The patient depicted in the photo was scheduled for a surgical procedure which was aborted at the beginning of the case. The photo was taken 2 weeks after the scheduled surgery. What was the most likely intraoperative event?

Correct Answer: cautery fire

This patient suffered from a burn secondary to a cautery fire. The fire was ignited when cautery was used in the presence of a high flow of oxygen through the nasal canula. It is imperative during surgery that oxygen be turned off or down below 2L when cautery is being used, especially monopolar cautery. The cautery will act as the igniter in a case where a ‘fuel’ such as oxygen is present. The photo does not depict a retrobulbar hematoma, which would appear as proptosis. An infection from non-sterile instruments would not have been apparent at the beginning of the surgery warranting abortion of the case. An allergic reaction to the drapes should not involve the areas of the skin that are not in direct contact with the drape and should not be persistent 2 weeks after the event.