title: One-Per-Mil Tumescent Infiltration Technique for Vascular Malformation Surgery in Hand and Upper Extremity.
abstract: BACKGROUND
  To present the efficacy of 1:1,000,000 tumescent solution for resection of vascular malformation in hand and upper extremity without tourniquet application.
  
  
  METHODS
  Four patients with five slow flow vascular malformations were retrospectively reviewed. Prior to incision, 1:1,000,000 tumescent solution was infiltrated subcutaneously surrounding the lesion until the skin turned pale. Amount of tumescent solution injected, the length of surgery, the clarity of the operative field, and the complications were recorded. Clarity of operative field was categorized as totally bloodless, minimum bleeding, acceptable bleeding, and bloody. In the surgeries under local anesthesia, we also recorded self-reported intra-operative pain using VAS score, onset of pain, and conversion of anesthesia.
  
  
  RESULTS
  The injected amount of the tumescent solution ranged from 4.5 to 200 mL, with the length of surgery ranged from 60 to 150 minutes. One out of 5 cases was totally bloodless, 3 cases were minimum bleeding and 1 case was acceptable bleeding. Minor skin necrosis was recorded in 1 patient. Neither intra-operative pain nor conversion from local to general anesthesia was reported.
  
  
  CONCLUSIONS
  1:1,000,000 tumescent solution is effective for resection of slow flow vascular malformation in hand and upper extremity without tourniquet application.
authors.affiliation: 1 Division of Plastic Surgery, Department of Surgery, Cipto Mangunkusumo Hospital/Faculty of Medicine University of Indonesia, Jakarta, Indonesia.
authors.forename: Theddeus O H
authors.initials: TO
authors.lastname: Prasetyono
authors.affiliation: 1 Division of Plastic Surgery, Department of Surgery, Cipto Mangunkusumo Hospital/Faculty of Medicine University of Indonesia, Jakarta, Indonesia.
authors.forename: Jesslyn
authors.initials: J
authors.lastname: Gustin
mesh_terms: D000328:Adult; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006225:Hand / Q000098:blood supply; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D034941:Upper Extremity / Q000098:blood supply*; D054079:Vascular Malformations / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods*; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine
keywords: Anesthesia; Epinephrine; Hand; Hemostatic techniques; Local; Vascular malformations