title: Full-thickness skin grafts. Clinical observations on the impact of using epinephrine in local anesthesia of the donor site.
abstract: METHODS
  A recent animal study indicated that epinephrine in local anesthesia adversely affects the survival of full-thickness skin grafts. Because animal models do not always correlate to humans, we performed a prospective observational study to elucidate the clinical outcome of using epinephrine in local anesthesia of the donor site. Seventy-two patients had cutaneous tumors excised by the Mohs micrographic technique. The resultant surgical defects were repaired using full-thickness skin grafts. Patients were randomly divided into two groups based on the local anesthetic used at the donor site: (1) 1% lidocaine (Xylocaine) (n = 33) or (2) 1% lidocaine with 1:100,000 epinephrine (n = 39).
  
  
  RESULTS
  Assessment of the skin grafts at 1 week revealed a significantly increased risk of developing graft complications in the lidocaine with epinephrine group compared with the plain lidocaine group. The overall cosmetic outcome of the grafted site at 6 weeks revealed no significant difference between the two groups.
  
  
  CONCLUSIONS
  Because there was only a minimal clinical effect of epinephrine on graft survival observed at 1 week and there was no effect on the 6-week cosmetic outcome, we do not recommend harvesting all full-thickness skin grafts with plain lidocaine. In certain clinical circumstances with compromised vascular supply or poor oxygenation, the use of plain lidocaine may be advantageous.
authors.affiliation: Department of Dermatology, University of California, Davis, Sacramento, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Fazio
authors.forename: J A
authors.initials: JA
authors.lastname: Zitelli
mesh_terms: D000368:Aged; D000772:Anesthesia, Local; D062109:Dermatologic Surgical Procedures; D004837:Epinephrine / Q000009:adverse effects / Q000494:pharmacology*; D004954:Esthetics; D005153:Facial Neoplasms / Q000601:surgery; D005260:Female; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D015580:Mohs Surgery; D009336:Necrosis; D011446:Prospective Studies; D012307:Risk Factors; D012867:Skin / Q000187:drug effects / Q000473:pathology; D012878:Skin Neoplasms / Q000601:surgery; D016038:Skin Transplantation / Q000009:adverse effects / Q000379:methods* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D008012:Lidocaine; D004837:Epinephrine