title: Ambulatory phlebectomy. A rare complication of local anesthetic: case report and literature review.
abstract: BACKGROUND
  Full-thickness skin necrosis can occur after infiltration of 1.0% lidocaine with 1/100,000 epinephrine for ambulatory phlebectomy.
  
  
  OBJECTIVE
  To demonstrate an exaggerated local response to epinephrine resulting in full-thickness skin necrosis and ultimately a permanent scar.
  
  
  METHODS
  A postoperative complication was clinically observed.
  
  
  CONCLUSIONS
  Permanent scar formation after ambulatory phlebectomy was found in a patient with a previous probable exaggerated local response to epinephrine. Uneventful phlebectomy resulted in the same patient when epinephrine was deleted from the local anesthetic, suggesting a local inability to eliminate epinephrine or an exaggerated local alpha-one response.
authors.affiliation: Iowa Vein Center, Mercy West Health Center, Des Moines, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Olivencia
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures; D000779:Anesthetics, Local / Q000009:adverse effects*; D004837:Epinephrine / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000009:adverse effects*; D009336:Necrosis; D012867:Skin / Q000473:pathology*; D012871:Skin Diseases / Q000139:chemically induced* / Q000473:pathology; D014648:Varicose Veins / Q000601:surgery*; D014662:Vasoconstrictor Agents / Q000009:adverse effects*
chemical_list: D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D008012:Lidocaine; D004837:Epinephrine