Implementation of an Electrosurgical Checklist in a Podiatry Unit in Relation to a Case of Inadvertent Burns during Hallux Valgus Surgery

Abstract

Iatrogenic burns are unpleasant and sometimes difficult to explain to patients. Podiatric surgeons routinely use electrosurgical devices to cut and coagulate tissue during surgical procedures. Although advances in technology have made electrosurgery increasingly safer for patients and personnel, its use is still poorly understood by the surgical community, and the hazards associated with its use still exist presently. Human error, direct or indirect transfer of electricity to a conductive device, or device malfunction can cause serious adverse events, including burns, electrical shocks, and or fires. Here, we report a rare case of a 43-year-old man who suffered severe burns during hallux valgus surgery. The surgeon and the nursing staff did not notice any injuries during the surgical intervention. This unusual clinical case serves to highlight the importance of implementing protocols to prevent injuries related to the use of electrosurgery. Based on this report, a specific checklist was implemented to prevent adverse events related to electrosurgery in our podiatric surgery unit to reduce the risk of electrosurgical complications. The implementation of the checklist can be useful to help health professionals improve patient safety during surgery and avoid potential medico-legal liability claims.

Keywords: burns; electrosurgical injury; electrosurgical safety; monopolar diathermy.

Figure 1

Postoperative radiological aspect of foot after the first procedure.

Figure 2

Postoperative appearance of the medial incision prior to staple removal.

Figure 3

Appearance of the foot at seven days (a), and two weeks postoperatively (b).

Figure 4

Rupture and desiccation of the blisters with areas of epidermal necrosis can be observed after three weeks (a). Aspect after surgical excision of epidermal necrosis areas (b).

Figure 5

Postoperative radiography one year after the second procedure. Signs of severe joint destruction compatible with resection arthroplasty can be observed.

Figure 6

Electrosurgical safety checklist model. Items to evaluate before the use of monopolar diathermy.