title: One-per-mil tumescent technique for upper extremity surgeries: broadening the indication.
abstract: OBJECTIVE
  We studied the effect of 1:1,000,000 epinephrine concentration (1 per mil) to attain a bloodless operative field in hand and upper extremity surgery and to explore its effectiveness and safety profile.
  
  
  METHODS
  This retrospective observational study enrolled 45 consecutive patients with 63 operative fields consisting of various hand and upper extremity problems. One-per-mil solution was injected into the operative field with tumescent technique to create a bloodless operating field without tourniquet. The solution was formulated by adding a 1:1,000,000 concentration of epinephrine and 100 mg of lidocaine into saline solution to form 50 mL of tumescent solution. Observation was performed on the clarity of the operative field, which we described as totally bloodless, minimal bleeding, acceptable bleeding, or bloody. The volume of tumescent solution injected, duration of surgery, and surgical outcome were also reviewed.
  
  
  RESULTS
  The tumescent technique with 1-per-mil solution achieved 29% totally bloodless, 48% minimal bleeding, 22% acceptable bleeding, and 2% bloody operative fields in cases that included burn contracture and congenital hand and upper extremity surgeries.
  
  
  CONCLUSIONS
  One-per-mil tumescent solution created a clear operative field in hand and upper extremity surgery. It proved safe and effective for a wide range of indications.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Cipto Mangunkusumo Hospital/Faculty of Medicine, University of Indonesia, Jakarta, Indonesia. Electronic address: teddyohprasetyono@yahoo.com.
authors.forename: Theddeus O H
authors.initials: TO
authors.lastname: Prasetyono
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Cipto Mangunkusumo Hospital/Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Biben
mesh_terms: D000293:Adolescent; D000328:Adult; D001132:Arm / Q000601:surgery*; D057668:Bloodless Medical and Surgical Procedures / Q000379:methods*; D002056:Burns / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003286:Contracture / Q000601:surgery; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006225:Hand / Q000601:surgery*; D006228:Hand Deformities, Congenital / Q000601:surgery; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D007223:Infant; D007279:Injections, Subcutaneous / Q000379:methods*; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014111:Tourniquets; D055815:Young Adult
chemical_list: D008012:Lidocaine; D004837:Epinephrine
keywords: Epinephrine; hemostatic technique; lidocaine; tourniquets; upper extremity