Annals of Burns and Fire Disasters - vol. XXV - n. 4 - December 2012

Over the last century electrocautery has emerged as an imperative adjunct to surgery across the entire range of surgical disciplines. A diathermy machine converts electricity of the main supply (240V; 50 Hz) into high frequency current (>100,000 Hz) to minimize the risk of electrical shocks. In monopolar mode, the current from the diathermy enters the patient through the active electrode and exits through the grounding pad. In bipolar mode the current passes between the two prongs of the electrode without any significant flow through the patient and there is no need for the grounding pad. Bovie deserves acknowledgement for his outstanding pioneering role in designing the first surgical diathermy machine in 1928. Since then cautery has been increasingly employed in surgery for cutting and coagulating, ensuring efficient haemostasis during surgery. It has become popular even for making skin incisions, given its quickness, effective haemostasis and associated lesser pain and minimal scarring. Although most of the newest diathermy machines are largely safe, the electric fields they generate are still inherently hazardous for the patient, operating surgeons, and theatre staff. They can cause burn injury, electrocution, operating room fire, smoke inhalation, and gene mutation. Several newer electromedical devices, laparoscopic diathermy and fiberoptic retractors are now emerging, and these pose the same hazards as cautery. The fire triangle consists of three elements necessary for initiation of an operating room fire, i.e. a heat source (e.g. electrocautery unit, laser), fuel (i.e. body tissues), and an oxidizer (supplemental oxygen). Iatrogenic cautery burns during surgery may result from one of the following four mechanisms: direct contact burns from the active electrode resting on the patient’s skin or contacting the operating staff; burns at the site of the grounding electrode; burns resulting from electrode heating of pooled solutions such as spirit; and burns occurring outside the operative field as a result of circuits generated between the active electrode and an alternate grounding source. We report our experience with three patients who presented to us with full-thickness deep burns following haemorrhoidectomy, surgery for coronary artery bypass grafting, and orthopaedic surgery. Our aim is to prompt awareness among the surgical staff regarding this avoidable hazard and promote a proactive attitude on the part of the surgical team towards prevention.