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