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Tourniquet-Free Hand Surgery Using the One-per-Mil Tumescent Technique
BACKGROUND: A pneumatic tourniquet is generally used to achieve a bloodless operation field in hand surgery. However, this has changed with tumescent solution-based wide-awake surgery. This study is a preliminary prospective case series study to elaborate the formula and indications of the tumescent...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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The Korean Society of Plastic and Reconstructive Surgeons
2013
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3605557/ https://www.ncbi.nlm.nih.gov/pubmed/23533019 http://dx.doi.org/10.5999/aps.2013.40.2.129 |
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author | Prasetyono, Theddeus O. H. |
author_facet | Prasetyono, Theddeus O. H. |
author_sort | Prasetyono, Theddeus O. H. |
collection | PubMed |
description | BACKGROUND: A pneumatic tourniquet is generally used to achieve a bloodless operation field in hand surgery. However, this has changed with tumescent solution-based wide-awake surgery. This study is a preliminary prospective case series study to elaborate the formula and indications of the tumescent technique in hand surgery without a tourniquet. METHODS: Seven patients (age range, 4 months to 37 years) underwent hand or upper extremity surgery for conditions such as nerve palsy, electric burn defect, fingertip injury, contracture, constriction ring syndrome, or acrosyndactyly. A "one-per-mil" tumescent solution (epinephrine 1:1,000,000+20 mg lidocaine/50 mL saline) was used to create a bloodless operating field without a tourniquet. Observation was performed to document the amount of solution injected, the operation field clarity, and the postoperative pain. RESULTS: The "one per mil" epinephrine solution showed an effective hemostatic effect. The tumescent technique resulted in an almost bloodless operation field in the tendon and in the constriction ring syndrome surgeries, minimal bleeding in the flap and contracture release surgeries, and acceptable bleeding in acrosyndactyly surgery. The amount of solution injected ranged from 5.3 to 60 mL. No patient expressed significant postoperative pain. Flap surgeries showed mixed results. One flap was lost, while the others survived. CONCLUSIONS: Epinephrine 1:1,000,000 in saline solution is a potential replacement for a tourniquet in hand surgery. Further studies are needed to delineate its safety for flap survival. |
format | Online Article Text |
id | pubmed-3605557 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | The Korean Society of Plastic and Reconstructive Surgeons |
record_format | MEDLINE/PubMed |
spelling | pubmed-36055572013-03-25 Tourniquet-Free Hand Surgery Using the One-per-Mil Tumescent Technique Prasetyono, Theddeus O. H. Arch Plast Surg Original Article BACKGROUND: A pneumatic tourniquet is generally used to achieve a bloodless operation field in hand surgery. However, this has changed with tumescent solution-based wide-awake surgery. This study is a preliminary prospective case series study to elaborate the formula and indications of the tumescent technique in hand surgery without a tourniquet. METHODS: Seven patients (age range, 4 months to 37 years) underwent hand or upper extremity surgery for conditions such as nerve palsy, electric burn defect, fingertip injury, contracture, constriction ring syndrome, or acrosyndactyly. A "one-per-mil" tumescent solution (epinephrine 1:1,000,000+20 mg lidocaine/50 mL saline) was used to create a bloodless operating field without a tourniquet. Observation was performed to document the amount of solution injected, the operation field clarity, and the postoperative pain. RESULTS: The "one per mil" epinephrine solution showed an effective hemostatic effect. The tumescent technique resulted in an almost bloodless operation field in the tendon and in the constriction ring syndrome surgeries, minimal bleeding in the flap and contracture release surgeries, and acceptable bleeding in acrosyndactyly surgery. The amount of solution injected ranged from 5.3 to 60 mL. No patient expressed significant postoperative pain. Flap surgeries showed mixed results. One flap was lost, while the others survived. CONCLUSIONS: Epinephrine 1:1,000,000 in saline solution is a potential replacement for a tourniquet in hand surgery. Further studies are needed to delineate its safety for flap survival. The Korean Society of Plastic and Reconstructive Surgeons 2013-03 2013-03-11 /pmc/articles/PMC3605557/ /pubmed/23533019 http://dx.doi.org/10.5999/aps.2013.40.2.129 Text en Copyright © 2013 The Korean Society of Plastic and Reconstructive Surgeons http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Prasetyono, Theddeus O. H. Tourniquet-Free Hand Surgery Using the One-per-Mil Tumescent Technique |
title | Tourniquet-Free Hand Surgery Using the One-per-Mil Tumescent Technique |
title_full | Tourniquet-Free Hand Surgery Using the One-per-Mil Tumescent Technique |
title_fullStr | Tourniquet-Free Hand Surgery Using the One-per-Mil Tumescent Technique |
title_full_unstemmed | Tourniquet-Free Hand Surgery Using the One-per-Mil Tumescent Technique |
title_short | Tourniquet-Free Hand Surgery Using the One-per-Mil Tumescent Technique |
title_sort | tourniquet-free hand surgery using the one-per-mil tumescent technique |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3605557/ https://www.ncbi.nlm.nih.gov/pubmed/23533019 http://dx.doi.org/10.5999/aps.2013.40.2.129 |
work_keys_str_mv | AT prasetyonotheddeusoh tourniquetfreehandsurgeryusingtheonepermiltumescenttechnique |