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One-Per-Mil Tumescent Infiltration Technique for Vascular Malformation Surgery in Hand and Upper Extremity.

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.