title: Retrospective Analysis of the One-per-Million Tumescent Technique in Post-Burn Hand Deformity Surgeries.
abstract: 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.
authors: Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, University of Indonesia and Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
authors: Theddeus Oh
authors: TO
authors: Prasetyono
authors: Diponegoro 71 Jakarta 13410, Jakarta, Indonesia.
authors: Astrid Felicia
authors: AF
authors: Koswara
keywords: Burns; Cicatrix; Contracture; Epinephrine; Hand