Mundinger Gerhard S, Rozen Shai M, Carson Benjamin, Greenberg Robert S, Redett Richard J
Johns Hopkins School of Medicine, Baltimore, MD, USA.
Eplasty. 2007 Nov 20;8:e1.
This study aims to contextualize an unintended intraoperative electrocautery burn that occurred on our service within the spectrum of all intraoperative electrocautery burns.
A case report of the incident was drafted, and the relevant literature present in PubMed and industry publications was reviewed.
Intraoperative electrocautery burns can be divided into 4 categories: (1) direct contact burns resulting from inappropriate operator use of the active electrode, (2) burns at the grounding electrode site due to improper attachment or placement, (3) burns resulting from electrode heating of pooled solutions, and (4) burns occurring outside the operative field as a result of circuits generated between the active electrode and an alternate grounding source. We herein report an unintended intraoperative electrocautery burn of the fourth category. An aberrant intraoperative circuit utilized previously placed in-dwelling titanium plating in the patient's right brow as the grounding electrode, resulting in 3 x 3-cm full-thickness skin necrosis overlying the site of hardware implantation.
Literature recommendations to reduce this type of electrocautery burn suggest avoiding grounding pad placement on the forearm and lateral thigh, although further investigation is needed to determine optimal grounding electrode placement with respect to known indwelling hardware.
本研究旨在将我们科室发生的一例意外术中电灼烧伤置于所有术中电灼烧伤的范围内进行背景分析。
起草了该事件的病例报告，并查阅了PubMed和行业出版物中的相关文献。
术中电灼烧伤可分为4类：（1）术者对活动电极使用不当导致的直接接触烧伤；（2）接地电极部位因附着或放置不当导致的烧伤；（3）电极加热积液导致的烧伤；（4）活动电极与备用接地源之间产生的电路导致手术区域外发生的烧伤。我们在此报告一例第四类意外术中电灼烧伤。术中一个异常电路利用了先前置于患者右眉的内置钛板作为接地电极，导致硬件植入部位上方出现3×3厘米的全层皮肤坏死。
文献中关于减少此类电灼烧伤的建议包括避免在前臂和大腿外侧放置接地垫，不过需要进一步研究以确定相对于已知内置硬件的最佳接地电极放置位置。
