Abstract
BackgroundSurgical intervention for spontaneous pneumothorax typically includes mechanical pleurodesis that frequently utilizes a Bovie scratch pad given its universal presence, low cost and ease of use. The pad is folded on itself after dividing it in half, allowing easier passage through the smaller incisions.However, unintentional foreign body retention may occur during the course of an operation leading to reoperations or even worse complications. This case is reported to raise awareness that dividing the scratch pad may allow the embedded radio-opaque marker to fall out and become retained as a foreign body.Case presentationThe patient is a 41 year-old female who presented with shortness of breath secondary to spontaneous pneumothorax. Chest CT scan showed apical blebs. The patient underwent video assisted thorascopic surgery (VATS) with bleb resection and mechanical pleurodesis using a divided and folded bovie scratch pad. Postoperative chest x-ray showed a retained foreign body. Reoperation confirmed this to be the radio-opaque marker of the scratch pad and was removed. The patient did well and was discharged the following day.ConclusionDividing the bovie scratch pad may damage and “weaken” the product allowing the radio- opaque marker to fall out during its use for pleurodesis and should be discouraged. Recommendation is made of using the scratch pad as a whole and not dividing it.Graphical abstractRetained radio-opaque marker of bovie scratch pad during VATS mechanical pleurodesis.
Highlights
Surgical intervention for spontaneous pneumothorax typically includes mechanical pleurodesis that frequently utilizes a Bovie scratch pad given its universal presence, low cost and ease of use
Surgery usually includes bleb resection in addition to mechanical pleurodesis aimed at promoting adhesions that would prevent lung collapse in case of a recurrence
Half of a folded Bovie scratch pad that is usually used as a cautery tip cleaner (CardinalHealth, Fig. 1) was utilized to abrade the parietal pleura
Summary
Surgical intervention for spontaneous pneumothorax typically includes mechanical pleurodesis that frequently utilizes a Bovie scratch pad given its universal presence, low cost and ease of use. Video assisted thorascopic surgery (VATS) is performed in cases of recurrences and when blebs are identified radiographically. Surgery usually includes bleb resection in addition to mechanical pleurodesis aimed at promoting adhesions that would prevent lung collapse in case of a recurrence. This case is reported to raise awareness that such practice of dividing the scratch pad may damage and weaken the product, allowing the radio-opaque marker to separate during its actual use while performing the pleurodesis and become
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