Cauterization is a medical procedure that involves the application of either chemicals or electricity to destroy tissues. The use of cautery is not routine in wound care but might be considered in certain situations. Some of the reasons that cautery might be indicated are to destroy granulation tissue, achieve homeostasis by stopping bleeding, and remove tissue growths or warts. It is a routine procedure for the management of some dermatological conditions and anterior epistaxis. 

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What Is Chemical Cauterization?

Chemical cauterization is a technique that involves the local application of a chemical agent to the tissue or a wound. The chemical agent then achieves homeostasis by destroying the bleeding point at the site. Hence chemical cauterization is often used in the management of epistaxis or nose bleeds. 

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Silver nitrate is a popular agent used for chemical cauterization. It serves as a cauterization agent by delivering free silver ions to the tissue, which later form an eschar and destroy the blood vessels. It can be applied to the tissue as a topical agent and is available in the form of a solution or an applicator stick. Other agents that can be used for cautery include trichloroacetic acid and cantharidin. However, one thing that wound care specialists and podiatrists should keep in mind when using chemical cauterization for wounds is that the agents are not limited to the site of application and might also affect healthy tissue.

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Chemical Cauterization Technique In Wound Care

The role of chemical cauterization in wound care is limited and is only indicated for short-term topical use. Some indications for chemical cauterization in wound care include removal of hypergranulation tissue, homeostasis, and wound edge closure. Before using chemical cauterization, the wound should be carefully assessed and evaluated by a wound care specialist or podiatrist. The wound dressing should be removed and the site should be cleansed with saline or another suitable wound cleanser. Agents such as silver nitrate can be quite painful and patients might require additional analgesia or local anesthetic application before the procedure. 

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The silver nitrate applicator is a wooden stick with 75% silver nitrate and 25% potassium nitrate at its tip. For silver nitrate to carry out its clotting action, it needs to be activated either by application of sterile water or moisture naturally present in the wound bed. After activation, the stick should be applied to the wound site in a rolling fashion till the site turns grayish. Care should be taken to avoid contact with normal, healthy tissue. As the duration of the application determines the cautery effect, some gentle pressure might be needed for better results. Generally, an application time of 2 minutes is considered sufficient. 

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The patient should be carefully monitored during the procedure and if the burning sensation is uncomfortable for the patient, the procedure should be stopped. At the end of the procedure, the wound site should be cleansed with gauze. The frequency of chemical cautery for a particular wound depends on the treatment needs. If the goal is to achieve homeostasis, a one-time application of silver nitrate would be enough. However, the removal of hypergranulation tissue might require additional applications of silver nitrate two to three times a day for up to 14 days. 

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Indications

Indications for the use of chemical cauterization in wound care include:

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• Homeostasis 
• Removal of hypergranulation tissue associated with wounds, skin graft sites, feeding tubes, stomas
• Wound epibole

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Considerations And Precautions 

Chemical cauterization can be an effective technique to achieve homeostasis and granulation tissue removal from the wound bed. While using silver nitrate for chemical cauterization, the following considerations should be kept in mind:

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• As silver nitrate is caustic to the skin, the operator should use nitrile gloves while carrying out the procedure. Silver nitrate is also corrosive to clothing; therefore, the healthcare provider should ensure adequate personal protection.
• If there is a sufficient amount of exudate or moisture in the wound, a dry silver nitrate stick can be directly applied. However, for a wound with minimal exudate, activation with sterile water would be needed.
• The area to be cauterized should be identified and protected by a petroleum jelly barrier.
• There is a risk of spillage to the surrounding skin and healthy tissue with harmful consequences. The damage to the surrounding healthy tissue or skin can result in scarring and pigmentation.
• Due to the imprecise nature of chemical cauterization, laser or electrical cauterization might be preferable.
• Patients should be educated about the self-care of their wounds after cauterization. They should be advised not to pick on their wound and should ensure that the site remains dry for at least 48 hrs.
• For the treatment of hypergranulation tissue, silver nitrate is considered an advanced treatment. It should only be used if all other options have failed to produce the desired results. 
• Patients should be screened for allergy to silver nitrate before the procedure. If any other chemical agent is used for cauterization, similar screening questions for allergies should be asked.

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