Iatrogenic electric burns and lessons learned from our cases

Abstract

In most cases, high-frequency electrosurgical instruments are used in modern surgery, which utilize their electrothermal effects to achieve targeted tissue destruction. However, there are three main potential causes that may result in electrical burn injuries during surgery: fire caused by the ignition of flammable antiseptic solutions, burns from unintended contact between the device and the skin, and the most common cause is the improper use of the monopolar device, often due to faulty placement of the neutral electrode. Although iatrogenic electrical burns are rare (sporadically reported in the literature), their significance cannot be overlooked. These injuries often present as deep, third-degree burns affecting all layers of the skin. Beyond the usual concerns with burns, electrical injuries require special attention to potential damage beneath the skin’s surface. The psychological effects of these injuries are also considerable. Furthermore, legal consequences are often involved, potentially affecting both the operating surgeon and the treating hospital. This article discusses three cases of intraoperative electrical burns. Our aim is to present three alternative treatment options (negative pressure wound therapy (NPWT) with split-thickness skin grafting, flap closure, necrectomy and primary closure), and to share our results in post-operative scar management, drawing the surgical team’s attention to these avoidable injuries, while emphasizing the importance of education and further training.