Complications, Implications, and Prevention of Electrosurgical Injuries: Corner Stone of Diathermy Use for Junior Surgical Trainees

Simple dentate area fractures of the mandible - can we prevent postoperative infections?

OBJECTIVE

To evaluate the occurrence of surgical site infections and predisposing factors for these in simple mandibular fractures.

MATERIAL AND METHODS

A retrospective study of patients with fractures of the dentate part of the mandible included patients with intraorally treated simple fractures of the mandibular body, symphysis, and parasymphysis. The primary outcome variable was postoperative surgical site infection. Use of antibiotics, injury mechanism, fracture and surgery-related explanatory variables, patient-related variables and level of oral hygiene according to the modified Total Dental Index were evaluated.

RESULTS

Of 254 patients with mandibular fractures, 107 were included in the final analysis. The infection group consisted of 18 patients (16.8%). Despite the high infection occurrence, significant differences were not found between antibiotic use or other studied variables and infection occurrence. Infections occurred mainly in patients without any specific explanatory factor for infection.

CONCLUSION

The notably high occurrence of surgical site infections despite antibiotic use after simple mandibular fracture surgery highlights the importance of perioperative tissue handling and local oral circumstances. It is also necessary to consider whether we generally accept the high risk of infection associated with the intraorally treated simple mandibular fractures.

Electrosurgery Use During Post-Mohs Micrographic Surgery Repair and Complication Rates-How Important is a Dry Field?

BACKGROUND

Electrosurgery is used to achieve hemostasis during surgery. There are no studies exploring the effects of the use or avoidance of electrodessication during Mohs micrographic surgery (MMS) repair. Given the growing concerns for tissue aerosolization, occupational smoke exposure, and spread of infectious diseases, it is important to determine the importance of electrical hemostasis.

MATERIALS AND METHODS

In this retrospective study, electronic medical records of a single, tertiary, academic dermatology practice were reviewed. All MMS cases that underwent surgical repair from January 1 to December 31, 2019, by 2 dermatologic surgeons (one who used electrodessication during repair and one who did not) were included. Patient demographic data, information regarding the procedures, and complications occurring 90 days after MMS were recorded.

RESULTS

One hundred ninety-eight cases of MMS repair used electrodessication, whereas 193 cases did not. There was no significant difference in the demographic makeup, MMS procedure, or 90-day complication rates between the 2 groups. No major adverse events were MMS-related.

CONCLUSION

The use or avoidance of electrodessication during MMS repair was not associated with increased 90-day postoperative complications, suggesting that a greater tolerance of moderate oozing at a surgical site during MMS repair is reasonable to minimize electrosurgical tissue damage and occupational smoke exposure.

Diathermy-induced Ventricular Fibrillation

Diathermy is extensively used in patients for intracardiac device implant and extraction. While diathermy helps with adequate hemostasis, it may rarely be associated with fatal dysrhythmias. We report a case of diathermy-induced ventricular fibrillation during device extraction. The case highlights the importance and supports the involvement of a defibrillation facility during pacemaker revisions requiring diathermy.

Electrosurgical unit: Iatrogenic injuries and medico-legal aspect. Italian legal rules, experience and article review

BACKGROUND

The use of the electrosurgical unit (ESU) is well-established in the surgical practice. The Authors, to better understand the genesis of injuries connected to the use of electrosurgical instruments, conducted an in-depth literature review pertaining to this topic.

MATERIALS AND METHOD

Using the most important medical databases, a research of experimental studies in the last 20 years was conducted.

RESULTS

The analysis of the mechanisms responsible for the lesions showed that high energy devices remain as the most common cause of injury. Adverse events are mainly given by thermal injuries; cases of electromagnetic interference are also described in patients with pacemakers or sacral nerve stimulator and spinal stimulators as well as cases of fire of the endotracheal tube in the course of tracheostomy for the use of the electrosurgical unit in an environment with a high concentration of oxygen or anesthetic gases. Also reported in the literature are individual cases of fires caused by sparks from the electrosurgical handpiece also for the use of disinfectants and/or in relation to surgical drapes.

CONCLUSION

In order to clearly define the medical-legal aspects, focusing on the professional responsibility of the surgical and nursing staff, the authors' attention was brought to the need for an effective prevention plan that highlights not only the importance of an accurate procedural knowledge in order to safety use the electrosurgical instruments, but also the need for a system that monitors any complications or adverse events resulting from the use of such instruments.

Fatigue strength reduction of Ti-6Al-4V titanium alloy after contact with high-frequency cauterising instruments

Contact of implants with high-frequency cauterising instruments has serious implications for patient safety. Studies have reported a possible direct connection of fatigue failure of Ti-6Al-4V implants with electrocautery contact. Such contacts were observed at the polished neck of titanium hip stems, which are subjected to high-tension loads. Evidence of electrocautery contact has also been found on a retrieved spinal fixator with a rough surface; however, no fatigue failure related to electrocautery contact has been reported thus far. The influence of the heat-affected zone caused by flashover on the mechanical behaviour of the Ti-6Al-4V titanium alloy is not yet fully understood. Then, the aim of this study was to investigate whether the polished areas of Ti-6Al-4V implants are especially susceptible to fatigue failure after electrocautery contact. Flashovers caused by electrocautery contact were induced on titanium specimens with different surface roughnesses. These specimens were subjected to cyclic loading in a four-point-bending test setup, which represented the stress resulting from physiological loading activities (~861 MPa). In this test setup, electrocautery contact was found to reduce the fatigue strength of the titanium alloy significantly-by up to 96%-as revealed from the median value of the cycles to failure. Cycles to failure showed a dependence on the flashover duration, with a flashover for 40 ms leading to fatigue fracture. Despite the lower fatigue strength of a rough polished surface in the undamaged state, it is less prone to the damaging effect of flashover than a smooth polished surface.