Case Reports

Cutaneous Burn Caused by Radiofrequency Ablation Probe During Shoulder Arthroscopy

Am J Orthop. 2015 February;44(2):E58-E60

References

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3. Pell RF 4th, Uhl RL. Complications of thermal ablation in wrist arthroscopy. Arthroscopy. 2004;20(suppl 2):84-86.

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5. Kouk SN, Zoric B, Stetson WB. Complication of the use of a radiofrequency device in arthroscopic shoulder surgery: second-degree burn of the shoulder girdle. Arthroscopy. 2011;27(1):136-141.

6. Lord MJ, Maltry JA, Shall LM. Thermal injury resulting from arthroscopic lateral retinacular release by electrocautery: report of three cases and a review of the literature. Arthroscopy. 1991;7(1):33-37.

7. Segami N, Yamada T, Nishimura M. Thermal injury during temporomandibular joint arthroscopy: a case report. J Oral Maxillofac Surg. 2004;62(4):508-510.

8. Huang S, Gateley D, Moss ALH. Accidental burn injury during knee arthroscopy. Arthroscopy. 2007;23(12):1363.e1-e3.

9. Lau YJ, Dao Q. Cutaneous burns from a fiberoptic cable tip during arthroscopy of the knee. Knee. 2008;15(4):333-335.

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Other possible causes of skin burns during arthroscopic surgery have been described, but none applies in our patient’s case. Segami and colleagues⁷ described a burn resulting from direct transfer of heat from the radiofrequency device to the skin because of their proximity. This mechanism was not the cause in our patient’s case; there was no evidence of a defect or burned deltoid muscle at time of surgery. Lau and Dao⁹ reported 2 small full-thickness skin burns caused by a fiberoptic-light cable tip placed on a patient’s leg; in addition, the hot (>170°C) cables caused the paper drapes to combust.⁹ Skin burns secondary to use of skin antiseptics have been reported,¹⁰ but such lesions typically are located beneath tourniquets or in areas of friction from surgical drapes. In some cases, lesions described as skin burns may actually have been pressure lesions secondary to moist skin and friction.¹¹

Whether type of radiofrequency device contributes to the occurrence of heat-related lesions during arthroscopic surgery is unknown. Some investigators have suggested there is more potential for harm with bipolar RFA devices than with monopolar devices.^12,13 Monopolar devices pass energy between a probe and a grounding plate, whereas bipolar devices pass energy through 2 points on the probe.¹⁴ Because the heat for the monopolar probe derives from the frictional resistance of tissues to each other rather than from the probe itself, the bipolar probe theoretically allows for better temperature control. In addition, bipolar probes require less current to achieve the same heating effect. However, recent studies have suggested that, compared with monopolar radiofrequency devices, bipolar radiofrequency devices are associated with larger increases in temperature at equal depths after an equal number of applications.^12,13

To our knowledge, no one has specifically investigated the type of bipolar device used in the present case. This case report, the first to describe a thermal skin injury caused by direct contact between a radiofrequency device and a metal needle inserted in the skin, is a reminder that contact between radiofrequency devices and spinal needles or other metal cannulas used in arthroscopic surgery should be avoided.

Cutaneous Burn Caused by Radiofrequency Ablation Probe During Shoulder Arthroscopy

References

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