Department of Dermatology, Stanford University School of Medicine, Redwood City, California, USA.
J Am Acad Dermatol. 2012 Oct;67(4):700-5. doi: 10.1016/j.jaad.2012.04.026. Epub 2012 May 26.
Surgical fires are a rare, but serious complication of dermatologic procedures involving electrosurgical and laser devices. Given the lack of data regarding basic fire safety principles, many dermatologists remain unaware of this potential risk.
We evaluated the flammability of topical preparations and surgical drapes commonly encountered in the immediate operative field during cutaneous and laser surgery.
Surgical dressings, drapes, and pork belly skin were examined for fire risk upon exposure to isopropyl alcohol, chlorhexidine gluconate, and aluminum chloride under dry, saturated, and damp conditions. Both electrosurgery and a carbon-dioxide laser were used as ignition sources.
At least some char was observed in 86 of 126 simulated conditions (68%). Flames occurred in 2 test conditions: dry underpad drapes and cotton balls exposed to the carbon-dioxide laser. In general, drapes and dressings dampened or saturated with isopropyl alcohol failed to ignite with electrofulguration or electrodessication, although sparks and moderate char developed on pork belly skin and the underpad drape. Materials dampened or saturated with chlorhexidine gluconate, which contains isopropyl alcohol, generated less smoke and char compared with materials exposed to aluminum chloride, which does not contain alcohol.
Future studies may assess the flammability of materials in the setting of oxygen supplementation.
In common cutaneous surgical environments, electrosurgery or ablative laser may lead to char and rarely to fire. Char may be seen in up to two thirds of simulated conditions, and in a minute proportion of conditions, fire is observed.
手术火灾是一种罕见但严重的皮肤科手术并发症，涉及电外科和激光设备。由于缺乏关于基本防火安全原则的数据，许多皮肤科医生仍然不知道这种潜在的风险。
我们评估了在皮肤和激光手术过程中，常见于手术现场的局部制剂和手术巾的可燃性。
在干燥、饱和和潮湿条件下，检查手术敷料、手术巾和猪腹皮暴露于异丙醇、葡萄糖酸洗必泰以及氯化铝时的火灾风险。使用电外科和二氧化碳激光作为点火源。
在 126 种模拟条件中的至少 86 种（68%）中观察到至少有一些烧焦。在 2 种测试条件下发生了火焰：干燥的衬垫和暴露于二氧化碳激光的棉花球。一般来说，用异丙醇浸湿或饱和的手术巾和手术巾不会因电灼或电干燥而点燃，尽管在猪腹皮和衬垫上会产生火花和中度烧焦。用含有异丙醇的葡萄糖酸洗必泰浸湿或饱和的材料比用不含酒精的氯化铝浸湿或饱和的材料产生的烟雾和烧焦少。
未来的研究可能会评估在补充氧气的情况下材料的可燃性。
在常见的皮肤手术环境中，电外科或消融激光可能会导致烧焦，偶尔会导致火灾。在多达三分之二的模拟条件中可以看到烧焦，在极少数情况下可以观察到火灾。
