Rare case of Operation Theatre Light Burn after a surgery: A Report

New Delhi: Accidental burns in operation theatre are very unusual. Burns due to electro-cautery and use of alcohol-based antiseptics are well documented in the literature. Iatrogenic burns due to prolonged operating light exposure are very rare and can cause severe damage in sensitive areas like the inguinal region.

Hemant Bansal et al reported OT light burn in a 40-year-old man operated at Department of Orthopaedics, JPN Apex Trauma Centre, AIIMS, New Delhi, India. He was surgically treated with open reduction and internal fixation for old neglected, non-union, pelvic ring injury right side. In the immediate postoperative day, the patient had a large blister adjacent to the surgical site at the right inguinal region which complicated with eschar formation, and later split skin grafting was done.

A 40-year-old man presented with pain and limp in right lower limb, inability to bear weight on the affected limb with difficulty in squatting and cross-legged sitting for eight weeks. He had a history of trauma (road traffic accident) 4 months back, with the pelvic injury of the right side which was managed conservatively on skeletal traction in another hospital. The patient had started walking with aid as tolerated after 6 weeks.

The radiograph of the patient revealed a combined mechanism of pelvic injury with a non-union of lateral compression type II right side pelvic injury according to Young–Burgess classification with a mild vertical shift of right hemipelvis which was progressively increasing due to weight-bearing on the affected side.

The patient was operated on in a supine position using a modifed ilioinguinal approach. After releasing fibrotic adhesions between fracture fragments and reducing the vertical shift, the pelvic ring was fixed using pubic symphysis and iliac crest plating. The surgery lasted for 4 h with 800 ml of cumulative blood loss. At the end of the surgery, skin and soft tissue around the incision were normal without any evidence of electrocautery or chemical irritation burn.

On a postoperative day one, the patient had a large blister over the inner inguinal region just above the suture line which was accidentally ruptured while dressing and then the patient was found to have second-degree burns with deep partial-thickness burn in the center and superficial partial thickness burn in the periphery as per Burn's classification. Burn site was managed with regular dressing. The burn wound later had eschar formation which was sequentially debrided and the exposed raw area was covered with split skin grafting with complete uptake.

Orthopaedic surgeries involving sensitive body areas like the inguinal region demands special attention. Hence, the authors suggest decreasing the illumination intensity at the operating site using less focused light for prolonged surgeries, avoiding the convergence of multiple lights at a particular area, and maintaining a minimum distance of 1 m between the operating site and light. Continuous irrigation of the operative site might also decrease the thermal effect of prolonged light exposure. Using a saline sponge to temporarily cover the non-active operative sites might also assist in decreasing the chance of this rare yet avoidable complication. With proper precaution and awareness, one can avoid this complication and improve patient care.

Further reading:

Operating Light Burn in an Orthopaedic Surgery: A Case Report

Hemant Bansal, Vivek Veeresh, Samarth Mittal, Vivek Trikha.

Indian Journal of Orthopaedics (2022) 56:510–513 https://doi.org/10.1007/s43465-021-00497-0