Cauterization (or cauterisation, or cautery) is a medical practice or technique of
burning
Combustion, or burning, is a high-temperature exothermic redox chemical reaction between a fuel (the reductant) and an oxidant, usually atmospheric oxygen, that produces oxidized, often gaseous products, in a mixture termed as smoke. Combusti ...
a part of a body to remove or close off a part of it. It destroys some tissue in an attempt to mitigate
bleeding
Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...
and damage, remove an undesired growth, or minimize other potential medical harm, such as
infection
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
s when
antibiotic
An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention of ...
s 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:
*To prevent
exsanguination
Exsanguination is death caused by loss of blood. Depending upon the health of the individual, people usually die from losing half to two-thirds of their blood; a loss of roughly one-third of the blood volume is considered very serious. Even a sing ...
*To close
amputation
Amputation is the removal of a limb by trauma, medical illness, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on indi ...
s
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. Actual cautery refers to the metal device, generally heated to a dull red glow, that a physician applies to produce
blisters
A blister is a small pocket of body fluid (lymph
Lymph (from Latin, , meaning "water") is the fluid that flows through the lymphatic system, a system composed of lymph vessels (channels) and intervening lymph nodes whose function, like the ...
, to stop
bleeding
Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...
of a
blood vessel
The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide away ...
, and for other similar purposes.
[, page 16.]
The main forms of cauterization used today are electrocautery and chemical cautery—both are, for example, prevalent in cosmetic removal of
wart
Warts are typically small, rough, hard growths that are similar in color to the rest of the skin. They typically do not result in other symptoms, except when on the bottom of the feet, where they may be painful. While they usually occur on the ...
s and stopping
nosebleed
A nosebleed, also known as epistaxis, is bleeding from the nose. Blood can flow down into the stomach, and cause nausea and vomiting. In more severe cases, blood may come out of both nostrils. Rarely, bleeding may be so significant that low bloo ...
s. Cautery can also mean the
branding of a human.
Etymology
Cauterize is a
Middle English
Middle English (abbreviated to ME) is a form of the English language that was spoken after the Norman conquest of 1066, until the late 15th century. The English language underwent distinct variations and developments following the Old English p ...
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).
History
Cauterization has been used to stop heavy bleeding since antiquity. The process was described in the
Edwin Smith Papyrus and
Hippocratic Corpus
The Hippocratic Corpus (Latin: ''Corpus Hippocraticum''), or Hippocratic Collection, is a collection of around 60 early Ancient Greek medical works strongly associated with the physician Hippocrates and his teachings. The Hippocratic Corpus cove ...
. It was primarily used to control hemorrhages, especially those resulting from surgery, in
ancient Greece
Ancient Greece ( el, Ἑλλάς, Hellás) was a northeastern Mediterranean civilization, existing from the Greek Dark Ages of the 12th–9th centuries BC to the end of classical antiquity ( AD 600), that comprised a loose collection of cult ...
.
Archigenes
Archigenes ( gr, Αρχιγένης), an ancient Greco-Syrian physician, who lived in the 1st and 2nd centuries AD.
Archigenes was the most celebrated of the sect of the Eclectici, and was a native of Apamea in Syria; he practiced at Rome in the ...
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
The Indigenous peoples of the Americas are the inhabitants of the Americas before the arrival of the European settlers in the 15th century, and the ethnic groups who now identify themselves with those peoples.
Many Indigenous peoples of the A ...
, ancient
Arabs
The Arabs (singular: Arab; singular ar, عَرَبِيٌّ, DIN 31635: , , plural ar, عَرَب, DIN 31635, DIN 31635: , Arabic pronunciation: ), also known as the Arab people, are an ethnic group mainly inhabiting the Arab world in Wester ...
, 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
A lye is a metal hydroxide traditionally obtained by leaching wood ashes, or a strong alkali which is highly soluble in water producing caustic basic solutions. "Lye" most commonly refers to sodium hydroxide (NaOH), but historically has been u ...
.
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
Muslim world
The terms Muslim world and Islamic world commonly refer to the Islamic community, which is also known as the Ummah. This consists of all those who adhere to the religious beliefs and laws of Islam or to societies in which Islam is practiced. I ...
, scholars
Al-Zahrawi
Abū al-Qāsim Khalaf ibn al-'Abbās al-Zahrāwī al-Ansari ( ar, أبو القاسم خلف بن العباس الزهراوي; 936–1013), popularly known as al-Zahrawi (), Latinised as Albucasis (from Arabic ''Abū al-Qāsim''), was ...
and Avicenna wrote about techniques and instruments used for cauterization.
The technique of
ligature
Ligature may refer to:
* Ligature (medicine), a piece of suture used to shut off a blood vessel or other anatomical structure
** Ligature (orthodontic), used in dentistry
* Ligature (music), an element of musical notation used especially in the me ...
of the arteries as an alternative to cauterization was later improved and used more effectively by
Ambroise Paré
Ambroise Paré (c. 1510 – 20 December 1590) was a French barber surgeon who served in that role for kings Henry II, Francis II, Charles IX and Henry III. He is considered one of the fathers of surgery and modern forensic pathology and a p ...
.
Electrocautery
Electrocauterization is the process of destroying tissue (or cutting through soft tissue) using
heat conduction
Conduction is the process by which heat is transferred from the hotter end to the colder end of an object. The ability of the object to conduct heat is known as its ''thermal conductivity'', and is denoted .
Heat spontaneously flows along a te ...
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
In electronics, acoustics, and related fields, the waveform of a signal is the shape of its graph as a function of time, independent of its time and magnitude scales and of any displacement in time.David Crecraft, David Gorham, ''Electronic ...
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
Electrodesiccation and curettage (EDC, ED & C, or ED+C) is a medical procedure commonly performed by dermatologists, surgeons and general practitioners for the treatment of basal cell cancers and squamous cell cancers of the skin. It provides de ...
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.
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
Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies fr ...
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
Warts are typically small, rough, hard growths that are similar in color to the rest of the skin. They typically do not result in other symptoms, except when on the bottom of the feet, where they may be painful. While they usually occur on the ...
or necrotized tissue, or for
hemostasis
In biology, hemostasis or haemostasis is a process to prevent and stop bleeding, meaning to keep blood within a damaged blood vessel (the opposite of hemostasis is hemorrhage). It is the first stage of wound healing. This involves coagulation, whi ...
. Because chemicals can leach into areas not intended for cauterization, laser and electrical methods are preferable where practical. Some cauterizing agents are:
*
Silver nitrate
Silver nitrate is an inorganic compound with chemical formula . It is a versatile precursor to many other silver compounds, such as those used in photography. It is far less sensitive to light than the halides. It was once called ''lunar caustic' ...
is the active ingredient of the
lunar caustic
Silver nitrate is an inorganic compound with chemical formula . It is a versatile precursor to many other silver compounds, such as those used in photography. It is far less sensitive to light than the halides. It was once called ''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
Trichloroacetic acid (TCA; TCAA; also known as trichloroethanoic acid) is an analogue of acetic acid in which the three hydrogen atoms of the methyl group have all been replaced by chlorine atoms. Salts and esters of trichloroacetic acid are calle ...
*
Cantharidin
Cantharidin is an odorless, colorless fatty substance of the terpenoid class, which is secreted by many species of blister beetles. It is a burn agent or a poison in large doses, but preparations containing it were historically used as aphrodisiac ...
is an extract of the
blister beetle
Blister beetles are beetles of the family Meloidae, so called for their defensive secretion of a blistering agent, cantharidin. About 7,500 species are known worldwide. Many are conspicuous and some are aposematically colored, announcing their ...
that causes epidermal necrosis and blistering. It is used to treat warts.
Nasal cauterization
Frequent
nosebleed
A nosebleed, also known as epistaxis, is bleeding from the nose. Blood can flow down into the stomach, and cause nausea and vomiting. In more severe cases, blood may come out of both nostrils. Rarely, bleeding may be so significant that low bloo ...
s are most likely caused by an exposed blood vessel in the nose, usually one in
Kiesselbach's plexus
Kiesselbach's plexus is an anastomotic arterial network (plexus) of four or five arteries in the nose supplying the nasal septum. It lies in the anterior inferior part of the septum known as Little's area, Kiesselbach's area, or Kiesselbach's tri ...
.
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
Liquid nitrogen—LN2—is nitrogen in a liquid state at low temperature. Liquid nitrogen has a boiling point of about . It is produced industrially by fractional distillation of liquid air. It is a colorless, low viscosity liquid that is wide ...
as a less painful alternative, though it is less effective. A physician may apply
cocaine
Cocaine (from , from , ultimately from Quechuan languages, Quechua: ''kúka'') is a central nervous system (CNS) stimulant mainly recreational drug use, used recreationally for its euphoria, euphoric effects. It is primarily obtained from t ...
in the few countries that allow it for medical use. Cocaine is the only
local anesthetic
A local anesthetic (LA) is a medication that causes absence of pain sensation. In the context of surgery, a local anesthetic creates an absence of pain in a specific location of the body without a loss of consciousness, as opposed to a general an ...
that also produces
vasoconstriction
Vasoconstriction is the narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels, in particular the large arteries and small arterioles. The process is the opposite of vasodilation, the widening of blood vessel ...
, making it ideal for controlling nosebleeds.
More modern treatment applies
silver nitrate
Silver nitrate is an inorganic compound with chemical formula . It is a versatile precursor to many other silver compounds, such as those used in photography. It is far less sensitive to light than the halides. It was once called ''lunar caustic' ...
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
Empty may refer to:
Music Albums
* ''Empty'' (God Lives Underwater album) or the title song, 1995
* ''Empty'' (Nils Frahm album), 2020
* ''Empty'' (Tait album) or the title song, 2001
Songs
* "Empty" (The Click Five song), 2007
* ...
.
Infant circumcision
Cauterization has been used for the
circumcision
Circumcision is a surgical procedure, procedure that removes the foreskin from the human penis. In the most common form of the operation, the foreskin is extended with forceps, then a circumcision device may be placed, after which the foreskin ...
of infants in the
United States
The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territorie ...
and
Canada
Canada is a country in North America. Its ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, covering over , making it the world's second-largest country by tot ...
. The
College of Physicians and Surgeons of Manitoba The College of Physicians and Surgeons of Manitoba is a regulatory college which acts as a medical oversight body in Manitoba, Canada. Its stated purpose is to "protect the public as consumers of medical care and promote the safe and ethical delive ...
advises against its use in neonatal circumcision. This method of circumcision resulted in several infants having their
penis
A penis (plural ''penises'' or ''penes'' () is the primary sexual organ that male animals use to inseminate females (or hermaphrodites) during copulation. Such organs occur in many animals, both vertebrate and invertebrate, but males do n ...
es severely burned, with at least seven male children being
reassigned as female.
See also
*
Cryosurgery
Cryosurgery is the use of extreme cold in surgery to destroy abnormal or diseased tissue; thus, it is the surgical application of cryoablation. The term comes from the Greek words cryo (κρύο) ("icy cold") and surgery (''cheirourgiki'' – χ ...
*
Diathermy
Diathermy is electrically induced heat or the use of high-frequency electromagnetic currents as a form of physical therapy and in surgical procedures. The earliest observations on the reactions of high-frequency electromagnetic currents upon the ...
*
Singe
References
External links
Valleylab division of Covidien (no longer part of Tyco Healthcare) , explaining the basics of electrosurgery*
{{Authority control
History of hematology
Medical treatments
Surgery