title: Dupuytren's fasciectomies in 60 consecutive digits using lidocaine with epinephrine and no tourniquet.
abstract: Dupuytren's contracture is a common hand problem. Its treatment, other than percutaneous fasciectomy, is an outpatient operation performed with the patient under regional or general anesthesia. If local anesthetics are used, they are used without epinephrine, and an arm or forearm tourniquet is essential. Multiple reviews have described the safety of local anesthetics with epinephrine in the digits. This study is a retrospective review of operations performed by the same surgeon in the hospital (43 digits) versus the office using local anesthetics with epinephrine and no tourniquet (60 digits). Results and complications were compared and tabulated. The hospital and epinephrine groups were comparable regarding preoperative measurements. Postoperative improvement in extension at the metacarpophalangeal and proximal interphalangeal joints was similar in both the hospital and epinephrine groups. Complications, including digital nerve and artery injuries, infections, and hematomas, were similar between the groups. There were no cases of digital necrosis or gangrene in the epinephrine group, even though one patient sustained a transection of a digital artery at the proximal interphalangeal joint. Because of the similarities in results and complications, there does not seem to be an advantage to performing Dupuytren's excisions with full arm tourniquet and outpatient admission in many cases. Local anesthetics with epinephrine are safe in the treatment of Dupuytren's contracture, although both the use of digital epinephrine and the use of mechanical tourniquets carry the potential for complications. Visibility is similar to that for facial or head and neck surgery and is aided by the use of loupe magnification. The old dogma against its use in the fingers is refuted, as seen by the results in these 60 consecutive Dupuytren's fasciectomies and the results of other authors.
authors.affiliation: Department of Plastic Surgery, University of California, San Francisco, San Francisco, Calif, USA. kdenkler@yahoo.com
authors.forename: Keith
authors.initials: K
authors.lastname: Denkler
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000779:Anesthetics, Local; D004387:Dupuytren Contracture / Q000601:surgery*; D004837:Epinephrine; D000071938:Fasciotomy; D005260:Female; D005385:Fingers / Q000294:innervation; D006801:Humans; D008012:Lidocaine; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine; D004837:Epinephrine