Burning hand

[SpliceOfLife]

When cauterizing through fascia using bovie I use the typical method of entry into one point then extending along a line of dissection but protecting the underlying viscera with my hand.

Problem is I keep burning my hand. Even when double gloved. I will get blisters and cuts days later after a particularly hot case. What the hell do you do to stop this???

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[Miles Gloriosus]

When cauterizing through fascia using bovie I use the typical method of entry into one point then extending along a line of dissection but protecting the underlying viscera with my hand.

Problem is I keep burning my hand. Even when double gloved. I will get blisters and cuts days later after a particularly hot case. What the hell do you do to stop this???

Maybe you need to lower your bovie setting?

 

[SpliceOfLife]

Maybe you need to lower your bovie setting?

Probably. But I'm a trainee not an attending. Attendings have their preferences. I can try to do this but will sometimes get shot down.

More importantly it's never immediately obvious. Sometimes it doesn't hurt that badly but cut/blister will only appear after a few days.

 

[Pir8DeacDoc]

I don't operate in the abdomen. But in the neck I make an entry into the platysma. Dissect under the muscle in line with the incision. And then lift up the muscle and spread with my hemostat. Since the muscle is elevated it can be safely divided with the bovie without putting my finger underneath.

 

[Dr.LeoSpaceman]

When cauterizing through fascia using bovie I use the typical method of entry into one point then extending along a line of dissection but protecting the underlying viscera with my hand.

Problem is I keep burning my hand. Even when double gloved. I will get blisters and cuts days later after a particularly hot case. What the hell do you do to stop this???

It's odd that you're getting delayed burns. Usually when it happens, you know immediately.

In any case, one alternative move is using two fingers and then bovie between your fingers so that you aren't directly on top of you're own glove/skin.

 

[Smurfette]

I can't bovie on my fingers...it hurts. I have small hands so I do what @Dr.LeoSpaceman says--put in 2 fingers and bovie in between them (or go between jaws of an instrument) until my incision is bigger.

 

[LucidSplash]

I don’t bovie on my finger, only between my fingers.

 

[DoctwoB]

As others have said, bovie between your fingers when possible. When not possible (I.e only one finger sized hole in fascia, extending port sites, etc) it is all about tension. If tissue is on tension it will spring apart with the bovie with less heat. Less tension = more char and heat.

 

[mikeGR]

I agree with the above - however, I would caution you to be extra careful, especially as a trainee, when you are "assuming" things. When you do not have excellent exposure/visualization and are using your fingers to dissect under the fascia and lift the fascia, you are assuming there is no tissue between your finger(s) and the fascia, which will be true 99% of the time, but eventually, you will have a case where you assumed wrong and you will injure bowel/other organ. To specifically answer your question, if you have good exposure, you don't have to use your finger to lift the fascia, you can use your forceps for that.

It's important to build good habits/routines during training. Try to do the basics (exposure, retraction) really well, even if it takes a bit longer at this stage. It will pay off.

 

[dpmd]

I do the two finger thing mostly, but when I need to go on my finger I do very short bursts and wait a few seconds so it isn't already hot. I never don't know at the time though because when I get myself it feels like a combination of a burn, cut, and brief electrocution. I guess be glad you aren't suffering that (those burns take weeks to heal too because they go deep)

 

[DoctwoB]

I don’t understand the question. My robotic arms don’t feel pain.

 

[Lem0nz]

Enter the abdomen sharply and tie all skin bleeders. You'll understand after doing this once that pain is all relative and you'll suddenly be immune to the lesser pain caused by the bovie.

 

[ACSurgeon]

In general if you limit your bovie time to shorter bursts you don’t give it time to heat as much.

 

[WinslowPringle]

Three finger technique - index and fourth finger close together but not completely touching and the small space between keeps you from actually bovie-ing on your fingers. Middle finger just below where the index and fourth fingers come together, pushing down and keeping those blasted loops of bowel out of your way.