Silent burn: the hidden danger and effects of bright light from fibre-optic cables in arthroscopic knee surgery

Following an uneventful arthroscopic menisectomy of the right knee, a white circular skin lesion, 1 cm in diameter, was noted on the anterior left thigh of a 23-year-old patient. The overlying paper surgical drape had not ignited nor produced smoke. Close inspection revealed a minute perforation in the drape with slight discolouration. No electro-cautery, radio-ablation or irritant skin preparation had been used during surgery. Tests failed to identify fault with the light source, fibre-optic cable or arthroscope. The lesion was diagnosed as a full-thickness thermal burn resulting from heat transmitted from a 300-W Xenon lamp via a detached fibre-optic cable. The effects of contact between an illuminated fibre-optic light cable and living human skin are described, with changes in appearances followed over 2 years. Patients may be burnt and permanently scarred without the knowledge of staff in operating theatres if detached light cables rest against surgical drapes.