TY - JOUR
T1 - A randomized controlled trial
T2 - Comparison of one-per-mil tumescent technique and tourniquet in surgery for burn hand contracture in creating clear operative field and assessment of functional outcome
AU - Prasetyono, Theddeus Octavianus Hari
AU - Sadikin, Patricia Marcellina
N1 - Funding Information:
This research has received grant from Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Grant number: I.B 02.01/X.2/34788/2016. TOHP contributed to the conception and design of the study, acquisition of the surgery as the single surgeon, analysis, and interpretation of the data, drafting the manuscript, critically revising the article for important intellectual content, and made final approval of the version to be submitted. PMS contributed to the data analysis and interpretation, drafting the manuscript and made final approval of the submitted version.
Funding Information:
This research has received grant from Cipto Mangunkusumo Hospital, Jakarta, Indonesia . Grant number: I.B 02.01/X.2/34788/2016 .
Publisher Copyright:
© 2022 Elsevier Ltd and International Society of Burns Injuries
PY - 2022/12
Y1 - 2022/12
N2 - Background: 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. Methods: 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). Results: 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. Conclusions: 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.
AB - Background: 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. Methods: 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). Results: 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. Conclusions: 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.
KW - Burns
KW - Contracture
KW - Epinephrine
KW - Hemostatic technique
KW - Lidocaine
KW - Tourniquet
UR - http://www.scopus.com/inward/record.url?scp=85122621674&partnerID=8YFLogxK
U2 - 10.1016/j.burns.2022.01.001
DO - 10.1016/j.burns.2022.01.001
M3 - Article
AN - SCOPUS:85122621674
SN - 0305-4179
VL - 48
SP - 1909
EP - 1916
JO - Burns
JF - Burns
IS - 8
ER -