Properties of n-butanol and ethanol with gasoline [4].
\r\n\tIt is a relatively simple process and a standard tool in any industry. Because of the versatility of the titration techniques, nearly all aspects of society depend on various forms of titration to analyze key chemical compounds.
\r\n\tThe aims of this book is to provide the reader with an up-to-date coverage of experimental and theoretical aspects related to titration techniques used in environmental, pharmaceutical, biomedical and food sciences.
High strategic risk of dependence on imported energy sources is attracting profoundly alarming concerns as indicated by recent international trend and past experience. Self-sufficient energy supply system is at least needed to maintain a certain minimum living standard in a nation in general and the society in particular so that easy access to domestic and neighboring energy sources is a key factor to maintain. Alcohol fuels are very promising alternative energy sources from this point of view.
\nWorldwide demand for liquid fuels will increase steadily at least through the mid-twenty-first century, but not in the form of CO2-emitting scheme, rather in a renewable and sustainable way. Actually, there had been many options that can use locally plentiful energy resources, typically in a biomass type.
\nThe major energy source nowadays is most certainly (hydrocarbon) gas, electricity, and liquid fuel, which is almost unanimously agreed upon. Current energy infrastructure has already been solidly established with (hydrocarbon-based) gas, electricity, and liquid fuel as convenient energy sources and such energy infrastructure appear to get more and more solidly implemented. Inconvenience related to the utilization of solid fuels is no longer tolerable, and rapid commercialization of electric vehicle is also foreseen in the near future. Liquid fuel gets replaced to the ultra-clean fuel that meets the ever-stringent environmental regulations. Electricity is produced from atomic energy, coal, natural gas, and petroleum oil products, but safety, environmental friendliness, and global warming issues must also be comprehensibly considered. Many Asian countries almost exclusively depend on imported liquid natural gas for energy source. This raises dual issues on the feasibilities of steady supply in energy sources and of reasonably affordable cost. In fact, natural gas that emits 40–55% level of reduced CO2 evolution compared to coal is surely a promising source of energy. Ethanol produced from sugarcane is one of the most carbon-efficient biofuels available globally, with life cycle greenhouse gas emissions around 70% lower than conventional hydrocarbon transport fuels [1]. Current worldwide trend of shifting to alternative clean, sometimes ultra-clean, gas/liquid fuel from more conventional liquid fuel of gasoline/light oil necessitated a new definition of role and position of alcohol fuels in the emerging picture.
\nAlcohol fuels were originally regarded as an alternative energy sources for petroleum oil to realize energy independence during oil crisis of the 1970s. A brief look into the history of bio-ethanol shows Ford Motor Company’s development of ethanol-fueled car in 1899, which was terminated by low-priced gasoline then. Oil crisis of the 1970s revived similar interest in the form of gasohol by mixing ethanol, which was developed and commercialized mainly in Brazil.
\nThe first starting point on alcohol fuels in the 1970s tells the basic background at that time. It is prompted by concerns about reliance on foreign sources of oil and a desire to support domestic agriculture. In the United States, in particular, E10 gasohol was implemented during the oil crisis of 1970s to reduce petroleum oil dependence and simultaneously to utilize surplus farm crops. At present, E15 product with 15% ethanol content is distributed for consumer market.
\nIn the twenty-first century, alcohol fuels are again becoming a frequent keyword for clean fuel utilization in connection with mitigation of climate change and clean fuel technology suitable for less-used local energy sources. As a matter of fact, demand for alcohol fuels is mainly derived from socioeconomic and political motivations rather than from consumer conscious reasons and economic viability.
\nThe centralized energy system that emphasizes cost-effectiveness had diminished the key driving force for technological advances in alcohol fuels. Petroleum-based liquid fuel has dominated the transportation area till now. Also, low petroleum oil cost lessened the motivation for further technology development for alcohol fuels. Global oil shock of the 1970s are not expected to break out again within the foreseeable future, and the prospect for alcohol fuel as a remedy to soaring petroleum price is not a plausible picture either. On the other hand, clean energy generation policy by utilization of locally acquired biomass or sea algae will be emphasized to replace local consumption of liquid fuel and to produce electricity or pure alcohols for fuel cells or other means, as a rather cleaner way.
\nFor the future energy sources, renewable-based energy society must be the final goal to reach, but unfortunately it takes a long time to reach the economics and technological easiness to be a common practice, which appears to take at least one or two decades. In order to bring the technology in earlier time, there exist many hurdles and require efforts in scientific and societal side.
\nAll in all, future energy generation direction had been solidly established as “to be clean, renewable, and sustainable,” but low petroleum cost lessened the necessity of alternative clean energy source development, e.g., alcohol fuels.
\nRecently, global warming is becoming a central social issue attracting worldwide attention and provides a kind of consensus that society should be changed to deal with alleviating the prime causes of CO2 evolution in addition to pollution-related issues such as fine dust. The utilization of alcohol fuels reduces carbon dioxide contents in the atmosphere, thus significantly alleviating global warming potential.
\nAlcohol fuels have been known as a good replacement of fossil-based liquid fuels [2]. Brazil and the United States consume alcohol fuels in the most significant proportions, and such trend will not easily change. In particular, bio-ethanol are well known for its use in Brazil as a gasoline supplement (Figure 1).
\nWorldwide ethanol production by country and year 2007–2015 [3].
When we say alcohol fuels, they comprise of methanol, ethanol, ethers (MTBE, ETBE, TAME, TAEE, and DME and DEE), and esters (biodiesels: methyl and ethyl esters of fatty acids derived from vegetable oils and animal fat), in a broad sense. Most widely used alcohol fuels typically include methanol, ethanol, and bio-butanol. Ethanol that is produced through yeast-based fermentation using corn or sugarcane is the most well-known. Bio-butanol is capable of overcoming technological limitations surrounding bio-ethanol, and it is currently becoming another promising focal issue of clean energy.
\nThe chapter deals with the current status of alcohol fuels and tries to elaborate the future direction for more wider utilization and the possible roles of alcohol fuels in attaining the far-reaching goal of low-carbon economy using sustainable energy resources.
\nAlcohols and ethers can replace gasoline and oil. Table 1 exhibits properties of n-butanol, ethanol, and gasoline for comparison. In Table 1, RON, MON, and RVP values for butanol and ethanol are meant for gasoline blend fuels.
\nItem | \nn-Butanol | \nEthanol | \nGasoline | \n
---|---|---|---|
Specific gravity @ 60°F | \n0.814 | \n0.794 | \n0.720–0.775 | \n
Heating value, MJ/L | \n26.9–27.0 | \n21.1–21.7 | \n32.2–32.9 | \n
Research octane number (RON) | \n94 | \n106–130 | \n95 | \n
Motor octane number (MON) | \n80–81 | \n89–103 | \n85 | \n
Reid vapor pressure (RVP) of 5 and 10% Alcohol/gasoline blends, psi | \n6.4/6.4 | \n31/20 | \n<7.8/15 (summer/winter) | \n
Oxygen, wt% | \n21.6 | \n34.7 | \n<2.7 | \n
Water solubility at 25°C, % | \n9.1 | \n100.0 | \n<0.01 | \n
Properties of n-butanol and ethanol with gasoline [4].
\nTable 2 contains a more wide range of properties of alcohols and ethers compared to gasoline and fusel oil. Fusel oil or fusel alcohol is defined as a mixture of several alcohols produced as a by-product of alcoholic fermentation.
\nItem\\fuel | \nGasoline | \nButanol | \nMethanol | \nEthanol | \nMTBE | \nDME | \nFusel oil | \n
---|---|---|---|---|---|---|---|
Chemical formula | \nC5–10H12–22\n | \nC4H10O | \nCH3OH | \nC2H5OH | \nC5H12O | \nCH3-O-CH3\n | \nC5H12O | \n
Molecular weight | \n106.22 | \n74.12 | \n32.04 | \n46.7 | \n88.15 | \n46.07 | \n76.42 | \n
Carbon, mass% | \n87.5 | \n64.91 | \n37.5 | \n52.2 | \n66.1 | \n52.2 | \n54.8 | \n
Hydrogen, mass% | \n12.5 | \n13.49 | \n— | \n34.7 | \n13.7 | \n13 | \n15 | \n
Oxygen, mass% | \n0 | \n21.6 | \n49.93 | \n34.7 | \n18.2 | \n34.8 | \n30.32 | \n
Density, g/ml | \n0.737 | \n0.810 | \n0.792 | \n0.785 | \n0.74 | \n0.661 | \n0.847 | \n
Boiling temperature, °C | \n27–225 | \n117.25 | \n78 | \n78.25 | \n52.2 | \n−25.1 | \n53.4–54.4 | \n
Reid vapor pressure, Kpa | \n53–60 | \n18.6 | \n32.4 | \n17 | \n54.47 | \n— | \n— | \n
Research octane no. | \n90–100 | \n98 | \n108.7 | \n108.6–110 | \n118 | \n— | \n106.85 | \n
Motor octane no. | \n82–90 | \n78 | \n86.6 | \n92 | \n102 | \n— | \n103.72 | \n
Low heating value, MJ/kg | \n44.0 | \n33.2 | \n20.1 | \n26.9 | \n34.9 | \n28.8 | \n29.536 | \n
Freezing point, °C | \n−40 | \n— | \n−97.5 | \n−114 | \n−108 | \n— | \n−52 | \n
Viscosity, mm2/s | \n0.5–0.6 | \n— | \n0.596 | \n1.2–1.5 | \n0.35 | \n— | \n0.61 | \n
Flash point, °C | \n−45 to −13 | \n— | \n11 | \n12–20 | \n−25.5 | \n— | \n— | \n
Autoignition temperature, °C | \n257 | \n385 | \n423 | \n425 | \n435 | \n253 | \n41.6 | \n
Detailed properties of alcohols, ethers, and related fuels [3].
Alcohol name | \nChemical formula | \nWater solubility | \n
---|---|---|
Methanol | \nCH3OH | \nMiscible | \n
Ethanol | \nC2H5OH | \nMiscible | \n
Propanol | \nC3H7OH | \nMiscible | \n
Butanol | \nC4H9OH | \n0.11 | \n
Pentanol | \nC5H11OH | \n0.03 | \n
Hexanol | \nC6H13OH | \n0.0058 | \n
Heptanol | \nC7H15OH | \n0.0008 | \n
Alcohol solubility in water in mol/100 g of H2O (1 bar, 25°C) [6].
In general, alcohols contain higher values than gasoline in oxygen content, octane number, and autoignition/flash point temperatures, while freezing point temperature is lower.
\nTetraethyllead has been banned for use as an additive to improve octane number of gasoline fuel. Methyl tertiary-butyl ether (MTBE) and alcohols are thus used as alternative additives to gasoline, but MTBE has also been banned after the 2000s, and alcohols have become useful additives to increase octane number of gasoline.
\nWater solubility of alcohols is an important property when alcohols are being used as fuel. Gasoline has a water solubility value of less than 0.01, whereas ethanol exhibits a full miscibility as 100. When alcohols contain a high solubility in water, spill or leakage of the mixed alcohol fuels can cause polluting the underground water.
\nMethanol, ethanol, and propanol are completely miscible in water, which means that they dissolve in water in any amount. Both methanol and ethanol dissolve readily in water, are fortunately biodegradable, and do not bioaccumulate. They are not rated as toxic to aquatic organisms [5].
\nStarting with the four-carbon alcohol (butanol), solubility is starting to decrease, and from the seven-carbon length heptanol, alcohols are practically immiscible in water (Table 3) [6]. This is one of the backgrounds for the development of butanol as another alcohol fuel.
\nOther important properties of alcohol fuels reside in its inherent swelling of plastics and corroding power for metals. These properties ask modification in the existing infrastructure of automobiles and other appliances.
\nEthanol is a clear, colorless, toxic liquid and has a characteristic odor. Ethanol is not classified as toxic to humans. Ethanol has a higher octane number than gasoline, providing premium blending properties as a liquid fuel. Ethanol contains less energy per volume than gasoline, and denatured ethanol (98% ethanol) contains about 30% less energy than gasoline per volume [7]. Since ethanol contains oxygen, using it as a gasoline additive results in up to 25% fewer carbon monoxide emissions than conventional gasoline [8].
\nEthanol is soluble in polar and nonpolar solvents and has a clearly higher vapor pressure than gasoline and an oxygen content of approximately 35%. Ethanol itself is a good solvent and can be mixed with water in unlimited quantities. Because ethanol is a short-lived compound in surface water and subsurface aquifer, substantially limiting the risk to aquatic organisms, environmental problem is minimal even when it is spilled. Ethanol degrades quickly in the natural environment, and the biodegradation is rapid in soil, groundwater, and surface water, with predicted half-lives ranging from several hours to 10 days [9].
\nMethanol, or wood alcohol, is a colorless, odorless, toxic liquid and is the simplest form (CH3OH) among alcohols [8]. Methanol is corrosive to some materials. Methanol can be produced from several sources: synthetic gas (syngas), formic acid, formaldehyde, and methane. Methanol is classed as toxic so it requires additional considerations during usage to limit inhalation exposure and skin contact.
\nMethanol is hygroscopic, meaning that it will absorb water vapor directly from the atmosphere. Because absorbed water dilutes the fuel value of the methanol and may cause phase separation of methanol-gasoline blends, containers of methanol fuels must be kept tightly sealed [10].
\nButanol has higher energy densities and could be distributed in the existing infrastructure [8]. The use of ethanol as an additive to gasoline to increase octane number has downside effects such as corrosion of metal component and vapor lock. Such troubleshooting can be remedied by modification of engine and fuel system, but addition of alcohols with high carbon number such as bio-butanol enables utilization in existing system without rendering any change.
\nAlcohols with high carbon contents such as butanol can be synthesized from syngas through catalytic reaction that employs modified catalysts used in Fischer-Tropsch or methanol synthesis.
\nAlcohols fuels can be made from all available organic materials. Natural gas, coal, biomass, and organic wastes are good sources. Alcohol fuels have been synthesized from corn and sugar cane as major raw materials, but focal issues nowadays are synthesis and production of alcohol fuels from non-food crops and agricultural residues. Non-food lignocellulosic biomass includes energy crops, cellulosic residues, and wastes.
\nGrain-based ethanol as a first generation has been tried to change to the second-generation cellulosic ethanol and other advanced cellulosic biofuels. Cellulosic ethanol has identified as a key biochemical route of converting biomass to fuels after the 2000s [8]. Algae-based third-generation feedstock for alcohol fuels emerged as a candidate that can provide a vast raw material for future alcohol fuel industry. Figure 2 illustrates the generations of raw feedstock for the alcohol fuel production and also shows the most apparent material that is being utilized in different countries.
\nKey raw materials for bio-ethanol production in different countries (modified figure from Ref. [11]).
Definitely there exists a clear difference between developing countries and developed countries in the priority choice, but basic understanding should be identical: use the locally available, underutilized feedstock, and choose the feedstock that tipping fee is available to treat the feedstock like municipal/industrial wastes. However, when wastes are involved as feedstock, it should be noted that not-in-my-backyard (NIMBY) problem occurs as a norm in almost every countries nowadays.
\nThe European Commission has recently resolved by voting against utilization of biofuels synthesized from biomass of food crop sources by the year 2030. Intensive interdisciplinary efforts are anticipated for timely commercialization of cellulosic bio-ethanol, which is the second-generation bio-alcohol.
\nAgricultural waste typically contains a relatively high content of alkali metals (potassium and sodium) and other inorganic elements including calcium, magnesium, and sometimes chlorine and sulfur. When applying thermal methods in converting these wastes to alcohol fuels, alkali metal components act to produce low-melting salts that will cause plugging and other ash-related problems during the process. In contrast, fermenting method can reduce the tendency of ash problems, which is a beneficial aspect in actual manufacturing process.
\nIn particular, rice husk contains ash content of over 90%, and rice straw consists of more than 30% as silica, although there is a variation with rice stock, climate, and geographical environment. Such inorganic contents work as a barrier to thermal conversion process, and fermenting can be a more appropriate way in converting this biomass feedstock.
\nStarch and carbohydrates have been used as a first-generation raw material to produce ethanol. During the year 2013, more than 90% of bio-ethanol had been produced from the starch and carbohydrates. Corn, grain, and cassava are major such crops. Downside issues are the destruction of environment during the crop cultivation and ethanol production as well as the use of valuable food resources as fuel production. Therefore, at current situation, large agricultural countries like the United States, Brazil, and China are major production places of biofuels including alcohol fuels. In the United States, 95% of ethanol has been produced from the starch in corn grain [7].
\nRecently, the production of bio-ethanol from grain-based raw materials is gradually becoming limited, and the second-generation bio-ethanol production from non-grain-based biomass is now receiving a gradually increasing priority.
\nBio-ethanol is currently becoming a solid option as automobile fuel, and it has been usually produced from starch of corn and cassava or sugary contents of sugar cane and sugar turnip. Bio-ethanol is also produced from lignin cellulose-based material of crop wastes. Sugar and starch are readily convertible to bio-ethanol but their availability is limited and they are costly. Therefore, work is underway to investigate into various processes to produce bio-ethanol from lignocellulose-based raw materials to utilize their abundant amount in nature and to meet the economic viability in the market [11]. Wood chips or crop residues are common lignocellulosic feedstock (Figure 3).
\nThree key components of lignocellulose [12].
Non-edible xylem parts that constitute most of the botanical stocks or cellulose are used to produce ethanol. Rice straws, weeds, and other shrubbery are good examples as raw material for alcohol production, and valuable food resources are not wasted in this case. However, a large-scale forest or farmland is still used and the low-production efficiency is a problem. Also, economically, viability is not satisfactory yet and is not applied at measurable proportion [13].
\nThe main obstacle of using lignocellulosic biomass resides in the difficulty in extracting the essential parts from the hard-binding components of lignin, hemicellulose, and cellulose in plants as shown in Figure 3.
\nHigh-growth productivity of lignocellulosic crops compared to corn and sugarcane is one of the key factors that bio-alcohols can be produced economically in the future. Figure 4 clearly shows the high growth rates in lignocellulosic crops like sorghum, energy cane, and water hyacinth.
\nHigh-growth productivity of lignocellulosic crops to corn and sugarcane [12].
Sea algae grow relatively faster than most of the land-based plants as shown in Table 4, and they are good source of raw material to produce alcohol fuels. They do not require large-scale farmland to cultivate, and non-edible algae are also a good source of bio-ethanol. Due to their fast growth rate, large-scale farming for 4–6 times cropping per year is possible and their carbon dioxide sequestration is 3–7 times more effective than that of grains. However, large-scale acquisition of the raw sea algae and its economic viability remains to be overcome before commercialization. Most of algae-related efforts are still under R&D probing stage.
\nCurrent biofuel yields from various biomass [14].
Fundamental background to try algae species for biofuel production relies on their higher efficiency in converting solar energy than higher plant biomass. However, actual cultivation of microalgal biomass is not easy, rather quite challenging and still expensive than growing crops. It is a similar situation as comparing the product that has been updated for several decades and the one that is starting to experience initial trial and errors.
\n\nFigure 5 illustrates the typical biofuel production procedures in which the basic process is identical with the hydrolysis/fermentation/separation parts of bio-ethanol production, except the feedstock cultivation and harvesting parts.
\nBiofuel production sequence from microalgae [14].
Ethanol can be produced in various ways: syngas from coal and biomass, synthesized from petroleum-based ethylene, or by fermentation of sugary contents. Bio-ethanol is produced through the procedures of fermentation of regenerative biomass, distillation, and purification.
\nSugar canes and corns are mainly used to produce bio-ethanol in Brazil and the United States, respectively. Overall manufacturing process for bio-ethanol composes the following key parts: pretreatment, saccharification (hydrolysis), fermentation, and purification as shown in Figures 6 and 7.
\nSteps involved in biochemical conversion of biomass to alcohol fuels (modified from Ref. [8]).
Schematic flow diagram of bio-ethanol production process [15].
Ethanol is mainly made by fermenting the sugars found in grains, such as corn and wheat, as well as potato wastes, cheese whey, corn fiber, rice straw, urban wastes, and yard clippings. There are several processes that can produce alcohol (ethanol) from biomass. The most commonly used processes today use yeast to ferment the sugars and starch in the feedstock to produce ethanol. Another process uses enzymes to break down the cellulose in woody fibers, making it possible to produce ethanol from trees, grasses, and crop residues [8].
\nSynthesis of ethanol as a sustainable source of energy, especially related to more high-end product form of alcohol with high carbon contents, requires the accumulation of technical know-how in preparation for future depletion of petroleum oil resources. The bio-alcohol production process is shown in schematic flow diagram for bio-butanol manufacturing in Figure 8.
\nSchematics of bio-butanol production process [4].
Recently, the conversion of valuable food resources into alcohol fuel is facing very negative criticism worldwide, and work is underway to switch the raw material for bio-ethanol to non-edible biomass. However, the production of bio-alcohol from non-edible cellulosic biomass requires solving the problem of breaking the hard biomass structure before converting into alcohol fuels. Pretreatment step is important. The pretreatment process is costly since it involves several process steps and costs for enzymes. It is very important to develop the low-energy/energy-saving process scheme and the suitable enzyme to overcome such technical/cost barriers.
\nThe first challenge in the conversion of biomass to alcohol fuels starts with the difficulty in breaking down the recalcitrant structure of biomass cell walls and further breaking down the cellulose to 5–6 carbon sugars that can be fermented by microorganisms [8]. Size reduction and uniformization in density/size are the first preparation step. Pretreatment by steam, hot water, or slight carbonization is a common procedure.
\nVarious ways of pretreatment are used in biomass conversion to alcohols as illustrated in Table 5. Recent types include steam explosion auto-hydrolysis, wet oxidation, organosolv, and rapid steam hydrolysis (RASH) [16]. Organosolv is a pulping technique that uses an organic solvent to solubilize lignin and hemicellulose. The principal purpose of most pretreatment is to increase the susceptibility of cellulose and lignocellulose parts of biomass at the next process in which acid and enzymatic hydrolysis occur. Cellulose enzyme systems react very slowly with un-pretreated biomass, whereas the rates of enzymatic hydrolysis enhance dramatically when the lignin barrier around the plant cell is partially disrupted [16].
\nPretreatment technologies currently available for alcohol fuels [12].
Saccharification is basically a step of breaking down the cellulose/hemicellulose through hydrolysis to make sugars such as glucose and xylose. The overall hydrolysis is based on the synergistic action of three distinct cellulase enzymes depending on the concentration ratio and the adsorption ratio of the component enzymes (endo-beta-gluconases, exo-beta-gluconases, and beta-glucosidases) [16].
\nTwo main procedures exist in hydrolysis: acid hydrolysis and enzymatic hydrolysis. Most commonly employed procedure is the enzymatic one because it has a better environmental and economic performance. Acid hydrolysis operates under severe conditions of high temperature and low pH, which results in corrosive conditions and requires a special construction material [17].
\nFermentation is the biological process using microorganisms to convert sugar and starch into ethanol. The production of bio-ethanol from starch-containing cereals typically includes the following five steps [15]:
Milling, which is the mechanical crushing of the cereal grains to release the starch components
Heating and addition of water and enzymes for conversion into fermentable sugar
Fermentation of the mash using yeast, whereby the sugar is converted into bio-ethanol and CO2
Distillation and rectification, which is a step of concentrating and cleaning the ethanol produced by distillation
Drying (dehydration) of bio-ethanol
In Brazil, bio-ethanol is produced from sugar cane. Sugar cane is a sugar-bearing crop, and it is readily converted into ethanol by fermentation with yeast. Harvested sugar cane is thoroughly washed and crushed into pieces, the juice is extracted, and finally it is converted into sugary juice, which is further fermented by yeast. During the process, hydrous alcohol is produced by non-dehydration process and anhydrous one by dehydration process. Anhydrous ethanol is mixed with gasoline for the prevention of phase separation, and hydrous alcohol is used as fuel for all kinds of vehicles. The process wastes during the washing and crushing are again utilized as a boiler fuel to generate steam and electricity for subsequent ethanol production. In addition, for each ton of bio-ethanol, 1 ton of GMO-free, high-protein animal feed can be produced.
\nCellulose hydrolysis and fermentation can be achieved through two different process schemes, depending on where the fermentation occurs: separate hydrolysis and fermentation (SHF) and simultaneous saccharification and fermentation (SSF) [16].
\nIn SHF, hydrolysis is performed in one reactor and the hydrolysates are fermented in the next second reactor. In SHF, feedstock and utility costs are high due to the cellulosic conversion that shows only about 73% to ethanol in 48 hours, while the remainders are burned. In SSF, hydrolysis and fermentation are carried out in a single reactor, and the operating cost is in general lower than the SHF case. In SSF, yeast ferments the glucose into ethanol as soon as the glucose is produced, which results in preventing the sugars from accumulating/inhibiting the final product.
\nThe SSF system offers a large advantage over SHF processes, because of their reduction of final product inhibition of the cellulase enzyme complex [16]. The SSF process shows a higher yield (88 vs. 73%) and greatly increases product concentrations (equivalent glucose concentration, 10 vs. 4.4%). The most significant advantage is that enzyme loading can be reduced from 33 to 7 IU/g-cellulose, which results in lowering the ethanol cost significantly.
\nA hybrid hydrolysis and fermentation (HHF) process is also proposed in converting lignocellulosic biomass into ethanol. This process configuration begins with a separate hydrolysis step which involves a higher temperature enzymatic cellular saccharification and ends with SSF step which involves a simultaneous step of mesophilic enzymatic hydrolysis and sugar fermentation.
\nAbout 66% of worldwide ethanol products are used for transportation purpose and 21% goes to industrial use. Most widely used area is gasohol in that alcohols are mixed to replace a portion of gasoline. In the near future, alcohol-using fuel cells and alcohol-mixed jet fuels are promising area of application.
\n\nFigure 9 shows the ethanol consumption trend for mixing to gasoline in the United States during the period of 1980–2020. During the years 2005–2010, ethanol use has drastically increased and remains as ca. 10% of the total gasoline consumed amount.
\nTrend of alcohol additive consumption for gasoline in the United States [18].
The most abundant application of alcohol fuels is related to internal combustion engine of automobiles. Mixing alcohol fuels into gasoline has also a purpose of reducing pollutants by oxygenating the fuel. Since methanol is less expensive to produce than ethanol, although methanol is generally more toxic and has lower energy density than ethanol, it has been used with ethanol as automobile fuels. Compared to gasoline, methanol and ethanol have characteristics of burning at lower temperatures and lower volatility, which results in difficulty in starting the automobile engine in cold weather.
\nCurrent alcohol mixing status of ethanol-based fuel utilization in different countries is tabulated in Table 6.
\nCountry | \nEthanol program | \n
---|---|
Brazil | \nMandatory of bio-ethanol proportion as mixture of 24 ± 2% | \n
United States | \n10% target for bio-ethanol proportion among primary energy sources (2010) | \n
EU | \nBiofuel proportion increase to 2% in 2005, to 5.75% in 2010 | \n
Canada | \nMandatory of bio-ethanol proportion in fuel set at 10% | \n
China | \nMandatory mixing of bio-ethanol at regional government level | \n
India | \nCurrent mandatory 5% mixing of bio-ethanol and to be increased to 20% | \n
Columbia | \n10% bio-ethanol to be mandatory at metropolitan area | \n
Thailand | \n10% mandatory mixing of bio-ethanol to be enforced within Bangkok area | \n
Argentina | \n5% bio-ethanol to be mandatory | \n
Ethanol mixing program to gasoline in different countries [11].
Currently, flexible fuel vehicle (FFV) with dual fuel supply system for ethanol and gasoline is commercialized and widely distributed. In the case of methanol blending to gasoline, it is limitedly used in China from the 2000s. In China, M15 (15% methanol/85% gasoline) is the most familiar type [19].
\nLow-molecular weight alcohols such as ethanol have replaced conventional octane boosting additives like MTBE in automobile fuels. Alcohols that are added to gasoline make the mixed fuel to combust more completely by acting of higher oxygen content by alcohols and provide the ensuing effects of higher combustion efficiency and lower air pollution emissions [20].
\nIn the United States, bio-ethanol is mandatorily mixed with transportation fuels. It has been reported that the bio-ethanol policy reduced crude oil reliance to 25% from 60%, and simultaneously creating 400,000 jobs, reducing 43% in greenhouse gas generation and cost-saving effect of $1.5/gallon-gasoline to the consumer [13].
\nSmall amounts of methanol and higher alcohols are also allowed to be blended into gasoline within EN228 limits. E85 is used in FFVs in certain areas within the EU (such as Sweden, France, and Germany) [21]. There was a trial to use a near-neat fuel as M85 which contains 85% methanol/15% gasoline.
\nRacing cars used methanol for a long time, mainly by not producing black smoke which otherwise will block the view of ensuing other racing cars. Other than this application to racing cars, methanol fuel has not applied widespread other than some experience in China, methanol programs in California during the 1980–1990s, and a trial in Sweden as a marine fuel.
\nMore than 98% of US gasoline contains typically 10% ethanol as E10 (10% ethanol/90% gasoline) [7]. Flexible fuel automobiles that can use E85 (85% ethanol/15% gasoline) exist in the United States and Brazil.
\nIn Brazil, 95% of automobiles are using fuel-flex engine system. Around 70% of automobiles in Brazil are able to run on ethanol, and the Brazil’s demand for ethanol is estimated to increase by around 70% by 2030 (Figure 10) [1, 22].
\nChanging trend of automobile fuel in Brazil [22].
As for bio-butanol, the commercial scale production facility has not been constructed in sufficient numbers. In the United States, bio-butanol can be mixed up to 12.5%, and the 16% mixture is reported to be equivalently effective to existing E10 [13].
\nEthers such as dimethyl ether (DME) contain oxygen in chemical structure which acts as an oxidant in minimizing soot formation. Other exhaust emissions such as unburned hydrocarbons, NOx, and particulate matter are also reduced [8]. DME is an ultra-clean fuel that has similar properties to LPG.
\nAlcohol fuel cell is an energy conversion device to generate electricity via electrochemical reactions on the catalytically active electrodes without direct combustion of alcohol fuel. Direct alcohol fuel cell (DAFC) is named for its direct supply of alcohol to fuel electrode and is called with specific terminologies as direct methanol fuel cell or direct ethanol fuel cell depending on the alcohol fuel source.
\nThe mechanism of electricity generation is based on the oxidation of methanol fuel at the anode (fuel electrode) and conduction of electron(s) to the cathode (air or oxygen electrode) via external conducting circuit and simultaneous electrolytic conduction of proton (H+) via polymer electrolyte to the cathode.
\nDAFC can provide portable energy source to electronic devices such as cellular phones and notebook computers [23]. DAFC that uses alcohol can have several advantages in terms of storage, transportation, safety, etc. over fuel cell systems like proton exchange membrane fuel cell (PEMFC) that use hydrogen.
\nAlternative jet fuel typically contains a complex mixture of primarily n/iso-paraffins, cycloparaffins, and alkylbenzenes with a carbon number range of 9–15 [24]. Carbon tax accelerates the development of jet fuel from renewable resources. Lowering emissions of particles and greenhouse gases during the flight are the fundamental reason of trying alcohol fuels as a jet fuel option.
\nUsing a 50/50 (v/v) blend of petroleum-based and lipid-based jet fuels for flight was already approved by the American Society for Testing and Materials (ASTM) committee. However, the lack of raw materials and relatively low jet fuel yield of this process limit its application [24].
\nGlobal recognition regarding the significant long-term impact due to climate change provides a key foundation for utilizing alcohol fuels, which means that alcohol fuels should be able to accommodate chances in reducing climate change gases(CO2, methane, N2O, etc.). Bio-ethanol is highly effective in reducing greenhouse gas evolution. Corn-based bio-ethanol is reported to generate 43% less greenhouse gases compared to pure gasoline.
\nFrom purely theoretical point of view, ethanol can be finally produced from the biomass that is made based on the CO2 absorbed by plants during photosynthesis, and thus it can be called carbon neutral. Unlike hydrocarbons which evolve voluminous amount of CO2 from their internal carbon atoms during combustion, ethanol can be regarded as carbon neutral without generating as much CO2 from internal carbon atoms. In practice, however, significant amount of greenhouse gas evolution is directly and indirectly caused by cultivation of biomass crops and synthesis of alcohol fuels.
\nThe range of CO2 reduction potential is large when alcohol fuels are used. Values range between 0.5 kg CO2-equivalent/liter of ethanol for ethanol produced from wheat and up to 2.24 kg CO2-equivalent/liter of ethanol for ethanol manufactured from sugar cane (Figure 11) [25].
\nEstimated carbon dioxide (CO2) emissions over the life cycle of alternative fuels [8, 26]. Note: BTL, biomass to liquid; CBFT, coal and biomass to liquid, Fisher-Tropsch; CBMTG, coal and biomass to liquid, methanol to gasoline; CCS, carbon capture and storage; CFT, coal to liquid, Fisher-Tropsh; CMTG, coal to liquid, methanol to gasoline.
According to the result shown in Figure 11, among alternative liquid fuels, only cellulosic ethanol, biomass to liquid (BTL), and CCS-involved processes (BTL-CCS, CBFT-CCS, CBMTG-CCS) exhibit the CO2-negative performance in life cycle analysis (LCA) perspective. Carbon capture and storage (CCS) process is not fully economically feasible and technically proven till now; moreover, considering public objection on CCS, connecting the process to CCS is not practical for the time being. In CO2 reduction aspect, cellulosic ethanol is the most reasonable choice as a renewable alternative fuel.
\nAdding ethanol to gasoline fuel of automobile, oxygen contents of fuel mixture increases and yielding the effect of reducing pollutants evolution. As alcohol fuels are inherently sulfur-free, it suits for cleaner environment. Besides, since ethanol is produced by fermentation with crops that contains starch, its purity is high, and no hazardous combustion by-products such as SO2 or metal oxides are generated during the combustion when compared to the petroleum-based fuel. But, high solubility into water by short carbon chain alcohols such as ethanol and methanol can cause an underground water pollution, although short carbon chain alcohols are well degradable in few days under normal circumstances. This problem can be minimized with the use of higher carbon chain alcohols like bio-butanol.
\nForest clearing and chemical fertilizer are involved to grow corn and other grains for the first-generation bio-ethanol, which eventually ends up with CO2 production and countervailing the CO2 reduction amount by bio-ethanol use, sometimes more than the reduced amount. In this regard, the second-generation lignin-based or third-generation algae-based raw material is a better candidate for bio-alcohols.
\nIt is especially noteworthy that the definition of (environment friendly) bio-energy is rather more stringently defined in the EU and United States: more than 35% reduction of greenhouse gas is required to qualify compared to fossil fuels of the same calorific value [27].
\nThe issue of required water amount asks the approach of water-energy nexus in that technology development will follow for the process of better environment-friendliness and sustainability [13]. As an example, recent water shortage encountered in Chennai, India, might be attributable to global warming, and the water quantity consumed for the production of alcohol fuels is emerging as an important issue. Chennai region went without rain for 200 days in 2018.
\nThe process consuming the largest amount of water is the cultivation of biomass crops. Among the production processes for alcohol fuels, refinery step consumes the largest amount of water. The water quantity consumed for US corn-based ethanol production is approximately equivalent to the water requirement that can sustain 5000 people for 1 year.
\nMoreover, the refinery process that is going to be extended for the second-generation cellulosic ethanol is expected to consume 2.9 times more water needed for corn-based ethanol refinery process. At present, cellulosic ethanol production process consumes about 9.8 L/L-ethanol [13], which is unduly high.
\nTo a great extent, expanding the distribution of bio-alcohol depends on the RFS system currently implemented in many countries. Basically, biomass ethanol cannot compete in normal market situation with petroleum-based fuels. As shown in Figure 12, liquid fuel cost of corn ethanol and cellulosic ethanol is similar to the level of crude oil price around $90–110/barrel. Considering the crude oil price during the 2000s, this high level of biomass-based ethanol price cannot compete in normal market situation. To make a room to enter the fuel market, incentive system of renewable fuel standard (RFS) was introduced.
\nCosts of alternative liquid fuels of different origins with zero carbon price [8, 26].
Important aspect in Figure 12 is that bio-ethanol route (corn ethanol, cellulosic ethanol) is cheaper than the biomass to diesel/gasoline (BTL) route and comparable to the coal/biomass to diesel/gasoline (CBFT) route.
\nMandatory addition of renewable energy sources in regulated proportions for transportation fuel is underway in 64 countries worldwide in connection with greenhouse reduction effects. Most such countries employ ethanol-based mixing program, while a few countries including Korea implement mandatory mixing of biodiesel only [13].
\nIn the EU, 27 countries operate the mandatory mixing policy for bio-alcohol. Many countries in different continents implement similar policy: 13 nations in North and South America, 12 nations in Asia-Pacific, 11 nations in Africa and contiguous nations along Indian Ocean, and 2 nations in non-EU sphere [13]. All in all, current trend regarding bio-ethanol mixing in major countries is summarized as follows: mandatory mixing ratios are 27% in Brazil since 2015, while nine provincial governments of China mandate 10% mixing and, it will be expanded to the entire China by 2020. RFS program was newly initiated in Vietnam since 2018 for 5% ethanol mixing. Canadian E5 mandates 5% mixing and E8.5 program is implemented in five Canadian states. Columbia implemented E8 since 2008, but E5 was targeted in Chile but not mandatorily regulated. Costa Rica mandatorily implement E7 while E10 and E2 are regulated in Jamaica and Mexico, respectively. The EU currently mandates 5.75% mixing with 10% objective for 2020 and recommends EU member nations to accomplish target 10% ratios of 2020 [13].
\nIn the United States, MTBE additive to transportation fuel was gradually becoming prohibited since 2002 to prevent the groundwater pollution, and 25 US states had banned the use of MTBE by 2007. Bio-ethanol has thus become a replacement for MTBE. Mandatory mixing of bio-ethanol in transportation fuel has been implemented for dual purposes of using US surplus corn products as raw material for bio-ethanol and simultaneously safeguarding US farm economy, which prompted legislation and implementation of mandatory mixing of bio-ethanol in transportation fuel.
\nMore specifically, Energy Policy Act of 2005 paved a way for RFS program which led to more concrete implementation plan in 2007 via Energy Independence and Security Act. The US Environmental Protection Agency (EPA) announced Regulatory Impact Assessment (RIA) in 2010, and RFS2 program was thus made available to the public, where LCA was required for the greenhouse gas evolution during the bio-ethanol production.
\nIn many countries, government-level subsidies are being curtailed for bio-alcohols with no significant contribution to the greenhouse gas reduction. For example, cellulosic bio-ethanol is given higher Renewable Identification Number (RIN) credit in the United States for its efficient greenhouse gas reduction and non-edible nature of raw material. RIN credit ratio is 0.85:2.85 for corn-based ethanol/cellulosic bio-ethanol, which sets a higher ratio for the cellulosic ethanol.
\nMethanol economy had been touted as a possible replacement for fossil fuel society. Now, hydrogen economy is starting to replace the momentum of methanol economy. Methanol has quite versatile usages in many sectors of modern industries for energy source and chemical raw material, which is a very good point when selling the product. Compared to the recent unmatched supply-demand issue in bio-ethanol, the point that there are many selling market can be a major advantage.
\nRelated technologies to methanol are mostly mature such that there are only economic uncertainties, not major technical difficulties. Its related utility can expand as an energy media for society if cost is appropriate with eventual goal of replacing fossil fuels with methanol.
\nMethanol is produced from various raw materials including biomass or wastes which has not been fully utilized till now. Methanol-based energy can be quite useful especially for developing countries to cope with global climate change issue and related environmental issues while simultaneously securing some portion of national energy security. But, the issue of slipping into underground water stream when it is not properly regulated might be an issue that is to be solved. Underground water contamination shall be much smaller than the case by petroleum-based liquid fuels, but it needs to be comparable eventually to hydrogen and clean gas energy sources.
\nHydrogen economy that is being a focal point in several developed countries can be a chance as well as danger to alcohol fuels. It is a chance because hydrogen can be manufactured with easily distributable alcohols but can be a danger when all liquid fuel-based infrastructure might be changed to the fully gas-based or hydrogen system in the long run.
\nDue to the concerns on climate change that requires CO2 reduction and the concerns on environmental pollutants like fine particulate and NOx, hydrogen has been hoped eventually to replace all other energy mainstream options. During the last few years, hydrogen economy has reborn as a cure for CO2 and environmental issues like an ultra-fine particles and PM2.5. But due to its high cost in hydrogen production as well as in application tools such as fuel cell and still-unstable infrastructure, hydrogen era might come after few decades of development and trial and errors. In contrast, alcohol fuels have been viewed as a cheap and reliable option in replacing fossil fuels. Especially, the possibility of utilizing abundant biomass prompts to try many ways in technology development and commercialization.
\nHydrogen is the most abundantly available element in the universe with immense possibility as essential energy source sometime in the future. At present, however, technologically and economically viable means of its utilization as an affordable energy source are not ready and many countries opt to pursue the hydrogen economy path as a mean for dealing with climate change and pollution problems in their major cities.
\nHydrogen economy involves the generation of renewable electricity from photovoltaic cell or wind turbine, and the so-called water-to-gas (PtG or P2G) which involves water electrolysis using the excess electricity to produce hydrogen. Green hydrogen energy generation and utilization is the ultimate goal in hydrogen economy in which society of no CO2 evolution and no fossil fuels will eventually be accomplished. On the other hand, methanol society focuses on the production of CO2-free energy source from renewable biomass or sea algae which grow by photosynthesis in nature. Green hydrogen energy will be further refined to maturity, at least by the 2030s, in such countries that can afford to bear the related high costs.
\nMore specifically, introduction of fuel cell vehicle using hydrogen will initiate and further expand in those countries which suffer from persistent air pollution (China, Korea, Japan, large metropolis areas of the EU and United States). In contrast, alcohol-based energy source such as ethanol and methanol is most suitably applicable in tropical or semitropical countries where biomass resources are abundantly available, while domestic energy sources are not plentiful.
\nFor realization of such alcohol-based energy generation from raw material of (very low) calorific value per unit volume, the current high-cost situation related to the pretreatment and production processes should be solved.
\nChanging the basic liquid fuel infrastructure that can accommodate alcohol fuels in a global scale will be slow like maneuvering a massive ship and very competitive even with right environmental slogans such as renewable, clean, and sustainable for the society. It is a well-known hidden fact that major local oil companies as well as auto manufacturers do not want to change their market unless certain compulsory regulation applies or proper incentives are given.
\nA report in July 2019 [28] on the US ethanol industry nearing breaking point succinctly shows the problem related to enlarged supply and dwindling demand. Report says that US ethanol production in early June 2019 reached almost 1.1 million barrel/day, the highest seasonally on record, but the economic margins to produce ethanol are at the lowest seasonally since 2015. Infrastructure for E85 gasoline as well as government policy like US Small Refinery Exemptions (SREs) plays key roles in demand side of alcohol fuels. This situation illustrates the weak point of alcohol fuel industry. Technical endeavor only cannot make a way for wider utilization. Policy and infrastructure should follow in parallel.
\nFood vs. fuel controversy is the main topic in utilization of alcohol fuels, which pushed the feedstock from corn to non-food lignocellulosic biomass. Technical breakthroughs in solving the difficulties in non-uniform/hard-to-break lignocellulosic biomass and in lowering the process cost are key factors, although it would not be an easy task, considering the already established relatively cheaper bio-ethanol industry from corn.
\nThere are clear directions, especially in developing countries in Africa and Southeast Asian countries, where environmentally benign liquid fuel supply is in great need and the centralized energy supply infrastructure might be too costly. When alcohol fuels can be supplied in enough quantity with reasonable cost, securing energy security and installing the distributed energy infrastructure can be a socially acceptable justification.
\nWhen a large volatility exists in oil and gas prices, a niche market of alternative fuels like alcohols can act a role. In the time of large availability of shale gas and shale oil in addition to a remarkably fast-advancing market share by renewable electricity, the probability in global energy price jump might be low. When the energy market situation goes down to local scale, however, there are many volatility in liquid fuel supply chain.
\nCountries with scant energy resources are expected to be more actively searching for a way to utilize pre-existing affordable energy source and raw materials for chemical industries instead of solely relying on imported natural gas and petroleum oil. It is necessary to diversify energy sources to satisfy domestic demand even for a small proportion at the start. Alcohol fuel could take some of such small proportion.
\nSince most countries prefer to use gas as a basic energy source, resulting in more demand for clean and easy-to-use gas resources, even Southeast countries which are currently gas-exporting countries are going to be net importer from the 2030s, as shown in Figure 13 [29]. Energy diversification through alcohol fuels must be a practical option to ease the burden in transportation and energy utilities in these countries.
\nLNG trend change into net importer by 2035 of Southeast Asian countries [29].
Because the demand for natural gas is large and the accommodating space is limited in urban areas, the centralized gas supply by pipeline appears to be essential. On the other hand, local villages and smaller township can satisfy their energy needs in a distributive way by alcohol fuels produced from locally available biomass and wastes. At present level, relevant technologies are not fully ripe, which necessitates international cooperation for comprehensive and interdisciplinary R&D.
\nFuture trend of energy utilization is in the type of distributed application. There are many limitations for making the system that will be competitive to the centralized big-scale system that has a huge advantage in the economics of scale.
\nNevertheless, the preference for the distributed energy system that is more suitable in effectively responding to the local energy demand is on the increase worldwide recently over centralized energy distribution systems. Distributed energy system market is expected to steadily expand, and this trend is most significant in the field of less than 50 MW output, where the gas turbine is taking large proportion of market share. Alcohol fuel is also expected to play a significantly important role in the distributed energy system market (Figure 14).
\nWorldwide distributed energy market prospect of less than 50 MW scale [30].
Locally produced biomass, wastes, and agricultural by-products are converted to alcohol fuels for energy sources, and they are locally distributable and consumed. Such system is cost-competitive by minimizing the transportation distance and is important as the basic infrastructure in securing the clean energy source as well as in proceeding to the sustainable society. However, the distributed energy application system costs more than the centralized energy distribution system, in general. It can be accomplished only by meeting the pre-conditions that cost should be down significantly and proper commercialization with reliable technologies should be available for greenhouse gas reduction and for alleviation of environmental pollution.
\nThere emerged several candidates that compete with alcohol fuels in the twenty-first century liquid fuel field. Green hydrogen and green electricity are the most prominent players. Whether alcohol fuels can compete with these two players will depend on the future progress in dealing with key required target: CO2 reduction, environmental cleanness, convenience in existing infrastructure, and price competitiveness. Moreover, energy-related focal points nowadays are sustainability, suitability for carbon-free (green energy) status, and alleviation of polluting materials such as fine dust, which are primarily emerging and ecologically important topics.
\nReplacement of fossil fuels with alternative clean fuel will eventually lead to green energy-based sustainable society. However, currently available technology is not up to the level of commercially viable standard for social acceptance in terms of CO2 evolution and fine dust, etc., which must be comprehensively overcome.
\nCurrently available elementary and applied technology can be utilized to synthesize liquid fuel in various forms. Although synthesis of liquid fuel is more costly than direct mining of petroleum, the application of currently available technology to alcohol fuel synthesis should be tried to make ways that can be economically feasible and lucrative when commercialized. In a sense, it is rather a problem-solving for cost-effective technology rather than the technology itself. Mass production of lignocellulosic ethanol necessitates economically competitive technology rather than the barely profitable or only technically feasible technologies.
\nActually, bio-alcohol such as bio-ethanol is an industry of low unit cost. Without installing a proper scale of plant size, cost competitiveness with other liquid fuels must be quite low [13]. Actual plant construction cost remains high because of the inherent limitation of using low-energy density raw feedstock and of complex nature involved in converting into alcohol fuels. Among these, pretreatment/detoxification and hydrolysate conditioning processes are especially costly. Such auxiliary processes have to be developed in such a way that overall process cost can be dramatically reduced through the introduction of more energy-efficient and process simplification [13].
\nAnother important aspect is that soils and climates in much of Africa have similar characteristics to those in Brazil [31]. Africa and South America have a great potential in increasing bio-energy products including alcohol fuels.
\nIn short, alcohol fuels should work as an energy source that can minimize the environmental impact as lower than natural gas at all applications while opening more applicable places as well as manufacturing a cheaper liquid fuel that can be used in big scales also in developing countries where plentiful but low-grade raw materials exist in plenty.
\nAlcohol fuel is one of the most important source of energy in view of its renewable nature and the abundance of feedstock on earth. Even when many bright prospects of alcohol fuels shed light on possible options for the environmental conscious society, still cost dictates and it will be that way. Carbon taxation might help, but the market might lead to a totally different direction such as hydrogen or green electricity from renewable energy, instead of choosing alcohol fuels. Abundant shale natural gas might play a replacing act of cheap oil that had prevented most of other energy source developments from the 1950s till the 1970s. All these situation point that the future of alcohol fuels depends upon the technological advances in cost and convenience in use.
\nAs discussed in this chapter, the direction of future energy is simple and clear. It is the low-carbon economy using sustainable energy resources but with affordable cost. Alcohol fuels can act as connecting threads between current conventional oil/gas society and the future hydrogen society in attaining this far-reaching goal.
\nCurrent status regarding alcohol fuels can be summarized as stagnant in scale and also in utilizing market. Since bio-ethanol dominates the alcohol fuel market, the system has an inherently sensitive structure to changes in supply-demand and government’s policies. More wide application ranges of alcohol fuels should be sought in areas such as fuel cells, marine ships, and jet fuels. Alcohol fuels must remain as an essential component for the realization of sustainable low-carbon society, and continuous research on key bottlenecks should be pursued systematically.
\nThis chapter will try and help general practitioners master minor surgical procedures.
General practitioners require these procedures for diagnostic or therapeutical reasons, in the outpatient setting as well in the emergency (excision of skin lesions or wound suturing for example). For that reason, the training of the general doctors in minor surgery is an additional tool for good medical practice and acquiring skills in minor surgical procedures has become a critical part of medical training.
Minor surgical procedures do not involve very sophisticated devices. However, some basic requirements in terms of infrastructure and equipment must be met [1, 2].
It is recommended that each facility has a specific room for these procedures. This room (Figure 1) must include:
Well-equipped room of minor surgery.
Surgical room: a well-ventilated room, with a suitable temperature, it is imperative that is clean, but it does not require sterile isolation. The surgical room should be cleaned properly at the end of the surgical session, particularly after contaminated procedures (e.g. abscesses).
Operating table: It should be easily accessible from all sides, Height-adjustable and articulated tables. It is essential that allows the doctor to work in comfort, both standing and sitting.
Doctor’s stool: A height-adjustable stool on wheels.
Side table: it is used to place the surgical instruments and material used during the surgery.
Lamp: It is necessary to have a directional light source, and it must provide adequate lighting with, at least, 45,000 lux of illuminance. It is advisable to have another auxiliary lamp with a magnifying glass.
Showcase and containers: For storing consumables and surgical instruments. There should also be properly marked containers for bio contaminated material, and a disposal system in accordance with current health legislation.
Resuscitation equipment: Including material for vascular access, airway intubation, saline, drugs for resuscitation (e.g. epinephrine, atropine, bicarbonate) and a defibrillator.
Performing minor surgical procedures carries some risk of transmission of infectious diseases (such as HCV and HIV), both from patient to doctor and vice versa. To minimize this risk, all physicians performing invasive procedures should adopt and apply universal precautions, which include:
Surgical attire: surgical shirts and trousers (“scrubs”) or gowns and sterile gloves. Surgical masks and eye goggles is considered highly desirable but not essential. Disposable gowns are very useful.
Hand washing: Hygienic scrubbing is suitable for minor surgery and involves using a normal soap solution (no brush) and washing thoroughly all skin folds for at least 20 seconds. Time span from scrubbing to glove placement should never exceed 10 minutes.
Sterile glove placement: Outer surface of the glove should be sterile, therefore they cannot be touched with the hands, only with the other glove; nonetheless, the inner or powdered part of the glove can be touched.
The quality, condition and type of instruments used in any procedure can affect its outcome. Choosing the right instruments for each surgical intervention is, therefore, an important issue [1].
Scalpel: A number 3 handle with leaves number 15 for dissection and 11 for incisions and withdrawal of points. The scalpel blade is installed on the handle in a unique position, matching the blade guide with the handle guide. The scalpel is handled with the dominant hand like a pencil (Figure 2), allowing small and precise incisions. To increase precision, hand should be partially supported on the working surface. Skin should be tightened perpendicularly to the direction of the incision using the contralateral hand, cutting the skin perpendicularly. In hairy areas (eyebrows or scalp), to avoid damaging the follicles, the incision should be parallel to the hairshafts.
Correct way of managing of the scalpel.
Scissors: The scissors allows us both the cutting dissection of the tissues and the blunt dissection.
A 14 cm long curved blunt May scissors (cutting scissors) and an 11.5 cm curved blunt Metzenbaum scissors (dissecting scissors) should be available.
Scissors are handled by inserting the distal phalange of the thumb and fourth finger into the rings, then supporting the second finger on the branches of the scissors. Usually scissors are inserted with the tip closed and are then opened, separating the tissues in the anatomical layers, except for sharp dissection they are inserted with the tip open, then cutting the tissue.
Needle-holder: needle-holders are meant to hold curved needles while stitching. The needle is held 2/3 of the way back from its point. A small or medium (12–15 cm). Long needle holders are not recommended.
Like other instruments with rings, the needle support is handled equally. To facilitate the passage of the needle through the tissues, the needle holder should describe a prono-supination movement, and for a proper edge eversion of the wound the angle of entry of the needle should be 90°. The non-dominant hand holds the skin with a retractor or dissecting forceps, opposing the pressure of the needle.
Dissecting forceps: Use of a 12 cm-long Adson forceps with teeth to handle the skin, plus a toothless Adson forceps for suture removal or two standard forceps, one with and one without teeth. It is important not to manipulate the skin using non-toothed forceps.
They used with the non dominant hand, between the first, second and third fingers.
They allow the surgeon to expose the tissues to manipulate them.
Homeostats: homeostats are used to pull tissue, for homeostasis and, in some cases, for blunt dissection in absence of small scissors. Usually with 12 cm curved non-toothed Mosquito forceps.
For most minor surgical interventions, a basic set of surgical instruments is enough (Figure 3). But some surgical procedures require the use of special instruments or equipment, such as:
Basic set of instruments of minor surgery: Scalpel (handle of the number 3 for scalpel number 15), scissors of May, Adson forceps with teeth, needle-holders and mosquito forceps.
Biopsy punch: it is an instrument consisting of a handle and a cylindrical cutting edge (trephine) for obtaining tissue biopsies. It allows the surgeon to obtain full- thickness samples of the skin.
The most useful in minor surgery is the 4 mm punch but they are manufactured in different diameters. They are handled with the dominant hand, performing rotational movements of the instrument to cut the skin and obtain the sample [3].
Curette: it allows scraping of lesions on the skin Surface with a simple surgical technique that involves “scraping” or enucleating different types of superficial, hyperkeratotic or raised partial-thickness skin lesions.
Cryosurgical equipment: these are devices that spray a cryogen, which is usually liquid nitrogen that uses extremely cold temperatures to treat benign and malignant skin lesions (solar lentigines, common warts, myxoid cysts, actinic keratosis, etc.).
It is available, cost-effective, and rapid treatment that rarely requires anesthesia [4].
Electrocautery: it applies an electric current with ability to coagulate and cut through different tissues. There are different terminals depending on the type of procedure that is to be performed [5].
Different types of suture materials are available: threads, staples, adhesive sutures and tissue adhesives.
Depending on the material used for the suture, the operation time will be modified and will require anesthesia or not.
Conventional sutures require the use of anesthesia, operating time is increased, and tissue is traumatized, but provide a secure wound closure and minimal wound- dehiscence rate compared to other types of closure [6].
They are classified according to their origin (natural, such as silk, or synthetic polymers that produce less tissue reaction), their configuration (monofilament or multifilament), and their size (the thickness of the suture is measured using a zero-scale [USP system] (Figure 4). The most commonly used in minor surgery range from 2/0 to 4/0 or 5/0.
Information on suture: (1) caliber of the thread (system USP and metric), (2) trade name of the suture, (3) composition and physical structure of the thread, (4) length of the thread, (5) color of the thread, (6) model of needle (every manufacturer uses different references), (7) I draw from the needle to scale 1:1, (8) circumference of the needle (expressed in parts of circle), (9) section of the needle, (10) length of the needle, (11) expiry date, (12) indexes of the manufacturer, (13) indicator of sterile packing.
The size and type of suture will be selected depending on the anatomical site, the type of wound and on the patient’s features.
Nonabsorbable sutures: They are not degraded by the body and they are used for skin wounds in which stitches that are to be removed or for internal structures that must maintain a constant tension (like tendons and ligaments), Polypropylene and Nylon, causes minimal tissue reaction.
Silk: Suitable for skin suture and for removable sutures in general, it is easy to handle and tie.
Nylon: Indicated for precise skin sutures and internal structures that must maintain constant tension.
Polypropylene: Indicated in continuous intradermal skin closure. It is a very soft suture with high package memory and, therefore, it requires more knots for secure tying, and it is more expensive than Nylon.
Absorbable sutures: A suture is considered absorbable if, when placed under the skin surface, it loses most of its tensile strength in 60 days. It has low tissue reactivity, high tensile strength. They are use in dermal suturing, subcutaneous tissue, deep suturing and ligatures of small vessels. The most commonly used, are the synthetic sutures (polyglactin 910 [Vicryl], polyglycolic acid [Dexon]…).
The period of time (in days) recommended for the extraction of points, together with an indication of the type of suture is described in Table 1.
Anatomical region | Skin suturing | Subcutaneous suturing (Vicryl® or Dexon®) | Stitch removal | |
---|---|---|---|---|
Adults | children | |||
Scalp | Staples 2/0 silk | 3/0 | 7–9 | 6–8 |
Eyelids | 6/0 monofilament or silk | — | 3–5 | 3–5 |
Ears | 4/0–5/0 monofilament or silk | — | 4–5 | 3–5 |
Face, neck, nose, forehead | 4/0 monofilament or silk | 4/0 | 4–6 | 3–5 |
Lips | 4/0 monofilament or silk | 4/0 | 4–6 | 4–5 |
Trunk/abdomen | 3/0–4/0 monofilament | 3/0 | 7–12 | 7–9 |
Back | 12–14 | 14 | ||
Lower extremity | 3/0 monofilament | 3/0 | 8–12 | 7–10 |
Penis | 4/0 monofilament | 3/0 | 7–10 | 6–8 |
Foot and pulp of fingers | 10–12 | 8–10 | ||
Upper limb/hand | 8–10 | 7–9 | ||
Mouth and tongue | 3/0 Vicryl® | — | — | — |
Indications of types of sutures and time for stitch removal.
Needle selection depends on the type of tissue to be sutured, its accessibility and suture thickness.
Needles are classified as triangular, spatulate or conical, according to their section. Triangular needles are considered the first choice in minor surgery, as they have sharp edges that allow suturing through highly-resistant tissues such as subcutaneous tissue, skin or fascia.
Curved needles are used with the needle holder, that is designed to hold needles atraumatically and safely. Short needle holders are preferred in minor surgery; however, they should be selected in accordance with the size of the needle and the surgical area.
Staples are applied by disposable staplers and they are available in different widths (R: normal staples, W: Wide staples). Staplers are preloaded with a variable number of staples. It has certain advantages such as the speed with which the suture is performed, low resistance and no tissue reaction.
They are applied with the dominant hand, while the non dominant hand everts the skin edges using dissecting forceps with teeth. Staple removal is performed using a staple extractor.
Indications: In linear wounds on the scalp, trunk and limbs, and for temporary closure of wounds in patients to be transferred or with other serious injuries.
Contraindications: Wounds on face and hands and regions that are going to be studied through CT or MRI.
It consists of adhesive tapes made of porous paper and capable of approximating the edges of a wound or incision. They are available in various widths and lengths, and it can be cut.
Indications: linear and superficial wounds with little tension. The regions where they are used most are: the face, chest, non-articular surfaces of the limbs and fingertips. They are also a good choice for elderly patients and to wound-reinforcement after stitch removal.
Any wound closed with adhesive suture should not be wet for the first few days, due to the risk of tape detachment.
Contraindications: irregular wounds, on the scalp and hairy areas, skin folds and joint surfaces.
Application and removal of adhesive sutures: For a good application the wound should be free of blood or secretions and dry. The suture tape is applied to the wound using dissecting forceps without teeth or fingers, first on one edge of the wound and then the other and along the wound.
Time for adhesive suture removal parallels time for conventional suture.
These products (cyanoacrylates) act as an adhesive, producing an epidermal plane closure, so they bind the most superficial epithelial layer (stratum corneum) and hold together the wound edges for 7–14 days. After this time, adhesive and stratum corneum are shed along.
Adhesive can be used in deeper wounds or with great tension, associated at sutures in the subcutaneous plane.
It have advantages when compared with sutures: More rapid repair time, less painful procedure, better acceptance by patients, no need for suture removal or follow-up, good cosmetically results. Finally they are safer than sutures because needlesticks are avoided [1, 7].
After cleanliness and hemostasis of the wound, tissue adhesive will be applied:
Using fingers or dissecting forceps to approximate the wound edges, apply the adhesive on the outer surface of the skin. Then Keep the edges in contact for 30–60 seconds. The process can be repeated 3 times.
The wound does not require dressings but should be kept dry 5 days. The glue will disappear after 7–10 days.
If adhesive contact the eyes, use of a generous amounts of ophthalmic antibiotic ointment should be placed within the eye and on the eyelid to break down the adhesive and reopening of eyelids with a gentle manual traction. If adhesive reach the cornea, it should be assessed for corneal abrasion.
The practice of any surgical procedure, however minimal, is not without risks. The possibility of complications during and after surgery must always be kept in mind. The results of surgical treatment are not always predictable, and depend on many factors, involving not only the physician’s skills, but also the patient.
There are two ways to dissect tissue: with a blunt dissection, separating the tissue, using Metzenbaum scissors or mosquito forceps, or cutting dissection, with a scalpel or scissors.
Incisions must parallel the minimal tension lines, which match skin relaxation lines and facial expression. Thus, they result in an acceptable scar, both functionally and cosmetically. There are diagrams of the relaxed skin tension lines, for correct incision planning before surgery.
The incision can be marked prior to skin antiseptic preparation or a previously sterilized marking pen can be used in the surgical field after skin preparation and draping.
For excisional biopsies, it is necessary to leave an adequate margin (1–2 mm) of healthy skin both around the lesion and in depth, depending on each lesion.
Incision: Used for drainage of abscesses or surgical exposure of deeper tissues (e.g., epidermal cysts, lipomas, lymph node biopsies). Depending of surgery or the anatomic area, Incisions can be angled, curved or straight.
Elliptical excision: Its should be oriented along the lines of minimal tension.
Usually the length of the ellipse should be 3 times its width and the ends form a 30° angle. Its used to remove skin lesions with a margin of healthy skin in depth and around lesion, and include all skin layers plus some subcutaneous fat (Figure 5). This technique allows diagnosis, treatment and facilitates closure producing good cosmetic results.
Characteristics of the elliptical excision.
It is the ideal technique to remove the majority of skin lesions [8, 9, 10].
The procedure involves the following steps:
Design of the incision
Preparation of the surgical field
Local anesthetic injection.
Superficial skin incision along the marked ellipse, going through the entire dermis to prevent jagged edges.
Using the nondominant hand the deep wedge-shaped incision is made (always under direct vision), until fat is reached and the lesion is, thus, removed en bloc.
Hemostasis of the surgical area.
Wound closure by layers
Cleaning the surgical area and dressing placement
After 48 hours the wound can be washed gently
Tangential excision: it is the technique of choice to remove very superficial lesions using scalpel or scissors, eliminating only the most superficial layers of the skin and for which diagnosis is certain. The defect created is allowed to heal by secondary intention. Tangential excision also called “skin shave”.
No surgical procedure is complete until the pathology report has been received and the patient informed of the results and prognosis.
Most episodes of bleeding in minor surgery can be controlled with pressure with a gauze or a surgical towel. It is recommended to apply a compressive bandage on the wound in the immediate postoperative period to reduce hematoma or seroma.
Tourniquet: Its allows the exploration of the wound and reduces the surgical time. Its use is limited to distal areas (the fingers nail surgery, etc.) and should not exceed 15 minutes.
The hemostats: The surgeon holds bleeding vessel with the tip of a hemostat without teeth and controls the bleeding. To avoid damaging important structures (for example, tendons or nerves) it is necessary to identify the bleeding vessel.
The ligatures: they are threads that tied around a blood vessel, occlude their light and prevent bleeding. After that, vessel should be fixed with a hemostat. The ligature should pass under the clamp and several knots must be tied.
In the hemostasis by electrocoagulation, the Bovie is used in coagulation mode.
This is the most appropriate for minor surgery, as it helps to distribute stress, and promotes the drainage of the wound. The number of sutures needed varies according to the length, shape and location of the laceration. In general, the sutures are placed away from each other so that no space appears on the edges of the wound.
Simple stitch (percutaneous): It is used alone or in combination with buried stitches in deeper wounds and it is considered the technique of choice.
Simple stitch with buried knot: Used to reduce tension within the wound and approximate the deep planes, before skin suturing. Absorbable material is used, the knot leaving in the depth of the wound, and is cut flush.
Mattress stitch or “U” stitch: It is useful in areas of loose skin (e.g., elbow, back of the hand), where the wound edges tend to invaginate. In addition this suture provides good obliteration of dead space, avoiding the need for buried sutures in shallow wounds.
Horizontal mattress stitch: provides a good eversion of wound edges, especially in areas where the dermis is thick or with high tension [6]
Half-buried horizontal mattress stitch: is used to suture wound angles or surgical edges of uneven thickness.
They are contraindicated if an infection is suspected and in very contaminated wounds.
Simple running suture: is a sequence of points with an initial knot and a final knot. It takes a short time to do it, but it makes it difficult to adjust the tension of the skin. It is rarely used in minor surgery.
Continuous intradermal suture (subcuticular): this type of suture allows the wound to be sutured without breaking the skin, avoids the “cross-hatching” and provides an optimal esthetic result. Non-absorbable monofilament suture material or absorbable material can be used. Intradermal sutures are used in wounds where it will be necessary to maintain the suture for more than 15 days. In minor surgery its usefulness is limited.
When a multifilament yarn is knotted (for example, Silk), three loops are usually sufficient (first a double loop plus two simple loops). When knotting a monofilament yarn (e.g., Nylon, polypropylene), an additional loop must be added to increase knot security. The knots should be placed on one side of the wound, rather than placed on top of the incision. This will allow a better visualization of the wound and will interfere less with the healing and facilitate the removal of points.
Local anesthetics block the transmission of nerve impulses and they causing, the absence of sensation in a specific part of the body, also other local senses may be affected.
Local anesthetics can be classified into two groups: esters and amides (lidocaine, mepivacaine, bupivacaine, prilocaine, etidocaine and ropivacaine). For their remarkable safety and efficacy we will only use amides. The association of vasoconstrictors allows better visualization of the surgical field. The most widely used is adrenaline and the maximum dose must not exceed 250 micrograms in adults or 10 micrograms/kg in children [11].
The concentration of the anesthetic is expressed in %. We must know that a concentration of 1% means that 100 ml of the solution contain 1 g of anesthetic. Therefore a 2 ml ampoule of 2% mepivacaine, its contain 40 mg (Table 2).
Due to the risk of necrosis and other alteration like delayed healing, adrenaline should not be used in acral areas (e.g., toes), or in traumatized and devitalized skin.
It is use in an intact skin and for lacerations and mucosae, especially in children. And their characteristics are shown in the Table 2.
Anesthetic | Mode of use | characteristics | Indications | Complications | Not indicated |
---|---|---|---|---|---|
LET® (4% lidocaine, 0.1% epinephrine 1:2000, 0.5% tetracaine) | 1–3 ml applied directly on wound for 15–30 minutes | Onset 20–30 minutes after application. | Can be effective in children for face and scalp lacerations and less effective in limbs | No important adverse effects reported | For mucosae and acral areas |
EMLA® lidocaine 25 mg/ml plus prilocaine 25 mg/ml, | 1–2 g of cream should be applied for each 10 cm2 of intact skin and occluded. Maximum dose is 10 g | Onset 60–120 minutes after application. Duration of effect is 30–120 minutes. Not useful on palms of hands and soles of feet | Admitted for procedures on intact skin: scraping and shaving, cryosurgery, electrosurgery, laser hair removal, pre-anesthesia for infiltration | Local mild irritation, contact dermatitis. There have been reports of Methemoglobinemia in children aged <6 months | For wounds or deep tissues |
Topical anesthetics used in minor surgical procedures and their characteristics.
Angular infiltration: From the point of entry, the anesthetic is infiltrated in three or more different directions, like a fan (Figure 6).
Perilesional infiltration: Starting from each point of entry the anesthetic is infiltrated in a single direction. The different points of entry will be forming a polyhedral figure.
Linear infiltration: If the lesion to be operated on is a skin laceration, the anesthetic should be directly infiltrated into the wound edges in a linear fashion. If the wound is bruised and has irregular edges, it is preferable to use a perilesional technique from the uninjured area, and follow along the margins of the wound to avoid introducing microbial contamination.
Anesthetic angular infiltration: it infiltrates following three or more different directions, like a fan.
The needle is inserted at the base of the proximal phalanx in a dorsal and lateral location, in the collateral palmar digital nerve, and then local anesthetic is injected (maximum 4 ml). The needle is removed and after aspiration proceeds to infiltrate again the subcutaneous plane.
The surgeon must wait 10–15 minutes to obtain a complete effect of the blockage.
It is important that general practitioners have an extensive knowledge of the lesions most frequently treated by minor surgery [12].
The following paragraphs contain an overview of the most important diagnostic consideration in lesions usually treated with minor surgery.
These lesions are easily treated with curettage, electrosurgery or cryosurgery. In case of doubt, an incisional biopsy should be sent for histopathological analysis.
They are also known as epithelial cysts, epidermoid cysts, or improperly, “sebaceous cysts.” The cyst wall consists of normal stratified squamous epithelium derived from the follicular infundibulum. Queratin is the main component inside the cyst. Their treatment is surgical removal for cosmetic reasons or due to recurrent infections.
They are a form of benign epithelial hyperplasia induced by the human papillomavirus (HPV). Clinical presentations of cutaneous HPV infection include:
Verruca Vulgaris or plantar wart: you can use liquid nitrogen or salicylic acid.
It is presents as pearly white papules of 1–5 mm (sometimes even bigger) with central dimpling. They may appear isolated or in groups in the neck, trunk, anogenital area or eyelids. Their first choice treatment is cryosurgery, curettage.
Lipomas are slow-growing benign tumors of mature adipose tissue. They appear as soft, elastic, smooth or multilobulated tumors of variable size, with ill-defined borders, and not adherent to deep planes. The diagnosis is usually made clinically. But ultrasound can be helpful to distinguish a lipoma from an epidermoid cyst or a ganglion cyst [13]. They are generally asymptomatic and they are treated by surgical removal [2].
They are not malignant and their treatment is justified for cosmetic reasons.
They are acquired lesions in the form of macules or papules or small nodules (<1 cm) and are constituted by groups of melanocytes located in the epidermis, dermis or both areas and rarely in the subcutaneous tissue. Sun exposure contributes to the induction of these lesions.
It is located in sun-exposed areas such as bald scalp, the face, shoulders, ears, neck and the back of the hands. It is caused by damage from exposure to ultraviolet radiation. Actinic keratoses are more prevalent in males of middle-aged.
Actinic keratosis is considered a precancer. 13–25% it could develop into a squamous cell carcinoma.
If lesions are scarce and localized, they may be treated with liquid nitrogen.
It is the most common skin malignancy. Approximately 70% of basal cell carcinoma occurs on the face, and 15% presents on the trunk [14]. Exposure to ultraviolet (UV) radiation in sunlight, especially during childhood, is the most important factors that contribute to the development of Basal cell carcinoma.
This is a malignant tumor that usually appears on a previous premalignant lesion and requires a multidisciplinary therapeutical approach involving dermatologists, surgeons, radiotherapists, and chemotherapists [14].
Of all skin malignancies, melanoma has the worst prognosis, Five-year survival rates for people with melanoma depend on the stage of the disease at the time of diagnosis.
High-risk areas for minor surgery include the facial and cervical regions, axillary and supraclavicular regions, wrists, hands and fingers, the groin, the popliteal fossa and the feet.
We must consider those regions with a greater tendency to develop pathological scars (e.g., shoulder, sternal and interscapular region). Also the skin of black patients and children are especially prone.
For most basic minor surgical procedures, no preoperative work-up is needed. Table 3 summarizes the precautions of minor surgery in primary care.
-Surgery in the lower extremities in patients with Diabetes Mellitus and peripheral vascular disease. -In patients with arrhythmia, severe hypertension, hyperthyroidism, pheochromocytoma or pregnancy, do not add vasoconstrictor to local anesthetic -Anatomic areas of risk -In patients with chronic use of corticosteroids. Protocol for minor surgery in anticoagulated patients - 3 Day Suspend Sintrom ® - 2 Day Suspend Sintrom ® and add subcutaneous LMWH - 1 Day Suspend Sintrom ® and add subcutaneous LMWH, single dose - 0 Day INR Control. If between 1 and 1.6 proceed to surgery. LMWH single subcutaneous dose. Patient will take the usual dose of Sintrom ® (the same as before the suspension). +1 Day LMWH single subcutaneous dose usual dose of Sintrom ® +2 Day usual dose of Sintrom ® +3 Day LMWH single subcutaneous dose. Usual dose of Sintrom ® +4 Day usual dose of Sintrom ® INR will be obtained on day +10 (seven days after surgery) |
Precautions of minor surgery.
In patients with increased anxiety, 5–10 mg oral or sublingual diazepam, or 1–5 mg sublingual lorazepam can be administered 30 minutes before surgery.
Contraindications for minor surgery: Malignant skin lesion, allergy to local anesthetics, pregnancy (surgery should be deferred until the end of pregnancy, if malignancy is suspected, the patient should be referred to a specialist), an acute illness, doubt about patient’s motivations, patients with psychiatric disorders or uncooperative patients or refusal to sign the informed consent form is a contraindication for any minor surgery procedure or technique.
Direct oral anticoagulants [DOACs] (Dabigatran, Rivaroxaban, Apixaban, Edoxaban): If a moderate or high bleeding risk surgery, it can be omitted for approximately 2–3 days before a procedure, and resume 24 hours after surgery. However, cutaneous procedures (e.g., skin biopsy, tumor excision, bone marrow biopsy) generally considered to confer a low risk of bleeding [15].
Vasovagal syncope is the most frequent complication and is more common in young men. Even some patients lose consciousness.
Treatment consists in administering oxygen and iv. fluids if needed and, in severe cases use atropine (0.5–1 mg sc or iv). Generally, most of patients recover spontaneously over a period of seconds to a few minutes.
Infection can occur in up to 1% of minor surgical patients, symptoms such as fever and/or chills are only rarely seen. Infections are treated by removing some of the stitches, plus daily cleaning and disinfection of the wound and allowing the wound to close by secondary intention. If necessary an oral antibiotic regimen may be initiated and inserted drain into the wound.
Hematoma-seroma: is paramount suturing the wound in layers with no gaps and, applying a compressive bandage to prevent their formation.
Wound dehiscence: After wound dehiscence, repairs will take place by secondary intention.
Hypertrophic scar and keloid scarring.
The authors declare no conflict of interest.
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',metaTitle:"Publication Agreement - Chapters",metaDescription:"IN TECH aims to guarantee that original material is published while at the same time giving significant freedom to our authors. For that matter, we uphold a flexible copyright policy meaning that there is no transfer of copyright to the publisher and authors retain exclusive copyright to their work.\n\nWhen submitting a manuscript the Corresponding Author is required to accept the terms and conditions set forth in our Publication Agreement as follows:",metaKeywords:null,canonicalURL:"/page/publication-agreement-chapters",contentRaw:'[{"type":"htmlEditorComponent","content":"The Corresponding Author (acting on behalf of all Authors) and INTECHOPEN LIMITED, incorporated and registered in England and Wales with company number 11086078 and a registered office at 5 Princes Gate Court, London, United Kingdom, SW7 2QJ conclude the following Agreement regarding the publication of a Book Chapter:
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\\n\\nLast updated: 2020-11-27
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The Corresponding Author (acting on behalf of all Authors) and INTECHOPEN LIMITED, incorporated and registered in England and Wales with company number 11086078 and a registered office at 5 Princes Gate Court, London, United Kingdom, SW7 2QJ conclude the following Agreement regarding the publication of a Book Chapter:
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\n\nCorresponding Author: The Author of the Chapter who serves as a Signatory to this Agreement. The Corresponding Author acts on behalf of any other Co-Author.
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\n\n3.4 The Corresponding Author and any Co-Author shall respect confidentiality rights during and after the termination of this Agreement. The information contained in all correspondence and documents as part of the publishing activity between IntechOpen and the Corresponding Author and any Co-Author are confidential and are intended only for the recipient. The contents may not be disclosed publicly and are not intended for unauthorized use or distribution. Any use, disclosure, copying, or distribution is prohibited and may be unlawful.
\n\n4. CORRESPONDING AUTHOR'S WARRANTY
\n\n4.1 The Corresponding Author represents and warrants that the Chapter does not and will not breach any applicable law or the rights of any third party and, specifically, that the Chapter contains no matter that is defamatory or that infringes any literary or proprietary rights, intellectual property rights, or any rights of privacy. The Corresponding Author warrants and represents that: (i) the Chapter is the original work of themselves and any Co-Author and is not copied wholly or substantially from any other work or material or any other source; (ii) the Chapter has not been formally published in any other peer-reviewed journal or in a book or edited collection, and is not under consideration for any such publication; (iii) they themselves and any Co-Author are qualifying persons under section 154 of the Copyright, Designs and Patents Act 1988; (iv) they themselves and any Co-Author have not assigned and will not during the term of this Publication Agreement purport to assign any of the rights granted to IntechOpen under this Publication Agreement; and (v) the rights granted by this Publication Agreement are free from any security interest, option, mortgage, charge or lien.
\n\nThe Corresponding Author also warrants and represents that: (i) they have the full power to enter into this Publication Agreement on their own behalf and on behalf of each Co-Author; and (ii) they have the necessary rights and/or title in and to the Chapter to grant IntechOpen, on behalf of themselves and any Co-Author, the rights and licenses expressed to be granted in this Publication Agreement. If the Chapter was prepared jointly by the Corresponding Author and any Co-Author, the Corresponding Author warrants and represents that: (i) each Co-Author agrees to the submission, license and publication of the Chapter on the terms of this Publication Agreement; and (ii) they have the authority to enter into this Publication Agreement on behalf of and bind each Co-Author. The Corresponding Author shall: (i) ensure each Co-Author complies with all relevant provisions of this Publication Agreement, including those relating to confidentiality, performance and standards, as if a party to this Publication Agreement; and (ii) remain primarily liable for all acts and/or omissions of each such Co-Author.
\n\nThe Corresponding Author agrees to indemnify and hold IntechOpen harmless against all liabilities, costs, expenses, damages and losses and all reasonable legal costs and expenses suffered or incurred by IntechOpen arising out of or in connection with any breach of the aforementioned representations and warranties. This indemnity shall not cover IntechOpen to the extent that a claim under it results from IntechOpen's negligence or willful misconduct.
\n\n4.2 Nothing in this Publication Agreement shall have the effect of excluding or limiting any liability for death or personal injury caused by negligence or any other liability that cannot be excluded or limited by applicable law.
\n\n5. TERMINATION
\n\n5.1 IntechOpen has a right to terminate this Publication Agreement for quality, program, technical or other reasons with immediate effect, including without limitation (i) if the Corresponding Author or any Co-Author commits a material breach of this Publication Agreement; (ii) if the Corresponding Author or any Co-Author (being an individual) is the subject of a bankruptcy petition, application or order; or (iii) if the Corresponding Author or any Co-Author (being a company) commences negotiations with all or any class of its creditors with a view to rescheduling any of its debts, or makes a proposal for or enters into any compromise or arrangement with any of its creditors.
\n\nIn case of termination, IntechOpen will notify the Corresponding Author, in writing, of the decision.
\n\n6. INTECHOPEN’S DUTIES AND RIGHTS
\n\n6.1 Unless prevented from doing so by events outside its reasonable control, IntechOpen, in its discretion, agrees to publish the Chapter attributing it to the Corresponding Author and any Co-Author.
\n\n6.2 IntechOpen has the right to use the Corresponding Author’s and any Co-Author’s names and likeness in connection with scientific dissemination, retrieval, archiving, web hosting and promotion and marketing of the Chapter and has the right to contact the Corresponding Author and any Co-Author until the Chapter is publicly available on any platform owned and/or operated by IntechOpen.
\n\n6.3 IntechOpen is granted the authority to enforce the rights from this Publication Agreement, on behalf of the Corresponding Author and any Co-Author, against third parties (for example in cases of plagiarism or copyright infringements). In respect of any such infringement or suspected infringement of the copyright in the Chapter, IntechOpen shall have absolute discretion in addressing any such infringement which is likely to affect IntechOpen's rights under this Publication Agreement, including issuing and conducting proceedings against the suspected infringer.
\n\n7. MISCELLANEOUS
\n\n7.1 Further Assurance: The Corresponding Author shall and will ensure that any relevant third party (including any Co-Author) shall, execute and deliver whatever further documents or deeds and perform such acts as IntechOpen reasonably requires from time to time for the purpose of giving IntechOpen the full benefit of the provisions of this Publication Agreement.
\n\n7.2 Third Party Rights: A person who is not a party to this Publication Agreement may not enforce any of its provisions under the Contracts (Rights of Third Parties) Act 1999.
\n\n7.3 Entire Agreement: This Publication Agreement constitutes the entire agreement between the parties in relation to its subject matter. It replaces and extinguishes all prior agreements, draft agreements, arrangements, collateral warranties, collateral contracts, statements, assurances, representations and undertakings of any nature made by or on behalf of the parties, whether oral or written, in relation to that subject matter. Each party acknowledges that in entering into this Publication Agreement it has not relied upon any oral or written statements, collateral or other warranties, assurances, representations or undertakings which were made by or on behalf of the other party in relation to the subject matter of this Publication Agreement at any time before its signature (together "Pre-Contractual Statements"), other than those which are set out in this Publication Agreement. Each party hereby waives all rights and remedies which might otherwise be available to it in relation to such Pre-Contractual Statements. Nothing in this clause shall exclude or restrict the liability of either party arising out of its pre-contract fraudulent misrepresentation or fraudulent concealment.
\n\n7.4 Waiver: No failure or delay by a party to exercise any right or remedy provided under this Publication Agreement or by law shall constitute a waiver of that or any other right or remedy, nor shall it preclude or restrict the further exercise of that or any other right or remedy. No single or partial exercise of such right or remedy shall preclude or restrict the further exercise of that or any other right or remedy.
\n\n7.5 Variation: No variation of this Publication Agreement shall be effective unless it is in writing and signed by the parties (or their duly authorized representatives).
\n\n7.6 Severance: If any provision or part-provision of this Publication Agreement is or becomes invalid, illegal or unenforceable, it shall be deemed modified to the minimum extent necessary to make it valid, legal and enforceable. If such modification is not possible, the relevant provision or part-provision shall be deemed deleted.
\n\nAny modification to or deletion of a provision or part-provision under this clause shall not affect the validity and enforceability of the rest of this Publication Agreement.
\n\n7.7 No partnership: Nothing in this Publication Agreement is intended to, or shall be deemed to, establish or create any partnership or joint venture or the relationship of principal and agent or employer and employee between IntechOpen and the Corresponding Author or any Co-Author, nor authorize any party to make or enter into any commitments for or on behalf of any other party.
\n\n7.8 Governing law: This Publication Agreement and any dispute or claim (including non-contractual disputes or claims) arising out of or in connection with it or its subject matter or formation shall be governed by and construed in accordance with the law of England and Wales. The parties submit to the exclusive jurisdiction of the English courts to settle any dispute or claim arising out of or in connection with this Publication Agreement (including any non-contractual disputes or claims).
\n\nLast updated: 2020-11-27
\n\n\n\n
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