Retrospective Analysis of the One-per-Million Tumescent Technique in Post-Burn Hand Deformity Surgeries

Abstract

BackgroundThe use of a tourniquet in hand surgery is generally accepted as necessary to create a clear visualization of the operative field. This study aims to determine the effectiveness of one-per-million tumescent solution (1:1,000,000 epinephrine concentration) in creating a bloodless operative field in post-burn hand deformity surgeries performed without a tourniquet.MethodsThis retrospective observational study was conducted on a series of 12 patients with post-burn hand deformities who underwent surgery between February 2013 and January 2014. A total of 29 operative fields were recorded. The one-per-million tumescent solution was used for hemostatis instead of a tourniquet. The clarity of the operative field, volume of solution injected, duration of surgery, scar thickness and density, and functional outcomes at least three months after the surgery were observed. The relationship of scar thickness and density with the clarity of the operative field was analyzed with the chi-square test.ResultsOf the 29 operative fields in which the one-per-million tumescent technique was used, 48.2% were totally bloodless, 44.8% had minimal bleeding, and 6.9% had an acceptable level of bleeding. Both scar thickness and density were shown to have a significant relationship with operative field clarity (P<0.05).ConclusionsThe one-per-million tumescent technique is effective in facilitating post-burn hand deformity surgeries involving meticulous, multiple, and lengthy procedures by creating a relatively clear operative field without the use of a tourniquet. Although scar thickness and density are associated with the clarity of the operative field, this technique can be considered safe and effective in creating a clear operative field.

Dorsal pentagonal island flap to reconstruct post-burn interdigital web

“…Fourteen dorsal pentagonal island flaps were successfully harvested from seven cases (Table 1). With the aid of oneper-mil tumescent technique without tourniquet, 13 all surgeries were conducted with a minimum to bloodless surgical field; thus, it was easy to dissect the tissue while avoiding any important structure.…”

“…The Vancouver scar scale is an effective method for evaluating scar condition, especially in the evaluation of the outcome of therapy. 19 In the preoperative situation the density of the scar, which is assessed according to pliability in the Vancouver scar scale, 13 is deemed to be sufficient to measure the potential of the scar to be the flap donor area. The more pliable the scar tissue the higher its potential to restore all interdigital web components: the interdigital fossa's depth, form, groove and the slant up to the metacarpal head level.…”

“…The selection of the dorsal pentagonal island flap was made by examining the donor site using modified Vancouver scar scale. 13 The donor for dorsal pentagonal island flap could only be considered if the density of the scar was moderate or pliable.…”

“…With regard to scar density, the scarred skin in the dorsal metacarpal had to be at least moderate or pliable according to modified VSS. 13 2. In some cases, the design needed to be slightly shifted, which was guided by skin mobility when the metacarpophalangeal (MCP) joint was extending and flexing (Fig 2).…”

No Tourniquet Technique of Surgery for Macrodactyly

“…3,5 Instead, the danger of end-artery organ necrosis that is stigmatized by physicians was previously derived from the preceding local anesthesia, which was the expired procaine, instead of epinephrine. 3,6 In addition, epinephrine has been widely practiced in surgeries for vascular malformation, 7 fractures, 8 hand intrinsic flaps, 9 burn contractures, 10 digital replantation, 11 etc.…”