May 31, 2012
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Fires were rare in simulated cutaneous, laser surgeries

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Although fire can be a potential complication of dermatologic procedures using electrosurgery and laser devices, char was seen in more than two-thirds of simulated conditions and flames occurred in minute proportions in a recent study.

To evaluate the flammability of various topical preparations and surgical drapes used during cutaneous and laser surgeries, researchers exposed them to isopropyl alcohol, chlorhexidine gluconate and aluminum chloride in 126 simulated events. Each item was tested under dry, saturated and damp conditions and subjected to carbon-dioxide lasers, electrofulguration and electrodesiccation as igniters.

Researchers observed some char in 86 of the simulations (68%), while flames only occurred in two cases: when dry underpad drapes and cotton balls were exposed to a carbon-dioxide laser. Electrofulguration and electrodessication failed to ignite drapes and dressings dampened or saturated with isopropyl alcohol, although sparks and moderate char were observed on pork belly skin and underpad drapes. Investigators also found that exposure of surgical drapes and dressings to aluminum chloride resulted in more smoke and char than exposure to chlorhexidine gluconate in 11 of 18 tested conditions, with no difference between damp and saturated materials.

“Exposure of dry materials to carbon-dioxide laser can generate flames,” the researchers concluded. “When exposed to electrosurgery and carbon-dioxide laser, materials soaked with aluminum chloride produce more smoke and char than those soaked with isopropyl alcohol. Dermatologists should be aware of flammable materials within the surgical field and educate staff regarding fire safety practices.”