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Thursday, September 16, 2010

Burns in the OR and how to avoid them.

Doctor my wife had back surgery and the next morning the nurse while checking her incision asked her how she burned her buttock because she had large blisters on it. She said she hadn't burned her buttock. The blisters burst that evening and they treated her with topical ointment. They kept her a 2 days longer then they had originally told her she would be able to go home. I took her to the family doctor and he just wasn't sure but thought they were 2nd and 3rd degree burns and prescribed Silvadene ointment which seemed to help it heal faster.
They won't give a explanation of the blister other then to say she scooted on her buttock and they were bed sores. She had these less then 24 hours after surgery and only was lying on her side in the bed.

Please give us your opinion.
Thanks for your help Sir,

J.B.



Dear Mr JB,
Thank you very much for your letter. I am sorry to hear your wife had a possible burn in the theatre. From the history it appears that this resulted after the operation. Whether it occurred in the theatre or afterwards in the ward prior to being noticed the next morning is difficult to say.
If it is did occur it the theatre, there are a few causes that can lead to this clinical presentation:-

1. Allergy to the scrubbing agent

Some patients are allergic to the skin scrubs or antiseptic that are used to clean the skin prior to surgery: like betadine , hibiscrub or cetrimide solution.
I have seen quite a few of these in some unfortunate patients. However they are usually 2nd degree superficial burns- with blistering on the following day and often tend to heal with conservative treatment i.e. dressings and local wound care.
Patients going to the OR must specifically be asked for any allergy to chemical and scrub agents.

2. Bedsores/ pressure sores.
Sometimes the patient is put in a particular position during surgery and due to the long hours of surgery pressure areas may show redness and blistering. Often this pressure area is superficial and tends to heal well with local wound care. Surgeons and OR staff must take great care to monitor pressure areas and change them if possible or provide extra padding.

3. Thermal Burns.
Electrocautery is used during surgery for the purpose of cutting tissue and coagulating blood vessels to control bleeding. When a monopolar cautery is used a cautery pad is applied over some part of the body to complete the circuit for the device to function. If for any reason there is a malfunction a burn may result over the area and skin pad to which it has been applied. If this is discovered early the burn may be superficial but often this is noticed when the pad has been removed after surgery and by this time the burn is normally a deep burn as every time the surgeon uses his cautery, probably the skin gets a burn. Deep burns of this kind often need surgical excision and skin grafting to heal the wound.

4. Thermal burns for the O.T lights.
In the past the lights used in the operation theatre generate a lot of heat and focusing the light on a area of skin for a long surgery sometimes resulted in a burn. In some patient who had a sensitive skin it formed a 2nd degree burn while in others it resulted in a 1st degree burn akin to a sunburn.
In recent times the quality of the OR lights have improved significantly and rarely does one see a burn for this source.

5.Thermal burns from materials used during surgery
Sometimes accidental burns can result from any hot materials used during surgery. If hot water is used for any purpose such as to soften a thermoplastic elements or otherwise and falls accidentally on the patient, a burn can result . This depends on the type of surgery and techniques used there in. However this is quite rare as surgeons and OR staff are extremely cautious when it comes to procedures that can cause burns in patients. High speed drills and mechanical devices should be used with care to avoid friction burns.

6. Lasers.
The use of laser can sometimes result in burn on the patients depending on the skin sensitivity, type of laser , intensity of the laser, the laser machine and the surgeons experience. Laser machines should be used carefully and always a test patch should be carried out before the complete procedure is undertaken.

7. Sticking tape allergy.
Many patients show allergy to skin tapes that are applied after the surgery is over. Prior history and allergy to skin tapes should be asked for. Similarly use tapes that are hypoallergenic and light on the skin. However these appears as redness or blistering when the tapes are removed and settle down and heal with local wound care.

I have put together a number of circumstances that can lead to burn like presentation in operation theatre. However surgeons and OR staff are well trained and take great care in preventing accidental injuries to patients entering the theatre. I hope that this reply is used only for educational purposes and is not for purposes of litigation or otherwise. Creating awareness among patients and medical professionals will help decrease these unfortunate OR incidents.

Asktheburnsurgeon.+

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