Medicolegal aspects of surgical diathermy burns: A case report and review of the literature

Abstract

Diathermy plays an integral part in most operations, either for dissection or coagulation, and it is used on a regular basis by surgeons of all specialties. Even though modern diathermy equipment is considered to be safe, accidents still do happen. These accidents particularly occur if the operation is performed in emergency situations in which the patient's clinical condition is urgently fatal and the members of the team could only focus to the surgical area. The false steps in monopolar diathermy application cause a situation called the diathermy burns. In this report we present the case of a man who had acute chest pain due to rupture of aortic aneurism. While he was being taken into operation, cardiopulmonary arrest developed. He was resuscitated intra operatively and the operation was completed. After this operation burns on the anterior surface of the right hand, elbow and the distal forearm were noticed. We wanted to emphasize that accidental diathermy burns can cause unsightly scarring that limits motion in affected joints or function of other tissues and review the literature to explain possible causes and dealing with this kind of situation in the medicolegal aspects.

Hand Skin Burn as a Complication of Electrosurgery Use in Prone Position in Surgery: A Case Report

“…ESU burns have the potential to cause morbidity to patients and prolong hospital stay with the need for subsequent surgical interventions as debridement and skin grafting [7,15]. A lawsuit is another aspect that lies a burden on patients and the health care system in these cases [16]. Our patient did not require further surgical intervention, but the hospital stay prolonged for five days more than the expected date of discharge.…”

“…This pattern of burn in the prone position is not mentioned in the literature up to our knowledge. Patient safety is granted by whole OR staff, and such an injury is predictable, therefore preventable with a basic understanding of ESU principals and proper training for safe use, and with knowledge of its possible complications as well as for the prone position [9,12,16].…”

Multi-component plasma fluid approach to sparking enhanced burns as a complication of diathermy

“…Although the incidence of electrosurgical injuries related to diathermy has been reported, it is difficult to comprehend the true impact on the patient body. [6][7][8][9] A potential difference produced by the diathermy device generates a current that passes through the patient to complete an electrical circuit unipolar or bipolar. In unipolar diathermy, the cathode represents diathermy tool tip, while the anode is the ground or return plate10.…”

Diathermy awareness among surgeons-An analysis in Ireland

“…Procedures commonly involving the use of these instruments include breast wide local excisions, axillary dissections, Whipple procedure, colectomy, liver resections, nephrectomy, cholecystectomy and prostatectomy. While diathermy is generally accepted as ‘safe’, electrosurgery-induced injuries are among the more common causes for malpractice litigation [1].…”

“…The second is lack of awareness of the correct functioning of the equipment, for example incorrect positioning of the grounding pad causing a burn to the patient. Both of these factors appear more common in emergency surgery [1]. Modern surgery is heavily reliant on diathermy and it is incumbent on the surgeon to be fully cognizant of its safe and appropriate use.…”