Ho Christopher Wei Guang, Kok Yee Onn, Chong Si Jack
Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
Burns. 2018 Dec;44(8):2018-2025. doi: 10.1016/j.burns.2018.03.003. Epub 2018 Oct 25.
Tumescent infiltration is a technique to reduce skin graft donor site bleeding, however there are no studies comparing tumescent solutions with different concentrations of adrenaline on donor site blood loss. We sought to evaluate the effect on skin donor site bleeding of different adrenaline concentrations in adrenaline-containing tumescent solutions in a prospective randomised trial.
Donor sites were marked into thirds and each segment randomised to receive tumescent infiltration containing no adrenaline, adrenaline 1:500,000, or adrenaline 1:250,000. Donor sites were photographed 10s after skin graft harvest. A laparotomy sponge was then placed onto the wound for a further 20s and photographed. These photographs were divided into their corresponding thirds and each scored on a scale of 0 (no bleeding) to 5 (severe bleeding) by a blinded independent panel of plastic surgeons.
11 patients (15 donor sites) were recruited. Donor site segments infiltrated with adrenaline 1:250,000 had significantly lower wound bleeding and sponge staining mean rank scores compared with segments infiltrated with adrenaline 1:500,000 (9.47 vs 21.57; p=0.035 and 9.63 vs 21.37; p<0.043 respectively). Segments infiltrated with adrenaline 1:500,000 had significantly lower wound bleeding and sponge staining mean rank scores compared with segments that were not infiltrated with adrenaline (21.5 7 vs 37.97; p=0.002 and 21.37 vs 38; p<0.002 respectively). There were no local or systemic complications.
We demonstrate that donor site infiltration with different adrenaline-containing tumescence solutions cause significantly different photographic bleeding scores. Adrenaline 1:250,000 tumescence resulted in significantly lower bleeding scores than lower concentrations of adrenaline without compromising safety or wound healing. These findings suggest that adrenaline tumescence reduces donor site blood loss in a dose-dependent manner.
肿胀麻醉是一种减少皮肤移植供区出血的技术，然而，尚无研究比较不同肾上腺素浓度的肿胀液对供区失血量的影响。我们试图在前瞻性随机试验中评估含肾上腺素的肿胀液中不同肾上腺素浓度对皮肤供区出血的影响。
将供区分成三等份，每个部分随机接受不含肾上腺素、肾上腺素1:500,000或肾上腺素1:250,000的肿胀麻醉。取皮后10秒拍摄供区照片。然后将一块剖腹手术海绵放置在伤口上20秒，再拍摄照片。将这些照片分成相应的三等份，由一组不知情的独立整形外科医生按照0（无出血）至5（严重出血）的评分标准进行评分。
招募了11名患者（15个供区）。与用肾上腺素1:500,000浸润的部分相比，用肾上腺素1:250,000浸润的供区部分伤口出血和海绵染色的平均秩次评分显著更低（分别为9.47对21.57；p = 0.035和9.63对21.37；p < 0.043）。与未用肾上腺素浸润的部分相比，用肾上腺素1:500,000浸润的部分伤口出血和海绵染色的平均秩次评分显著更低（分别为21.57对37.97；p = 0.002和21.37对38；p < 0.002）。未出现局部或全身并发症。
我们证明，用不同含肾上腺素的肿胀液浸润供区会导致显著不同的照片出血评分。肾上腺素1:250,000肿胀麻醉导致的出血评分显著低于较低浓度的肾上腺素，且不影响安全性或伤口愈合。这些发现表明，肾上腺素肿胀麻醉以剂量依赖的方式减少供区失血量。
