Division of Plastic Surgery, Department of Surgery, Cipto Mangunkusumo Hospital/ Faculty of Medicine Universitas Indonesia, Jl. Diponegoro No. 71, Jakarta 10430, Indonesia; ICTEC (Indonesian Clinical Training and Education Center), Cipto Mangunkusumo Hospital/ Faculty of Medicine Universitas Indonesia, Jl. Diponegoro No. 71, Jakarta 10430, Indonesia; Medical Technology Cluster, IMERI (Indonesian Medical Education and Research Institute), Faculty of Medicine Universitas Indonesia, Education Tower, 2nd Floor, Jl. Salemba Raya No. 6, Jakarta, Indonesia.
Division of Plastic Surgery, Department of Surgery, Cipto Mangunkusumo Hospital/ Faculty of Medicine Universitas Indonesia, Jl. Diponegoro No. 71, Jakarta 10430, Indonesia.
Burns. 2022 Dec;48(8):1909-1916. doi: 10.1016/j.burns.2022.01.001. Epub 2022 Jan 5.
This study aims to compare the use of one-per-mil tumescent solution (a mixture of epinephrine and 0.2% lidocaine in a ratio of 1:1,000,000 in normal saline solution) and tourniquet to create clear operative fields and to evaluate the functional outcomes after post burn hand contracture surgery.
The subjects of this randomized controlled trial were divided into one-permil tumescent technique and tourniquet group for a similar surgical procedure. Three independent assessors evaluated the clarity of the operative fields through recorded videos for the first 15 min and the first 10-minute of each hour of the surgery. Functional outcome was evaluated at least three months postoperatively using total active and passive motion (TAM and TPM) of each digit. Malondialdehyde (MDA) and tumor necrosis factor alpha (TNF-α) were tested during baseline (5 min before the procedures), ischemia phase, and reperfusion phase (a phase when the blood flow returned to the tissue).
35 subjects were included in this study: 17 in the tumescent group and 18 in the tourniquet group. We found a significant difference in the clarity of operative field between tumescent and tourniquet groups, 5 vs 35 bloodless operative fields, respectively (p < 0.05). TAM and TPM of each digit before surgery and 3 months postoperatively showed no significant difference between both groups (p > 0.05). Furthermore, we found no difference in MDA and TNF-α levels between both groups at their respective phases.
The use of one-per-mil tumescent technique does not replace tourniquet use to create bloodless operative fields in burned hand contracture surgery. However, the postoperative functional results were similar in both groups showing that tumescent technique can be used as an alternative to tourniquet without compromising outcomes. The MDA and TNF-α examinations do not provide conclusive outcomes regarding ischemia and reperfusion injury.
本研究旨在比较使用 1%肿胀液（肾上腺素和 0.2%利多卡因以 1:1000000 的比例混合于生理盐水溶液）和止血带以形成清晰的手术视野，并评估烧伤后手挛缩手术后的功能结果。
这项随机对照试验的受试者被分为 1%肿胀技术组和止血带组，进行类似的手术程序。三名独立评估员通过记录视频评估手术前 15 分钟和每个小时的前 10 分钟的手术视野清晰度。术后至少三个月通过每个手指的总主动和被动运动（TAM 和 TPM）评估功能结果。在基线（手术前 5 分钟）、缺血期和再灌注期（血流恢复到组织时的一个阶段）期间测试丙二醛（MDA）和肿瘤坏死因子-α（TNF-α）。
这项研究纳入了 35 名受试者：肿胀组 17 名，止血带组 18 名。我们发现肿胀组和止血带组之间手术视野清晰度有显著差异，分别为 5 个和 35 个无血手术视野（p<0.05）。术前和术后 3 个月每个手指的 TAM 和 TPM 在两组之间无显著差异（p>0.05）。此外，我们发现两组在各自阶段的 MDA 和 TNF-α 水平没有差异。
在烧伤后手挛缩手术中，使用 1%肿胀技术不能替代止血带以形成无血手术视野。然而，两组的术后功能结果相似，表明肿胀技术可以替代止血带而不会影响结果。MDA 和 TNF-α 检查在缺血和再灌注损伤方面没有提供确凿的结果。
