A 32 year old athlete saw his family doctor with a skin tag on his back that was catching on his clothes whenever he ran. He wanted it removed as his back was getting sore when he ran. His doctor offered to remove it in his clinic in one of the minor operation sessions.

The following week the patient came for removal of the tag. His doctor explained that he was going to remove it using diathermy and the patient consented. For the surgery, he was lying on a sterile sheet of paper spread on the couch. The assisting nurse sprayed the skin with Cryogesic, a topical cryo-analgesic. The spray pooled on his back and soaked in to the paper sheet. There was no time for the alcohol based spray to evaporate. The patient’s back was still wet when the doctor started using the diathermy. Immediately the wet paper caught fire along with his back that was still not dry. Patient suffered a superficial burn. The doctor and the nurse apologised and immediately applied wet towels and ice pack. The area about the size of the palm was treated with Flamazine cream dressing. It took nearly 2 months to heal.

The patient sued for medical negligence as the doctor should have known that alcohol based solutions posed a risk of fire when diathermy was used. The insurance company did not argue and settled the claim quickly to avoid escalating legal costs.

Learning Points: Flammable fluids used for skin prep should be used with caution. Most of them form a flammable/explosive vapour-air. The preparation should not be allowed to pool and the area should be dry before electrosurgery commences.

Case reported in Medical Protection Society Casebook.