%0 Journal Article
%T Tourniquet-Free Hand Surgery Using the One-per-Mil Tumescent Technique
%A Theddeus O. H. Prasetyono
%J Archives of Plastic Surgery
%D 2013
%I The Korean Society of Plastic and Reconstructive Surgeons
%R http://dx.doi.org/10.5999/aps.2013.40.2.129
%X Background A pneumatic tourniquet is generally used to achieve a bloodless operationfield in hand surgery. However, this has changed with tumescent solution-based wide-awakesurgery. This study is a preliminary prospective case series study to elaborate the formula andindications of the tumescent technique in hand surgery without a tourniquet.Methods Seven patients (age range, 4 months to 37 years) underwent hand or upperextremity surgery for conditions such as nerve palsy, electric burn defect, fingertip injury,contracture, constriction ring syndrome, or acrosyndactyly. A ¡°one-per-mil¡± tumescentsolution (epinephrine 1:1,000,000+20 mg lidocaine/50 mL saline) was used to create abloodless operating field without a tourniquet. Observation was performed to document theamount of solution injected, the operation field clarity, and the postoperative pain.Results The ¡°one per mil¡± epinephrine solution showed an effective hemostatic effect. Thetumescent technique resulted in an almost bloodless operation field in the tendon and in theconstriction ring syndrome surgeries, minimal bleeding in the flap and contracture releasesurgeries, and acceptable bleeding in acrosyndactyly surgery. The amount of solution injectedranged from 5.3 to 60 mL. No patient expressed significant postoperative pain. Flap surgeriesshowed mixed results. One flap was lost, while the others survived.Conclusions Epinephrine 1:1,000,000 in saline solution is a potential replacement for atourniquet in hand surgery. Further studies are needed to delineate its safety for flap survival.
%K Epinephrine
%K Lidocaine
%K Upper extremity
%U http://www.e-aps.org/Synapse/Data/PDFData/2023APS/aps-40-129.pdf