Elsevier

Burns

Volume 42, Issue 4, June 2016, Pages e74-e80
Burns

Case report
Iatrogenic surgical microscope skin burns: A systematic review of the literature and case report

https://doi.org/10.1016/j.burns.2015.08.014Get rights and content

Highlights

  • We present all adverse events associated with surgical microscope skin burns in the literature.

  • We present all adverse events reported to the FDA regarding surgical microscope skin burns.

  • Iatrogenic microscope soft tissue burns are rare events.

  • It is unclear what factors are associated with iatrogenic surgical microscope skin burns.

  • We report “best practice” recommendations to prevent these deleterious events.

Abstract

Cutaneous burns associated with microscope-use are perceived to be uncommon adverse events in microsurgery. Currently, it is unknown what factors are associated with these iatrogenic events. In this report, we describe the case of a 1-year-old patient who suffered a full thickness skin burn from a surgical microscope after a L4-S1 laminectomy. Additionally, we present a systematic review of the literature that assessed the preoperative risk, outcome, and management of iatrogenic microscope skin burns. Lastly, a summary of the Food and Drug Administration's (FDA) Manufacturer and User Facility Device Experience (MAUDE) database of voluntary adverse events was reviewed and analyzed for clinical cases of microscope thermal injuries. The systematic literature review identified only seven articles related to microsurgery-related cutaneous burns. From these seven studies, 15 clinical cases of iatrogenic skin burns were extracted for analysis. The systematic review of the FDA MAUDE database revealed only 60 cases of cutaneous burns associated with surgical microscopes since 2004. Few cases of microscope burns have been described in the literature; this report is, to our knowledge, one of the first comprehensive reports of this iatrogenic event in the literature.

Introduction

Over the past 30 years, microsurgery has evolved significantly. Advances in surgical techniques have paralleled advances in technology, optimizing outcomes and efficiency in general microsurgical practice and enhancing the microsurgeon's ability to tackle increasingly complex cases. Among the technological advances has been the dramatic improvement in optics, magnification, and illumination of the standard operating microscope [1].

Though improved technology has allowed for expansion of microsurgical techniques to previously untreatable problems, there are potentially adverse consequences associated with the use of such technology. Operating at increased levels of magnification requires the utilization of powerful heat-generating light sources. As the distance from the light source to the tissue decreases, the intensity of the radiant heat on the tissue increases. Recent case reports in the fields of hand surgery [2], [3] and otolaryngology [4], [5] have reported a few cases of microscope burns. However, these iatrogenic events are believed to be uncommon and few studies have assessed what factors play a role in causing them. In this article, we present a case report of a microscope burn in a young child after an L4/S1 laminectomy. Secondly, we also present a systematic review which aims to first, examine the clinical impact of these iatrogenic events, and second to generate several hypotheses on factors that might play a role in increasing the risk of microscope burns in microsurgery. Finally, based on the available evidence, we present “best practice” recommendations to assist the microsurgeon in preventing these deleterious events from occurring in the future.

Section snippets

Systematic literature review

Using guidelines established by The PRIMA Group for systematic reviews and meta-analyses [6], an initial literature review was conducted on May 02, 2015 with the following broad search terms into the MEDLINE database: “microscope” OR “microsurgery” AND “burn.” A total of 918 citations were identified. The abstract of all these citations were examined using strict inclusion/exclusion criteria for applicability. When there was doubt regarding the relevance of the study, the full-text article was

Case:

A 1-year-old female was referred to the neurosurgical team at our institution for skin asymmetry associated with a skin tag on the cephalad aspect of the gluteal cleft. The patient had been born at 33 weeks gestational age to a G1P1 mother following an uneventful pregnancy. On exam, the patient demonstrated age-appropriate physical and cognitive development, and had normal bowel and bladder function as well as lower extremity strength, sensation, and reflexes. A magnetic resonance image (MRI)

Discussion

Although recent advancements in lens optics, magnification, and illumination have led to enhanced visualization of the surgical field, such improvements have been associated with an increased risk of soft tissue thermal injuries [2], [3], [4]. Currently, there is a paucity of literature on thermal injuries from surgical microscope use, suggesting that this problem remains relatively rare. However, given the potential for significant morbidity and liability associated with iatrogenic cutaneous

Conclusions

Iatrogenic microscope soft tissue burns caused by surgical microscopes, although rare, can cause extensive soft tissue damage and place undue harm on surgical patients. Currently, there is certainly a lack of data and published material in this field. With the increase in the number of microsurgical reconstructions, the risk of iatrogenic microscope burns also has the potential to increase. Based on our literature review and analysis, we recommend the following guidelines to decrease the risk

Acknowledgments

None.

References (12)

There are more references available in the full text version of this article.

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