Surgical diathermy is an invaluable aid in modern surgery, and most contemporary diathermy machines are considered safe. The literature has proven to be very sparse in terms of reference to complications, although prolonged courses of treatment are required in individual cases. We report a case of burns that occurred during a saphenous vein coronary bypass graft caused by the inadequate use of the electrosurgical materials. Care should be taken in the use of these resources to avoid complications of this kind.
The ever-increasing use of high-frequency (HF) surgery is an intrinsic part of modern-day surgery. 1 Risks and complications are still on the increase despite the incorporation of various safety measures. The origins of diathermy date back to the discoveries of D’Aversonal in 1893 2 and Nagelschimidt in 1909, 3 who investigated the effects of the controlled use of HF currents on biological tissue.
As the technique became more widespread, there was a rise in the number of injuries and complications reported and, above all, of burns directly associated with diathermy. 4-10 These were generated by the increasing use, in the interest of patient safety, of other electrical devices such as ECGs, 11-13 temperature probes, 14 cerebral compression probes, etc, coupled with ignorance of current flow interactions brought about by the concomitant use of various devices. The potential explosion of combustible gases in anesthesia, endogenous intestinal gas, 15,16 the induction of arrhythimias, 17,18 and the effect on pacemakers as the result of alternating current frequency pose additional risks in electrosurgery. Battig 4 described neuromuscular phenomena that can lead to fasciculation of the legs during urological surgery involving the use of an electrosurgical knife at frequencies of less than 0.3 MHz in the vicinity of the obturator nerve.
Additionally, muscle fibers can be activated by the direct electrical stimulation of diathermy and also by blocked motor endplates. This can lead to contraction of the major muscles, which may, in turn, be misinterpreted as inadequate anesthesia. This work discusses in detail the various circumstances that may lead to burns in the use of diathermy.
From the Burns Unit of Hospital de Pronto Socorro de Porto Alegre, Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, Porto Alegre, Brazil.
Address correspondence to Julio Walter Vedovato, MD, Av Julio de Castilhos, 2140/901 Centro, Caxias do Sul/RS Brazil CEP 95010–002.