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Overview of Electrocautery

Transmission of infection

Electrocautery, also known as thermal cautery, refers to a process in which a direct or alternating current is passed through a resistant metal wire electrode, generating heat. The heated electrode is then applied to living tissue to achieve hemostasis or varying degrees of tissue destruction. Electrocautery can be used in various minor surgical procedures in dermatology, ophthalmology, otolaryngology, plastic surgery and urology.

Indications

Electrocautery is a safe and effective method of hemostasis during cutaneous surgery. It is also useful in the treatment of various small benign skin lesions, although only lesions that do not require histological review should be treated with electrocautery.
Electrocautery shares many indications with electrosurgery and is of particular importance in patients who have implanted electrical devices in whom external electromagnetic interference should be avoided. Furthermore, unlike electrosurgical instruments, electrocautery devices maintain function in a wet field.
Low temperatures can be used for superficial tissue destruction in the treatment of superficial and relatively avascular lesions, including the following:

Burns

There is a risk of fire or explosion if flammable materials are in close proximity to the treatment site.
Alcohol, oxygen and bowel gas are all highly flammable. Alcohol cleansers should be avoided; if they are used, they should be allowed to dry completely. If the patient uses a portable oxygen generator, it should be stopped briefly for the procedure. Eschar buildup should be removed from the surgical electrode to avoid sparking or flaming.

Transmission of infection

The same principles of infection transmission apply to both electrosurgery and electrocautery. The 3 potential modes for infection transmission in these procedures include the treatment electrode, surgical smoke and aerosolized blood microdroplets. Experimental studies involving animal skin have shown transmission of hepatitis B virus, human papillomavirus (HPV) and Staphylococcus aureus from an inoculated site to an uninfected site by means of the contaminated electrodesiccation electrode.
During electrosurgical procedures, aerosolized blood droplets can be propelled a distance of up to 30 cm and can be infectious if inhaled. Surgical smoke can also contain viable viruses and bacteria, in addition to hazardous chemicals and carcinogens. The viable HPV virus has been identified in the vapor of warts being treated with electrocoagulation.
To prevent the risks of infection transmission, a smoke-evacuating system should be used, along with facial masks, protective eyewear and surgical gloves. Disposable or sterilized electrodes should be used.

Outcomes

Electrocautery is a safe and effective method of treatment for benign cutaneous lesions and hemostasis for surgical patients.

Studies have also shown that thermal cautery occlusion in vasectomies is more effective than clipping and excision of a segment of the vas.

Furthermore, surgical lacrimal punctual occlusion for dry eyes using a thermal cautery device is associated with low recanalization rates, higher visual acuity and overall greater subjective improvement in symptoms.

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