Prevention of surgical fires in facial plastic surgery

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Harith Alani
James Southwell-Keely
Elias Moisidis
Roger Haddad
Frederick Clarke
Michael Kernohan


anesthesia, local, risk factors, fires, electrocoagulation


Introduction: The objective of this review is to draw attention to the risk factors, causes and prevention of surgical fires in facial plastic and reconstructive surgery performed under local anaesthesia and sedation using a review of the literature.
Method: Comprehensive search terms were developed, and PubMed and MEDLINE® searches were performed, including articles published in the last 25 years (1993–2018). Reference review was also undertaken. Eligible manuscripts described surgical fires involving patients undergoing surgical procedures under local anaesthesia in the head and neck region.
Results: Risk factors forming the three arms of the fire triangle are detailed. High oxygen concentration in proximity to the surgical field where electrocautery is being used is the most common combination leading to surgical fire accidents.
Conclusion: Summary recommendations for the prevention of surgical fires are presented. Preventing the development of an oxidiser-enriched environment is the main risk-reducing measure. Identifying high-risk cases and improving communication between the surgical, anaesthetic and nursing staff who control the arms of the fire triangle are very important measures in avoiding theses catastrophic events.


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