Definition & Overview
The chemical cauterisation of granulation tissue is a medical procedure used to manage wounds or tissue damage. Granulation tissue refers to new connective and vascular tissues that grow on the surface of a wound. Some examples include proud flesh, sinus, or fistula. Chemical cauterisation works by burning the granulation tissue. Doing so helps control bleeding and minimise infections. It also helps promote faster wound healing.
Chemical cauterisation is just one method of cauterisation. As the term implies, it uses a chemical agent to cauterise the tissue. It is different from electrocautery or thermal cautery, which uses heat as the cauterising agent.
Who Should Undergo and Expected Results
There are many reasons why granulation tissue may need to be cauterised. Sometimes the granulation tissue that grows over a wound becomes too thick, causing an overgrowth. In other cases, granulation tissues cause obstruction, such as inflammation within the nasal passages, or form an abnormal tunnel that connects one organ to another.
Thus, chemical cauterisation is beneficial for patients who suffer from hypergranulation or overgranulation. This refers to the overgrowth of proud flesh on the surface of a wound or skin ulcer. It is caused by prolonged stimulation of fibroplasia during the wound healing process. Since the overgrowth of proud flesh can prevent epithelialisation, it also inhibits the healing process. By cauterising the proud flesh hypergranulation, the normal wound healing process can continue.
Chemical cauterisation is also widely used as a non-invasive way to treat various sinus problems, such as sinusitis and rhinitis. The procedure is often used when the condition can no longer be managed with oral or intranasal medications. Patients who suffer from chronic sinus issues can undergo chemical cauterisation 2 to 3 times per year. The treatment can give them long-lasting relief from their symptoms, even when they eliminate other treatment options. This means they do not need to use antihistamines, nasal sprays, and decongestants. This makes chemical cauterisation a more efficient method of dealing with the problem. The procedure also helps prevent future recurrences of the said infections.
Patients who are good candidates for nasal cauterisation are those who experience the following symptoms:
- Sinus infections
- Sinus headaches
- Facial pain
- Nasal congestion and stuffiness
- Ear pressure
- Chronic ear infections
- Trouble tasting food
Chemical cauterisation is also an effective way to get rid of fistulas. A fistula is an abnormal hollow passage that forms between an organ and the surface of the body. It is usually caused by disease, but can also be congenital. One example is an anal fistula, which forms between the end of the bowel and the anal skin. This type of fistula, which is made up of granulation tissue, can be removed with chemical cauterisation.
Chemical cautery offers several unique advantages. These include:
- The level of pain that patients experience during the procedure is very minimal.
- Unlike electrocautery, it does not put the patient at risk of burns.
- It offers a non-invasive alternative to surgery.
- It does not interfere with other medications.
- It has minimal to no side effects.
- It works in majority of patients.
How is the Procedure Performed?
A standard chemical cauterisation procedure typically takes around 30 minutes. The procedure time may be longer for larger wounds, but most patients are able to go back to work on the same day.
During a chemical cauterisation, the following steps are taken:
- The doctor inspects the treatment area, such as the nostrils (for nasal cauterisation).
- A blood test is performed to check for anti-clotting elements and anaemia.
- A local anaesthetic is administered.
- Once the anaesthesia takes effect, the doctor uses a stick coated with a chemical cauterising agent, such as silver nitrate, on the treatment area to burn off the proud flesh, nasal tissue, or fistula.
- The tissue reacts with the agent, causing the blood vessels to melt and fuse together. This stops bleeding and removes excess granulation tissue. It also closes off the normal skin surface to minimise the risk of infection.
- After the procedure, the doctor also applies silver nitrate on the treatment area to prevent future overgrowth of granulation tissue.
For nasal cauterisation, there are additional steps taken. This is because the nasal passageway offers limited space during the treatment. The procedure begins with the administration of intranasal anaesthesia, followed by a vasoconstricting agent that helps reduce congestion. The cauterising agent is then applied twice. After the procedure, the doctor applies medication to soothe the nasal tissues. The treatment should be performed repeatedly to experience long-term benefits.
This procedure works by cleansing the nasal and sinus lining. It protects the said area from germs, pollen, and other irritants.
Possible Risks and Complications
After the procedure, patients are at risk of:
- Allergic reaction to anaesthesia
Blisters and soreness will resolve on their own after a few days without treatment. These risks are fairly minor, making chemical cauterisation of granulation tissue a relatively safe procedure.
Demiral AH, Seyfettin K. “Silver nitrate cauterization for anal fistulas with high blind tract chemical therapy in complicated anal fistulas.” EJOHG. http://www.jaypeejournals.com/eJournals/ShowText.aspx?ID=4680&Type=FREE&TYP=TOP&IN=_eJournals/images/JPLOGO.gif&IID=363&isPDF=YES
Hah JH, Kim BJ, Sung MW, Kwang HK. “Chemocauterisation of congenital fistula from the accessory parotid gland.” Clin Exp Otorhinolaryngol. 2008 Jun; 1(2):113-115. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671793/