑ "David Reimer, 38, Subject of the John/Joan Case" The New York Times, New York, USA, Published May 12, 2004
  29. ↑ Charles Seabrook. $22.8 million in botched circumcision. Atlanta Constitution, Tuesday, March 12, 1991.
  30. ↑ Schmidt, William E (October 8, 1985). "A Circumcision Method Draws New Concern". The New York Times.
  31. ↑ Vincent Lupo. Family gets $2.75 million in wrongful surgery suit. Lake Charles American Press, Wednesday, May 28, 1986.
  32. ↑ 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.
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