Cautery Basics

A question hit my inbox recently regarding cautery.

If you’ve never heard the term before, cautery (aka cauterization) means the intentional burning or scarring of tissue as a means to:

  1. Stop blood loss and seal blood vessels
  2. Sever tissue (for instance during a female sterilization procedure where the tubes allowing the egg to travel to the uterus are severed with electrocautery)
  3. To remove growths (like moles, warts, etc.)

Basically, the purpose of cautery is to destroy tissue. The burns produced are typically second degree (blisters), but if handled clumsily can easily become third degree burns that go clear through the skin.

Surgical cautery is often used in modern settings to seal a single stubborn blood vessel, to carefully pare off or to destroy unwanted tissue as in the case of cancerous cells, moles, or lesions caused by viruses, or to surgically separate tissues with minimal blood loss. The two types of cautery used for modern surgical intervention include electrocautery which uses an electrical instrument (see photo) to generate the burns or chemical cautery which involves the application of acids, freezing chemicals, or other chemical substances that produce a chemical or frost burn.

The old fashioned form of cautery was a little… less refined. A (typically iron) implement was heated to glowing red hot and pressed against or into an open wound, typically deeper wounds like arrow or bullet hole. In most cases, the person would have been better served to apply pressure to stop bleeding and then keep the wound clean with boiled water.

The other historical use for cautery is to seal a field amputation. Amputation is the removal of a whole or partial limb, typically arms, legs, feet, or toes (or more rarely, castration). Prior to modern micro-surgical technique (and especially in battle-field situations where time was limited and patient numbers were overwhelming) amputations were performed by applying a tourniquet above the cut line to prevent massive bleeding, cutting through the tissue to the bone, sawing through the bone, and cutting through the remaining tissue. As you can imagine, this was a very blood procedure. The risks of infection were astronomical, but the risks of bleeding to death when the tourniquet was removed were even higher. Rather than allow their patients to die from blood loss, field surgeons performed cautery to seal the end of the amputation. Keep in mind this was also before the use of anesthesia became widespread. Ye-ouch!

So when is cautery appropriate?

Basically the only times when cautery is really a good idea* is when you’re in a well controlled situation (operating room, hospital ER) or when the risks of not performing cautery outweigh the huge risks of second and third degree burns.

There are a few other instances when a writer might consider the benefits of cautery, though. Historically cautery has been used to brand people (as tribal markings, disfigurement, self-mutilation, or marks of ownership in cases of slavery), as a torture method, or as a means of obscuring distinguishing features (birthmark, scars).

What is cautery like?

The first thing the people who aren’t the one being cauterized will probably notice is the smell. If you’ve never smelled burning human flesh (and often hair)… well, let’s just say you don’t forget it. There will be a small amount of smoke if the cautery involves heat, and possible a chemical smell if a chemical cauterization agent is used.

The person getting this treatment will probably not notice much other than the burning AGONY OH MY GOD THE GOGGLES, THEY DO NOTHING! Screaming. Lots of screaming.

Aftercare

After the fact, treatment consists of keeping it clean (preferably with water boiled for 20 minutes or so), keeping it covered with a clean dressing, and try not to use it more than necessary so the tissue can heal. Don’t poke it or pick at it. Watch for signs of infection – spreading redness, pus, blackening tissue that sloughs off, foul odors.

One small caveat – I noticed that the Wikipedia page lists prevention of infection as one of the reasons for cautery, which always kind of struck me as dumb, considering the fact that you are basically scalding the skin and creating an ideal environment (moist, warm, full of the food of dying tissue) for bacteria to grow. Turns out that cautery done in the old days caused as much infection as it prevented (if not more), so I did not include that in my list of reasons why, though it has reportedly been one of the justifications for this procedure. (edit: I actually submitted a correction to the Wikipedia page, with reference and the page now lists prevention of infection as a historical rational that has no modern day merit)

*Which is not to say that characters can’t have good intentions and still do something incredibly stupid *evil grin*

About arizela

I’m a NICU nurse and lactation counselor, currently on hiatus to pursue a PhD in nursing which focuses on the development of health across the lifespan. I write books, articles, and blogs in between my duties as mom, wife, and student. I own a tool belt, and I’m not afraid to use it.

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11 Responses to Cautery Basics

  1. Eek! And ick. I read an article about the enormous numbers of amputations during the Civil War (and probably every previous war), with only a quick mention of cauterization – as if it were a minor part of the operation. Though with luck the victim had passed out by then …

    • Otterkit says:

      Oh, now finally I get a straight answer! I’m a comic artist, and I’m doing a scene where a man’s deeply wounded out in the middle of nowhere, and his friend cauterizes the wound to stop the bleeding. I knew it was a bad idea, but also a very common one for the time. I loved what you wrote here, it helped me think things through a lot better. It did, however, bring up two questions that you could perhaps answer for me.
      1) maybe a dumb question, but why do humans pass out under pain?
      2) what would be the effects of a wound like this on the victim? How long would such a wound need care before it was out of danger of infection?
      Thanks!

      • arizela says:

        Hi, Otterkit. The site is officially closed due to the author being completely out of time, but you caught me in a moment when I needed a break from studying. Lucky you! I’ll give you my best answers, but remember that when you’re talking about human beings, all the answers are relative to the individual and different people heal at different rates and tolerate different things.

        1) That depends on who you ask and what kind of pain. There are a couple different mechanisms involved. Psychosomatic (real, physical symptoms generated by the mind) reactions can happen in an effort of the mind to shield itself from the experience of pain, whether the pain is physical or emotional. Physiologically, (and more commonly) stimulation of the Vagus nerve, which is responsible for sensing the state of the body and slowing down the heart, can cause fainting. Basically what happens is the Vagus nerve senses something is WRONG. It gets overwhelmed and slows the heart rate down too much. The heart slowing down causes the blood pressure to drop, which means the brain isn’t getting the juice it needs to run. The brain flips off the lights in order to get your body horizontal, because then the pressure doesn’t have to be as high to get the blood where it needs to go. This is more likely to happen if there’s also bleeding involved (because the blood pressure is even lower). Even a small amount of bleeding can cause the psychosomatic reaction in individuals who are sensitive to that sort of thing, so it’s hard to tell which mechanism causes the actual fainting.

        2) That question is impossible to answer without a lot more information. “Deeply wounded” is pretty vague. Are we talking penetrating body wounds? A big, shallow cut? Are there arteries involved? Is there adequate circulation to the wound to promote healing afterwards? How much of the body surface is burned in the attempt to cauterize the wound? Basically you’ll want to keep in mind that scar tissue (not just a scab, but actual tissue) takes about 21 days to form, so if the wound is big enough that it has to fill up with scar tissue (burns usually are), then it’s going to take up to 3 weeks to heal enough to not be at risk of infection. Much longer if the person is malnurished, sickly, elderly, or in other ways not in ideal condition. On the other hand, if the wound is irritated or traumatized further by whatever mad cap things the character is forced to do for the story, it could take much longer to heal. Take a look around the site. There are a number of other articles on infected wounds and various types of injuries that might help you out.

        Good luck!
        Arizela

  2. Ev Bishop says:

    I came across your blog through google (My search: “Are amputations still cauterized?”), and I’m so glad to have discovered you.

    Your reason for writing (“This blog is written for the purpose of informing writers for realism in fiction”) is exactly why I’m here. I’ll definitely be back and can’t wait to peruse your site in more detail.

    Thanks and happy writing!

  3. Yobby says:

    Thanks – very interesting – just watched a movie where a character gets a wound cauterized & remember seeing this done in other movies so googled it & came across your site – very informative

  4. Kai says:

    Hopefully I’m not too late to the party. ._.

    I am well aware that cauterizing wounds usually does more harm than good. It increases the risk of infection and doesn’t even work a lot of the time. BUT Tina doesn’t know all that. She’s a firekin, so she can heat up her pinkie red-hot and trace it along the edge of a wound, and that was the first solution that popped into her head.

    Her best friend Gianni is injured. He’s a healer, but he’s currently drifting in and out of consciousness, so he can’t tell her how to treat his wounds. Her school gave a brief lecture on cautery when she was a kid, so she figures her only option is to use her power to (try to) help. I know cautery isn’t the best solution, so that’s why I wanna know how it would REALLY affect these wounds.

    1: 2 inch long cut across right jaw down to the bone.

    2: Stab wound in left shoulder, about 2 inches deep and 1 1/2 inches in diameter.

    3: A an upside-down U-shaped 8 inch long gash on his right bicep. The flap of skin is hanging down and exposing muscle.

    4: A similar wound on his left inner thigh, but it’s a regular U-shape, not upside-down. I think these would be considered avulsions.

    5: A stab wound 2 inches above his right knee (the guy was trying to get at his groin but kept missing) about as big as the stab wound in his shoulder.

    6: An 8 inch long horizontal gash on the left side of his lower abdomen. About half an inch deep.

    Like I said, I know cautery isn’t the best idea, but Tina doesn’t know that. If it would seal a particular wound, that’s what I’ll have happen. If it won’t work, and the blood will just keep coming, she’ll freak out and try to find another solution. Luckily, Gianni is an elf, so I have a bit of leeway on how much crap he can survive.

    • arizela says:

      Hi there, Kai.

      The one to the bone won’t do much, because bones are actually porous so they can get blood to the living cells within them. The stab wounds into muscle will probably seal up, but may end up causing permanent damage to the muscle and weakening other structures. The ones with flaps of skin aren’t going to do much unless she actually trims off the skin and seals the rest of the wound. The gash across the abdomen is going to be the trickiest beast in this scenario. Abdominal wounds are always quite risky to treat in any fashion like this, because there’s always the risk that the abdominal cavity was perforated. If that’s the case, bad, bad things are waiting for this character if he can’t wake up enough to heal himself soon. (Infection called peritonitis which is incredibly painful and often fatal). If not, then she’s as likely to melt the subcutaneous tissue (layer of fat under the skin) as to seal the wound. And in all cases, she’s going to cause some significant burns which are going to be a lot harder to deal with than the stitches that he’d need without her help.

      Good luck to you and your trauma victim!

      • Kai says:

        What she can’t cauterize, she’ll try cauterizing again. And when that doesn’t work, she’ll sloppily try to stitch the wounds. He can’t heal himself, only others, but he knows how to treat infections and whatnot.

        Thank you, and good for you on pursuing your education! 🙂

  5. Mirel says:

    I was referred here by someone in a Nanowrimo forum. Very helpful, thank you so much for providing the information! Still not sure whether to have my MC use this process or have her try something else, but you’ve given me plenty to chew over…

  6. tarjetas de boda personalizadas says:

    Incredible! This blog looks exactly like my old one! It’s on a
    entirely different topic but it has pretty much the same layout and design. Wonderful choice of colors!

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