Guideliner radiopaque marker4/6/2023 ![]() ![]() The FB was confirmed to be the radio-opaque marker of the Bovie scratch pad. The patient was discharged the following day in good condition. Intraoperatively, the FB was easily identified and removed (Fig. Options, including no intervention versus VATS retrieval of the FB, were discussed with the patient who opted for the latter. Following chest tube removal, on postop day-3 prior to discharge, a two-view chest x-ray showed an apical pneumothorax, in addition to an “abnormality” in the apex of the hemithorax (Fig. The postoperative portable chest x-ray reported no unusual findings (Fig. 1) was utilized to abrade the parietal pleura. Half of a folded Bovie scratch pad that is usually used as a cautery tip cleaner (CardinalHealth, Fig. The patient underwent uneventful Video Assisted Thorascopic Surgery (VATS) with bleb resection and mechanical pleurodesis. Chest x-ray and computed tomography showed spontaneous pneumothorax with apical blebs. The patient is a 41 year-old female who presented with acute shortness of breath. Institutional review board approval was not required and was waived for the purpose of this study. Informed consent was obtained from the patient. Cardiothoracic surgeries account for 10% of all retained FBs with an incidence of 1 in every 5500 cases. Foreign body (FB) retention remains the sentinel event most frequently reported to the Joint Commission with 50% occurring in minimally invasive operations. 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 easily separate during its actual use while performing the pleurodesis and become retrained. It was customary for us to fold the scratch pad on itself after dividing it in half in order to pass it through the smaller VATS incisions. Surgery usually includes bleb resection in addition to mechanical pleurodesis aimed at promoting adhesions that would prevent lung collapse in case of a recurrence. Video assisted thorascopic surgery (VATS) is performed in cases of recurrences and when blebs are identified radiographically. Tube thoracostomy is usually required in symptomatic patients with larger pneumothoraces. Medical management includes observation for first time smaller pneumothoraces, especially if patients are minimally symptomatic. Symptoms often include chest pain and/or acute dyspnea, and may resolve spontaneously within 24-h with no intervention. It may follow activities that increase intrathoracic pressure but can also occur at rest. Spontaneous pneumothorax typically occurs among tall thin adolescent men with an annual incidence of 18–28 and 1.2–6 cases per 100,000 men and women, respectively. Retained radio-opaque marker of bovie scratch pad during VATS mechanical pleurodesis. Recommendation is made of using the scratch pad as a whole and not dividing it. Conclusionĭividing 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. The patient did well and was discharged the following day. Reoperation confirmed this to be the radio-opaque marker of the scratch pad and was removed. Postoperative chest x-ray showed a retained foreign body. The patient underwent video assisted thorascopic surgery (VATS) with bleb resection and mechanical pleurodesis using a divided and folded bovie scratch pad. The patient is a 41 year-old female who presented with shortness of breath secondary to spontaneous pneumothorax. ![]() 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. However, unintentional foreign body retention may occur during the course of an operation leading to reoperations or even worse complications. The pad is folded on itself after dividing it in half, allowing easier passage through the smaller incisions. 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. ![]()
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