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LNCtips.com: Thermal Spread Injuries


Thermal spread injuries are caused by instruments or devices that use heat to cauterize tissues and vessels during surgery.  The word "spread" means that the heat can also unintentionally extend to adjacent areas and cauterize them too.  The thermal spread might only be a millimeter or two.  However, that might be enough to inadvertently burn through a patient's healthy bowel, ureter, or bladder, causing spillage, fistulas, or obstructions.  You would think that it would be easy for plaintiffs to win cases involving thermal spread.  However, that's not always the case.

Surprisingly, these injuries are often defensible.  That's because surgeons may cause damage to adjacent tissues, but not through any negligent actions.  In fact, damage to adjacent organs and tissues is a known complication to surgery. Consent forms signed by the patient almost always list this potential consequence as as a known complication. 

Although injuries to adjacent structures are a known complication, plaintiffs might still be able to sue for negligence under certain conditions.  Surgeons must, of course, act within standards of care when performing surgery.  If they deliberately cauterize the wrong tissue, that's not a case of thermal spread.  For example, biliary injuries became more common with the advent of laparoscopic surgery because of misinterpretation of gallbladder anatomy.

In terms of thermal spread, plaintiffs may be able to prove negligence if the surgeon fails to recognize that an injury has occurred or fails to timely treat it.  For example, most bowel injuries are diagnosed after the surgical procedure, not during it.  Recognition of thermal injuries can be difficult, because they may occur a day or two after surgery when the friable, burnt tissue breaks open.  I know of one case in which a patient felt a sudden "snap" the day after laparoscopic surgery; it was most likely due to a bowel perforation from thermal spread.

Damages from thermal spread injuries can be devastating.  Failure to recognize thermal spread injuries can lead to sepsis and death.  Even if the injury is recognized early, treatment may require extensive reconstructive surgery. 

When reviewing these types of cases, legal nurse consultants need to determine if the injury was possibly caused by thermal spread.  If it was, the LNC then needs to determine when the surgeon recognized it and when treatment was initiated.  Those conclusions will help the attorney ascertain if medical malpractice has occurred.

...Katy Jones