Preventing and Managing Operating Room Fires in Plastic Surgery: A Review of Incidence, Risk Factors, and Recommendations with Case Experiences.

Fires in operating rooms are rare yet devastating incidents. There are guidelines for the prevention and management of surgical fires; however, these recommendations are based on expert opinion and case reports. Almost all surgical procedures have an oxidizer (oxygen, nitrous oxide), an ignition source (such as a laser or "Bovie"), and a fuel, which together make up the three elements of an operating room fire. Our review analyzes each fire component to decide on the most effective clinical approach for reducing the risk of fire. We investigate the incidence, risk factors, legal repercussions, preventive strategies, and the precise management of fires in the operating room, with a particular focus on plastic surgery procedures. In addition, we share insights from our own experiences and propose guidelines based on our findings to enhance safety and response measures in surgical settings. Fires most commonly occur around the head, neck, and upper chest. High-risk procedures include tonsillectomies, tracheostomies, laryngoscopies, and facial/neck surgeries. Checklists help ensure proper precautions are taken, like using moist towels and lowering oxygen concentration. If a fire erupts, prompt removal of the oxygen source and irrigation are critical. From our experience, fires spread rapidly and can cause severe burns and inhalation injuries. We share illustrative cases of surgical fires at our institution over the past decade. Our review underscores the importance of fire prevention and preparedness through safety protocols, equipment maintenance, staff training, and maintaining situational awareness. More research is needed to quantify risk factors and determine optimal management strategies when fires do occur.