Our Summary

The research paper reports on a method of using a very diluted solution called a ’tumescent solution’ for the surgical removal of slow-flowing vascular malformations (abnormal blood vessels) in the hand and upper extremity (arm), without needing a tourniquet (a device that stops blood flow).

The study looked back at four patients who had five such surgeries. Before the surgery began, the solution was injected under the skin around the area of the abnormality until the skin turned pale. The researchers noted how much solution was used, how long the surgery took, how clear the surgical area was of blood, and any complications.

The clarity of the surgical area was ranked as totally bloodless, minimum bleeding, acceptable bleeding, and bloody. For surgeries done under local anesthesia, they also recorded any pain felt during surgery, when the pain began, and if there was a need to switch to general anesthesia.

The results showed that the amount of solution used varied between 4.5 to 200 mL, and the surgeries lasted between 60 to 150 minutes. One surgery was totally bloodless, three had minimal bleeding, and one had acceptable bleeding. There was minor skin death in one patient. No patient reported pain during surgery or a need to switch to general anesthesia.

The conclusion of the study is that the diluted solution is effective for the surgical removal of slow-flowing vascular malformations in the hand and upper extremity without needing a tourniquet.

FAQs

  1. What is the 1:1,000,000 tumescent solution used for in hand surgery?
  2. What were the recorded outcomes of using the tumescent solution in the surgeries mentioned in the article?
  3. Were there any reported complications or issues involving pain during the surgeries where the 1:1,000,000 tumescent solution was used?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hand surgery is to follow all post-operative care instructions carefully, including keeping the hand elevated and applying ice as directed to reduce swelling and promote healing. It is also important to attend all follow-up appointments with your doctor to monitor progress and address any concerns.

Suitable For

Patients with slow flow vascular malformations in the hand and upper extremity are typically recommended hand surgery. These patients may experience symptoms such as pain, swelling, and decreased function in the affected limb. Hand surgery may be recommended to improve function, alleviate pain, and address any cosmetic concerns associated with the vascular malformation. In some cases, hand surgery may be performed using a 1:1,000,000 tumescent solution for resection of the vascular malformation without the need for tourniquet application. This technique has been shown to be effective in providing a bloodless surgical field and minimizing intra-operative pain.

Timeline

Before hand surgery:

  • Patient consultation with a hand surgeon to discuss the procedure and potential risks and benefits
  • Pre-operative assessment including medical history, physical examination, and possibly imaging studies
  • Discussion of anesthesia options, including local anesthesia with tumescent solution
  • Infiltration of 1:1,000,000 tumescent solution surrounding the vascular malformation until the skin turns pale
  • Surgical resection of the vascular malformation without the use of a tourniquet

After hand surgery:

  • Post-operative monitoring for complications such as bleeding or skin necrosis
  • Pain management with appropriate medications
  • Follow-up appointments with the hand surgeon to monitor healing and assess the outcome of the surgery
  • Rehabilitation and physical therapy as needed to regain function and strength in the hand and upper extremity.

What to Ask Your Doctor

Some questions a patient should ask their doctor about hand surgery using 1:1,000,000 tumescent solution for resection of vascular malformation in the hand and upper extremity without tourniquet application may include:

  1. How does the tumescent solution work to help with the surgery?
  2. What are the potential benefits of using 1:1,000,000 tumescent solution for my specific condition?
  3. Are there any potential risks or side effects associated with the use of tumescent solution during the surgery?
  4. How will the injection of the tumescent solution affect my recovery process?
  5. How long is the typical surgery time when using tumescent solution for resection of vascular malformation in the hand and upper extremity?
  6. Will I experience any pain during the surgery, and if so, how will it be managed?
  7. What is the expected outcome of the surgery when using 1:1,000,000 tumescent solution?
  8. Are there any specific post-operative care instructions I should follow after the surgery?
  9. How long is the recovery time typically for this type of surgery?
  10. Are there any alternative treatment options available for my condition that do not involve the use of tumescent solution?

Reference

Authors: Prasetyono TO, Gustin J. Journal: Hand Surg. 2015 Oct;20(3):447-52. doi: 10.1142/S0218810415500380. PMID: 26388008