A randomized controlled trial: 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 |
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| Institution: | 1. Division of Plastic Surgery, Department of Surgery, Cipto Mangunkusumo Hospital/ Faculty of Medicine Universitas Indonesia, Jl. Diponegoro No. 71, Jakarta 10430, Indonesia;2. ICTEC (Indonesian Clinical Training and Education Center), Cipto Mangunkusumo Hospital/ Faculty of Medicine Universitas Indonesia, Jl. Diponegoro No. 71, Jakarta 10430, Indonesia;3. 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;1. Institute of Regenerative Medicine, Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang 212001, Jiangsu Province, China;2. Department of Dermatology, Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang, Jiangsu 212001, China;3. School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212001, China;4. Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, China;1. Department of Orthopedics, Orthopedic Research Center, Poorsina Hospital, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran;2. Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran;3. Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran;1. Department of Physiology, School of Medicine, Cellular and the Molecular Research Center, Guilan University of Medical Science, Rasht, Iran;2. Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran;3. Department of Parasitology, School of Medicine, Guilan University of Medical Science, Rasht, Iran;4. Department of Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran;5. Department of Orthopedics, Poorsina Hospital, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran;6. Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran;7. Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran;8. Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran;1. WFBMC Burn Center; Wake Forest Baptist Health System, USA;2. Burn Center; University Medical Center New Orleans, USA;3. Louisiana State University School of Medicine, USA;4. Wake Forest University School of Medicine, USA;1. School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA;2. Department of Surgery, Georgetown University School of Medicine, Washington DC 20007, USA;3. The Burn Center, MedStar Washington Hospital Center, Georgetown University School of Medicine, Washington DC 20007, USA;4. Department of Biochemistry, University of Vermont, Department of Biochemistry, Larner College of Medicine, Burlington, VT 05405, USA;5. United States Army Institute of Surgical Research, JBSA Fort Sam, Houston, TX 78234, USA;6. Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA |
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| Abstract: | BackgroundThis 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.MethodsThe 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).Results35 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.ConclusionsThe 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. |
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| Keywords: | Epinephrine Lidocaine Hemostatic technique Contracture Burns Tourniquet |
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