Operating Microscope Skin Burn During Arteriovenous Fistula Creation in a Pediatric Patient

The operating microscope is an essential adjunct for the successful creation of arteriovenous anastomoses in the pediatric population. 1 Improvements in technology have led to powerful illumination systems being available on modern microscopes; unfortunately, this places patients at risk for thermal injury related to the illumination. A 15-year-old Hispanic male weighing 79 kg with a body mass index of 27 was newly diagnosed with immunoglobulin A nephropathy and developed acute renal failure requiring dialysis. Lopez et al published an extensive review of operating microscope burns in 2016 with recommendations on how to reduce the incidence of burns, and he also noted that children are at higher risk. 3 Their recommendations included using the lowest light intensity possible, using the longest focal length possible, minimizing the amount of time microscope light is used, irrigating the surgical site often and covering exposed skin when able, and avoiding or minimizing vasoconstrictive medications.