Microscope-Induced Thermal Burns During Lymphaticovenular Anastomosis

Abstract

 Bright illumination sources using xenon lamps have improved microsurgical visualization under operating microscopes; however, surgeons must recognize the potential for accidental thermal damage to soft tissues.
 In this article, we present two reports of microscopic thermal burn in lymphaticovenular anastomosis (LVA) . We also present our simple method to prevent this injury.
 A 23-year-old woman and a 57-year-old woman with bilateral lymphedema of the legs had LVAs on both legs under local anesthesia. The burn wound in the 23-year-old woman was a full-thickness burn and that in the 57-year-old woman was a deep dermal burn. Both healed without skin grafting.
 The working distance and high illumination intensity are important risk factors. The use of epinephrine as part of the local anesthetic mixture that reduces blood flow is also a major risk factor for thermal burns. LVA in particular requires high magnification, which leads to an increased intensity and closer working distance. The surgical conditions for LVA make patients prone to microscope-induced thermal burns.