DOI QR코드

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

  • 투고 : 2014.10.16
  • 심사 : 2014.12.01
  • 발행 : 2015.03.15

초록

Background The 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. Methods This 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. Results Of 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). Conclusions The 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.

키워드

참고문헌

  1. Karia RA. Hemostasis and tourniquet. Oper Tech Sports Med 2011;19:224-30. https://doi.org/10.1053/j.otsm.2011.02.004
  2. Flatt AE. Tourniquet time in hand surgery. Arch Surg 1972;104:190-2. https://doi.org/10.1001/archsurg.1972.04180020070013
  3. Robertson RD, Bond P, Wallace B, et al. The tumescent technique to significantly reduce blood loss during burn surgery. Burns 2001;27:835-8. https://doi.org/10.1016/S0305-4179(01)00057-2
  4. Cartotto R, Musgrave MA, Beveridge M, et al. Minimizing blood loss in burn surgery. J Trauma 2000;49:1034-9. https://doi.org/10.1097/00005373-200012000-00010
  5. van der Veer WM, Bloemen MC, Ulrich MM, et al. Potential cellular and molecular causes of hypertrophic scar formation. Burns 2009;35:15-29. https://doi.org/10.1016/j.burns.2008.06.020
  6. Oragui E, Parsons A, White T, et al. Tourniquet use in upper limb surgery. Hand (N Y) 2011;6:165-73. https://doi.org/10.1007/s11552-010-9312-6
  7. Avci G, Akan M, Yildirim S, et al. Digital neurovascular compression due to a forgotten tourniquet. Hand Surg 2003;8:133-6. https://doi.org/10.1142/S0218810403001595
  8. Odinsson A, Finsen V. Tourniquet use and its complications in Norway. J Bone Joint Surg Br 2006;88:1090-2.
  9. Denkler K. A comprehensive review of epinephrine in the finger: to do or not to do. Plast Reconstr Surg 2001;108:114-24. https://doi.org/10.1097/00006534-200107000-00017
  10. Wilhelmi BJ, Blackwell SJ, Miller JH, et al. Do not use epinephrine in digital blocks: myth or truth? Plast Reconstr Surg 2001;107:393-7. https://doi.org/10.1097/00006534-200102000-00014
  11. Denkler K. Dupuytren's fasciectomies in 60 consecutive digits using lidocaine with epinephrine and no tourniquet. Plast Reconstr Surg 2005;115:802-10. https://doi.org/10.1097/01.PRS.0000152420.64842.B6
  12. Chowdhry S, Seidenstricker L, Cooney DS, et al. Do not use epinephrine in digital blocks: myth or truth? Part II. A retrospective review of 1111 cases. Plast Reconstr Surg 2010;126:2031-4. https://doi.org/10.1097/PRS.0b013e3181f44486
  13. Thomson CJ, Lalonde DH, Denkler KA, et al. A critical look at the evidence for and against elective epinephrine use in the finger. Plast Reconstr Surg 2007;119:260-6. https://doi.org/10.1097/01.prs.0000237039.71227.11
  14. Lalonde DH, Lalonde JF. Discussion. Do not use epinephrine in digital blocks: myth or truth? Part II. A retrospective review of 1111 cases. Plast Reconstr Surg 2010;126:2035-6. https://doi.org/10.1097/PRS.0b013e3181f52549
  15. Prasetyono TO, Biben JA. One-per-mil tumescent technique for upper extremity surgeries: broadening the indication. J Hand Surg Am 2014;39:3-12.e7. https://doi.org/10.1016/j.jhsa.2013.09.034
  16. Prasetyono TH, Saputra DA, Astriana W. One-per-mil tumescent technique for bone and joint surgery in hand. HAND 2014:1-5.
  17. Sullivan T, Smith J, Kermode J, et al. Rating the burn scar. J Burn Care Rehabil 1990;11:256-60. https://doi.org/10.1097/00004630-199005000-00014
  18. Schwanholt C, Greenhalgh DG, Warden GD. A comparison of full-thickness versus split-thickness autografts for the coverage of deep palm burns in the very young pediatric patient. J Burn Care Rehabil 1993;14:29-33. https://doi.org/10.1097/00004630-199301000-00008
  19. Schwarz RJ. Management of postburn contractures of the upper extremity. J Burn Care Res 2007;28:212-9. https://doi.org/10.1097/BCR.0B013E318031A172
  20. Prasetyono TO. Tourniquet-free hand surgery using the one-per-mil tumescent technique. Arch Plast Surg 2013;40:129-33. https://doi.org/10.5999/aps.2013.40.2.129
  21. Cox C, Yao J. Tourniquet usage in upper extremity surgery. J Hand Surg Am 2010;35:1360-1. https://doi.org/10.1016/j.jhsa.2010.03.016

피인용 문헌

  1. Dorsal pentagonal island flap to reconstruct post-burn interdigital web vol.101, pp.4, 2015, https://doi.org/10.1308/rcsann.2019.0003