Surgical Burns and Diathermy Injury Claims

What “diathermy” means in surgery

To understand how these injuries occur, it is helpful to understand the tools used during your procedure. You may see the term "diathermy" in your medical notes or hear it mentioned by your consultant. While it sounds technical, the concept is straightforward.

Surgical diathermy and electrosurgery

In the majority of modern surgeries in Ireland, surgeons do not just use steel scalpels. They use electrosurgery, commonly referred to as diathermy.

Think of diathermy as an electronic cutting tool. It uses a high-frequency electric current to cut through tissue or to seal blood vessels (cauterise) to stop bleeding.

• Cutting: The device acts like a precise, hot knife.
• Coagulating: The device generates heat to clot the blood and seal the vessel.

Because this equipment relies on electricity and heat, it carries inherent risks. The surgical team must manage the electrical current carefully to ensure it only affects the specific millimetre of tissue the surgeon intends to treat. If that energy goes astray, or if the equipment is faulty, it can cause significant burns to healthy skin or organs.

Diathermy in physiotherapy vs diathermy in theatre

It is important not to confuse surgical diathermy with the diathermy used in physiotherapy clinics.

• Physiotherapy Diathermy: This uses specific wavelengths to generate "deep heat" in muscles and joints to treat pain or inflammation. It is non-invasive and generally gentle.
• Surgical Diathermy: This is a high-power tool used in the operating theatre to cut and burn tissue.

If you have suffered a burn during an operation, we are dealing exclusively with surgical diathermy.

How surgical burns and diathermy injuries happen

Modern operating theatres in Ireland are generally safe environments. However, when safety protocols are skipped, or equipment is not monitored, the intense heat generated by surgical tools can cause severe damage.

Understanding the mechanism of your injury is the first step in our investigation.

Direct contact burns (active electrode contact, hot instruments)

The most common cause of injury is inadvertent direct contact. The device used by the surgeon (often resembling a pen) becomes extremely hot.

• Accidental activation: If the surgeon or an assistant accidentally presses the "on" button while the device is resting on the patient's skin (draped or undraped), it can cause an immediate, deep burn.
• Retained heat: Even after the device is turned off, the tip can remain searingly hot for a period. If this tip touches the skin, or if a hot instrument is placed down on the patient rather than in a safety holster, a burn will occur.

Return electrode and grounding pad burns

For the electricity to work safely, it must complete a circuit. It enters the body through the surgical tool and must leave safely. This is usually done via a "return electrode" or "grounding pad",a sticky pad placed on your thigh, back, or buttock.

This pad disperses the electricity over a large area so you don't feel any heat. However, injuries happen if:

• The pad is not stuck down correctly: If the pad peels off partially, the electricity is forced through a smaller area, causing a concentrated burn at the pad site.
• Placement over hair or bone: If not placed on a fleshy, hair-free area, the connection may be poor, leading to heat buildup.
• Fluid invasion: If surgical fluids soak the pad, it can alter the electrical conductivity and cause burns.

Insulation failure and stray energy injuries (including laparoscopic procedures)

This is particularly relevant in keyhole (laparoscopic) surgery. The instruments used are long and coated in a protective plastic insulation.

If there is a tiny nick or crack in that insulation,which can be invisible to the naked eye,electricity can leak out. This "stray energy" can jump to nearby organs (like the bowel) or skin, burning tissue that the surgeon cannot even see on the monitor. These injuries are dangerous because the damage might not be noticed until days after the surgery when the patient becomes unwell.

Skin preparation solution and surgical fires

Before surgery, your skin is cleaned with an antiseptic solution. Many of these solutions contain alcohol and are highly flammable.

• Pooling: If too much fluid is used, it can pool in the belly button, groin, or under the body.
• Vapours: If the surgical drapes are placed too quickly before the alcohol dries, flammable vapours get trapped.

When the surgeon activates the diathermy tool, a spark can ignite these vapours or the fluid itself. This can result in a surgical fire, causing flash burns to the patient. This is almost always considered a preventable "Never Event."

Burns linked to positioning, warming devices, hot fluids, light sources

Not all burns in the theatre are electrical.

• Warming Blankets: Devices used to keep patients warm (like Bair Huggers) can cause thermal injuries if used incorrectly or against bare skin without a barrier.
• Light Sources: The fibre-optic cables used for cameras and light sources become incredibly hot. If a cable is disconnected and laid on the patient’s skin, it can burn through the skin in seconds.
• Hot Fluids: Overheated saline used for irrigation can also cause scalding.

Chemical burns and skin reactions that mimic burns

Sometimes, what looks like a burn is a severe reaction to the chemicals used. If a harsh chemical cleaning solution is left in contact with the skin under pressure (e.g., under a heavy thigh or tourniquet) for hours, it can cause chemical necrosis,the death of skin tissue. This looks and behaves very much like a heat burn and can be just as damaging.

Why these injuries can be serious

A burn sustained during surgery is not a minor inconvenience. Because the patient is under anaesthetic, they cannot pull away or complain of pain. This means the heat source often remains in contact with the skin longer than it would in a conscious accident, potentially leading to full-thickness (third-degree) burns.

Infection risk, delayed healing, scarring, nerve involvement

• Infection: Burned tissue is highly susceptible to infection. In a post-operative environment, this increases the risk of complications like MRSA or sepsis, potentially delaying your discharge from the hospital.
• Scarring: Surgical burns often result in permanent cosmetic disfigurement. Depending on the location, this can be visually distressing.
• Nerve Damage: If the burn is deep, it may damage underlying nerves, leading to chronic pain, numbness, or loss of sensation in that area.

Additional treatment pathways (burns unit care, dressings, grafts)

A significant surgical burn changes your recovery path entirely.

• You may require transfer to a specialist Burns Unit.
• You may need skin grafts, where healthy skin is taken from another part of your body to cover the burn.
• The injury will require long-term dressings and wound management, usually involving community care nurses or frequent return visits to the clinic.

Psychological impact after a theatre injury (kept factual and supportive)

We recognise the emotional toll of these injuries. You consented to an operation to fix a problem, only to acquire a new one. This can lead to:

• Loss of trust: Many clients feel anxious about undergoing necessary future medical treatment.
• Body image issues: Scarring, particularly on visible areas, can affect confidence and mental well-being.
• Anger and frustration: Knowing the injury was likely preventable can be difficult to process.

When a surgical burn may raise questions about standards of care

In Irish medical negligence law, not every bad outcome is considered negligence. However, surgical burns are rarely a natural consequence of surgery. They often point to a breakdown in safety protocols. When we investigate these claims, we look for specific failures in the standard of care.

Equipment checks, settings, and supervision

Hospitals and surgical teams have a duty to ensure all equipment is safe.

• Was the diathermy machine serviced and calibrated?
• Was the insulation on the laparoscopic instruments tested before use?
• Was the power setting on the machine too high for the delicate tissue involved?

Skin prep drying time and theatre safety steps

Strict guidelines exist regarding skin preparation.

• Drying Time: The surgical team must wait a specific time for alcohol-based prep to dry before draping the patient.
• Pooling Checks: The team must check that fluid has not pooled in skin folds or under the patient before starting.
• Failure to adhere to these simple checklists is a common cause of avoidable burns.

Documentation and monitoring patterns that often matter in review

When we review your medical records, we look for:

• The Operation Note: Does it mention an incident? Or was the burn only noted in the recovery room?
• The Electrosurgical Checklist: Most theatres have a log of where the grounding pad was placed and who placed it.
• Nursing Notes: These often contain the first accurate description of the injury when the patient arrives in the recovery ward.

Informed consent and material risk discussion

While surgeons must warn you of the risks of surgery (e.g., infection, bleeding), a burn from a dropped instrument or a faulty pad is generally not considered a normal risk that you "consent" to. You consent to the inherent risks of the procedure, not to negligent errors. Therefore, a defence of "you signed a consent form" is rarely valid for a preventable surgical burn.

What to do if you suspect a diathermy burn or surgical burn

If you have been discharged from the hospital or are recovering on the ward and discover a burn, taking the right steps immediately is vital for both your health and any potential future investigation.

Medical steps first (assessment, wound care, follow-up)

Your health is the priority.

• Seek Assessment: Do not ignore it. Show it to a nurse or doctor immediately. If you are already at home, visit your GP or return to the hospital.
• Specialist Opinion: Ask if the injury requires review by a plastic surgeon or a tissue viability nurse. Surgical burns can be deeper than they look.

Practical steps: photos, symptoms diary, keeping dressings instructions

• Photography: Take clear, well-lit photos of the injury as soon as you notice it. Continue to take photos weekly to track the healing or deterioration. Use a ruler or a coin in the photo to show scale.
• Diary: Write down when you noticed it, what was said to you by the medical staff, and the pain levels you are experiencing.
• Dressings: Keep a record of the dressings you are prescribed and the frequency of changes.

Records and information: requesting charts, operative notes, incident forms

You have a right to access your medical records under Data Protection laws (GDPR) and Freedom of Information acts (for public hospitals).

• Request a copy of your operation note and inpatient notes.
• Ask if an incident report form was filled out regarding the burn.

Open disclosure in Ireland and what it can involve

The HSE and the Medical Council support a policy of open disclosure. This means that if an adverse event happens (like a surgical burn), the medical team should:

• Acknowledge the injury to you.
• Explain how it happened.
• Apologise (an apology is not an automatic admission of legal liability, but it is a requirement of ethical practice).
• Explain the plan for your care.

If you feel the hospital is being vague or dismissing your questions about a burn, this is a red flag.

How these cases are assessed in Ireland

Investigating a surgical burn claim requires a methodical, professional approach. At Michael Boylan LLP, we specialise in guiding persons through this complex process.

The role of independent medical experts

We cannot rely solely on our own opinion. To prove a case, we must engage independent medical experts.

• We usually commission a report from a consultant surgeon in the relevant field to confirm if the technique used was appropriate.
• We may also need a plastic surgeon to assess the scarring and long-term prognosis.
• These experts determine if the care you received fell below the acceptable standard.

The legal elements: duty, breach, causation, impact

To succeed in a medical negligence action, four things must be proven:

1. Duty of Care: The hospital/surgeon owed you a duty (this is automatic).
2. Breach of Duty: The care fell below the standard expected of a reasonably competent practitioner.
3. Causation: The breach directly caused the burn (i.e., it wasn't going to happen anyway).
4. Damages: You suffered actual harm (pain, scarring, financial loss) as a result.

Public vs private care settings and who may be involved

• Public Patients (HSE): Claims are generally handled by the State Claims Agency (CIS). They manage the defence for HSE hospitals.
• Private Patients: If your surgery was in a private hospital, the claim is usually against the specific consultant’s medical defence organisation or the hospital’s private insurers.

Why the Injuries Resolution Board route does not apply to medical negligence

It is important to know that the Injuries Resolution Board (formerly PIAB), which assesses car accidents and work accidents, does not generally assess medical negligence claims.

• These cases are complex and usually require court proceedings or settlement negotiations led by solicitors.
• You cannot simply fill out a form online to get an assessment for a surgical error; you require legal representation.

Time limits and special situations

Acting promptly is essential in medical law. Generally, the Statute of Limitations for medical negligence claims in Ireland is strictly two years. This time limit usually begins on the date the injury occurred. However, in some cases, it may start from the "date of knowledge." This is the date when you first realised,or should have reasonably realised,that the injury was significant and potentially caused by a medical error. For example, if a surgical burn was hidden under a cast and only discovered weeks after your discharge, the two-year clock might technically start from that date of discovery. That said, proving this later date can be legally complex, so we always advise clients to rely on the stricter two-year rule from the date of the procedure to be safe.

There are important exceptions for children and protected parties:

• If a child suffers a surgical burn, the standard two-year time limit does not begin to run until they turn 18 years old. This means they technically have until their 20th birthday to bring a claim. In practice, however, parents or guardians usually initiate the case much sooner on the child's behalf as a "Next Friend," rather than waiting until adulthood.
• Similarly, if a patient lacks the mental capacity to manage their own affairs, the time limits may be suspended indefinitely or until capacity is regained.

It is also common for the true extent of a surgical burn to reveal itself slowly. What looks like a superficial mark initially may become necrotic (tissue death) or infected weeks later, leading to delayed scarring or nerve symptoms. You do not need to wait for your treatment to finish before seeking advice. In fact, it is vital to seek legal guidance as soon as you suspect the injury is not resolving as it should, ensuring that evidence is preserved while your memory of events is fresh.

Common questions about diathermy burns and surgical burn injuries

Can a burn be a recognised complication rather than an error?

While all surgeries have risks, a burn to healthy skin far from the surgical site is rarely a "recognised complication" that you accept. Most surgical burns are considered preventable "Never Events" or failures in technique/equipment.

What if I only noticed the burn after discharge?

This is common. You should immediately photograph it, see your GP/A&E, and ensure it is recorded in your medical notes. The fact that it was discovered later does not invalidate your claim, provided medical evidence links it to the surgery.

What records usually exist for diathermy use in an operation?

The theatre team usually keeps a specific log. This records the machine used, the power settings, the time it was used, and the location of the grounding pad. These logs are crucial evidence.

Can a device issue matter as well as clinical decision-making?

Yes. If the machine malfunctioned (e.g., a software error or insulation failure), the claim might involve the manufacturer of the device as well as the hospital.

What if the burn is small but leaves permanent scarring?

The size of the burn does not determine if negligence occurred. Even a small burn on the face or neck can have significant value due to cosmetic impact. If the burn was caused by negligence, you are entitled to be compensated for that scarring.

Get the answers you deserve

Waking up with a burn injury is a breach of the safety you were promised. At Michael Boylan LLP, we know that you want more than just compensation,you want to know how this happened and ensure it doesn’t happen to anyone else.

We have the expertise to analyse theatre records, interrogate safety protocols, and hold providers accountable for preventable theatre injuries.

If you or a loved one has suffered a burn or diathermy injury during surgery, please contact us. We will listen to your story with empathy and provide an honest assessment of your options.

Contact our specialist team today for a confidential discussion.

*In contentious business, a solicitor may not calculate fees or other charges as a percentage or proportion of any award or settlement.