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

Area of Science:

• Vascular Surgery
• Microsurgery
• Anesthesiology

Background:

• Vascular malformations in the hand and upper extremity present unique surgical challenges.
• Tourniquet application is often employed but carries risks.
• Evaluating alternative methods for improved surgical outcomes is crucial.

Purpose of the Study:

• To assess the efficacy of a 1:1,000,000 tumescent solution for vascular malformation resection.
• To determine if tourniquet application can be avoided during these procedures.
• To evaluate the safety and effectiveness of this tumescent solution in a clinical setting.

Main Methods:

• Retrospective review of four patients with five slow-flow vascular malformations.
• Subcutaneous infiltration of 1:1,000,000 tumescent solution prior to incision.
• Recording of injected solution volume, surgery duration, operative field clarity, and complications.
• Assessment of intraoperative pain using VAS scores and anesthesia conversion rates.

Main Results:

• Injected tumescent solution volumes ranged from 4.5 to 200 mL; surgery duration was 60 to 150 minutes.
• Operative field clarity: 1 case totally bloodless, 3 with minimum bleeding, 1 acceptable bleeding.
• One patient experienced minor skin necrosis; no intraoperative pain or anesthesia conversion was reported.

Conclusions:

• 1:1,000,000 tumescent solution is effective for slow-flow vascular malformation resection in the hand and upper extremity.
• This technique allows for resection without tourniquet application.
• The method appears safe, with minimal complications and no reported intraoperative pain.