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Does tumescent infiltration have a deleterious effect on undermined skin flaps?
1Johns Hopkins University, Johns Hopkins Hospital, Baltimore, MD, USA. oscar@ramirezmd.com
Plastic and Reconstructive Surgery
|January 10, 2001
Summary
Intradermal tumescent solution with epinephrine can cause superficial flap loss due to vasoconstriction and pressure. Wait 15-30 minutes after injection if skin appears orange before any surgical intervention.
Area of Science:
- Plastic Surgery
- Dermatology
- Surgical Complications
Background:
- Tumescent liposuction involves injecting a solution with epinephrine to reduce bleeding and aid fat removal.
- Epinephrine's vasoconstrictive properties are crucial for surgical hemostasis but can impact tissue perfusion.
- Superficial injection planes and flap elevation may alter the pharmacokinetics of injected epinephrine.
Observation:
- A patient developed a 'peau d'orange' skin appearance after tumescent solution injection with epinephrine.
- This skin change was associated with superficial flap loss in the treated area.
- The observed flap loss was attributed to epinephrine-induced vasoconstriction and hydrostatic pressure.
Findings:
- The combination of epinephrine's vasoconstriction and the tumescent fluid's hydrostatic pressure compromised flap viability.
- Delayed clearance of epinephrine from the superficial tissues exacerbated the ischemic effects.
- Suture removal and flap undermining were ineffective once flap necrosis had begun.
Implications:
- Clinicians should be aware of the potential for flap compromise with superficial tumescent injections.
- Monitoring for 'peau d'orange' is a potential indicator of compromised perfusion.
- Allowing adequate time (15-30 minutes) for epinephrine recirculation may mitigate risks associated with immediate surgical manipulation.