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Cauterization is a medical term describing the burning of the body to remove or close a part of it. The main forms of cauterization used today are electrocautery and chemical cautery. Cautery can also mean the branding of a human, either recreational or forced. Accidental burns can be considered cauterization as well.
Cauterization in the Past The verb to cauterize; known in English since 1541; from Medieval French cauteriser; from Late Latin cauterizare "to burn or brand with a hot iron"; itself from Greek kauteriazein; from kauter "burning or branding iron"; from kaiein "to burn." Cauterization was used to stop heavy bleeding, especially during amputations. 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. The downside was extensive tissue damage. Later special medical instruments called cauters were used to cauterize arteries. Ambroise Paré introduced the technique of ligature of the arteries in lieu of cauterization. Electrocautery Electrocauterization ( also called electric surgery) is the process of destroying tissue with electricity and is a widely used technique in modern surgery. The procedure is frequently used to stop bleeding of small vessels (larger vessels being ligated) or for cutting through soft tissue i.e. abdominal fat in a laparotomy or breast tissue in a mastectomy. Monopolar vs Bipolar Two kinds of electrocautery are used, unipolar and bipolar (aka. monothermy and diathermy, respectively). Both involve high frequency alternating current and a pair of electrodes, one called active and the other returning. The difference lies in the placement of these electrodes: Frequency But how is the patient kept from being electrocuted? The secret lies in the frequency of the alternating current. Normal "house-current" AC runs at 50-60 Hz and is quite lethal, for at every alteration nerves and muscles get stimulated, causing violent cramps 60 times a second. But because nerve and muscle stimulation ceases at 100,000 Hz (alterations simply become too fast for the cells to pick up) electrosurgery can be performed safely at “radio” frequencies above 100 kHz. Cutting vs. Coagulation Different cauterizing effects can be achieved by changing the voltage of the current as well as the pattern of electric pulses. When lower voltage is used with a continuous AC current, heat is produced very fast and tissue is completely vaporized at the tip of the probe. The effect is dubbed "cutting". When a higher voltage current is used in a pulsed manner, heat is produced more slowly, tissue damage is more widspread (a few mm from the probe) and blood coagulates. Hence this mode is called "coagulation" mode. Probes The cautery probes are shaped in a variety of ways depending on their purpose. A common monopolar probe is penshaped but ending in a small slender spatula, roughly 5 mm X 30 mm. The shape is reminiscent of a scalpel. This can serve both as a coagulator and as an electric scalpel. The typical bipolar probe resembles a pair of tweezers, which are used to grab a hold of a small piece of tissue and cauterize it. Variants of these probes are used both in open surgery and in modern minimally invasive surgery. The surgeon operates the probe either by pushing a button on the shaft of probe itself or by using a footpedal. Alternate Burnsites When using monopolar electrocautery it is important that the grounding pad be the only way by which the current passes through the body. Electricity always follows the path of least resistance, and if that is via some ground-connected piece of metal touching the patient by chance, a burn might result there as well as at the tip of the cautery probe. Thus great care must be taken that the patient be insulated from the ground and that the large grounding pad be thoroughly attached to the patient. Chemical cautery Many chemical reactions can destroy tissue and some are used routinely in medicine, most commonly for the removal of small skin lesions (i.e. warts or necrotized tissue) or hemostasis. Some cauterizing agents are: Nasal Cauterization If a person has been having frequent nose bleeds, it is most likely caused by an exposed blood vessel in their nose. Even if the nose is not bleeding at the time, it is cauterized to prevent future bleeding. The different methods of cauterization include burning the affected area with acid, hot metal, lasers, or silver nitrate. People often find such a procedure painful. Sometimes liquid nitrogen is used as a less painful alternative, though it is less effective. In the few countries that permit the use of cocaine for medicinal purposes, it is occasionally used topically to make this procedure less uncomfortable, cocaine being the only local anesthetic which also produces vasoconstriction, making it ideal for controlling nosebleeds. | ||||||||
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