Begaj Ardit, Asher Christian M, Hamilton Alexander E
Department of Plastic Surgery, Royal Preston Hospital, Preston, United Kingdom.
J Cutan Aesthet Surg. 2021 Jan-Mar;14(1):107-109. doi: 10.4103/JCAS.JCAS_66_20.
Adequate local anesthetic, in harvesting a split-thickness skin graft (SSG), traditionally involves multiple passes of a needle across the length and width of the marked donor site. We describe a technique using hyaluronidase to uniformly anaesthetize an SSG donor site with one injection, in one pass, of one needle. 1. Preop application of EMLA cream/AMITOP to the donor site 2. Mix 10 mL 1% lidocaine solution with Adrenaline 1:200,000 with 1 vial of Hyaluronidase 1500 units. The mixture is buffered with 1 mL 8.4% sodium bicarbonate to neutralize acidity and minimize pain. 3. Mark out the SSG donor site 4. Using a 27-G long needle (sterican), enter perpendicular to the skin in the middle of the proximal aspect of the donor site. Inject some local anesthetic subdermally, creating a mound. 5. Change the angle of the needle to 180° and continue to inject the remaining anesthetic along one half of the width of the donor site. 6. Using a rolled 4 × 4 swab, apply firm advancing pressure to distribute the mound across the remaining width and length of marked donor site. 7. As the mound advances, the hyluronidase/anesthetic mixture will distribute uniformly across the donor site within the same plane. The skin blanches secondary to the adrenaline during its distribution. The technique described is a fast, reproducible way to improve patient comfort through the elimination of repeated passes of a needle, distributing the anesthetic uniformly across the donor site, and facilitating the acquisition of an SSG of uniform thickness.
在取刃厚皮片（SSG）时，传统的充足局部麻醉方法是用针在标记的供皮区的长和宽上多次穿刺。我们描述了一种使用透明质酸酶的技术，通过一针一次注射就能均匀麻醉SSG供皮区。1. 术前在供皮区涂抹EMLA乳膏/AMITOP。2. 将10毫升1%利多卡因溶液与1:200,000肾上腺素以及1瓶1500单位的透明质酸酶混合。用1毫升8.4%碳酸氢钠缓冲该混合物以中和酸度并使疼痛最小化。3. 标记出SSG供皮区。4. 使用27G长针（施蒂瑞肯针），在供皮区近端中部垂直刺入皮肤。在皮下注射一些局部麻醉剂，形成一个隆起。5. 将针的角度改为180°，并沿着供皮区宽度的一半继续注射剩余的麻醉剂。6. 使用一根卷起的4×4纱布，施加稳固的推进压力，使隆起分布到标记的供皮区的剩余宽度和长度上。7. 随着隆起推进，透明质酸酶/麻醉剂混合物将在同一平面内均匀分布在供皮区。在其分布过程中，由于肾上腺素的作用皮肤会变白。所描述的技术是一种快速、可重复的方法，通过消除针的反复穿刺、使麻醉剂在供皮区均匀分布以及便于获取厚度均匀的SSG来提高患者的舒适度。
