Tumescent anesthesia combined with skin and soft tissue expansion for the repair of 41 cases of congenital giant melanocytic nevi / 中华皮肤科杂志

Objective:To investigate the efficacy of tumescent anesthesia combined with skin and soft tissue expansion for the repair of congenital giant melanocytic nevi.Methods:From July 2015 to December 2019, 41 patients with congenital giant melanocytic nevi, including 24 males and 17 females aged 7 - 45 years, were collected from the Department of Dermatology, Xijing Hospital, the Fourth Military Medical University. Skin lesions ranged from 5 cm × 12 cm to 12 cm × 18 cm in size, and were located on the scalp in 13 cases, on the face in 18 cases, as well as on the trunk in 10 cases. Before surgery, the composition of tumescent solution was adjusted according to the body weight, operation duration, skin lesion area, etc., and the total dose and peak plasma concentration of lidocaine should be below 35 mg/kg and 4 mg/L respectively. All the patients received tissue expander placement and second-stage flap transfer under tumescent anesthesia.Results:During surgery, satisfactory effect of tumescent anesthesia was achieved in all the 41 patients, the pain score assessed by a numerical rating scale was 1.82 ± 0.54. In addition, the surgical field and dissection levels were clear with little bleeding and no related complications. Follow-up of 3 - 36 months showed that the skin flaps matched the surrounding skin tissues well, with relatively concealed incision lines and soft flat scars.Conclusion:For the treatment of congenital giant melanocytic nevi, tumescent anesthesia is effective and safe, which combined with skin and soft tissue expansion can effectively reduce the incidence of postoperative complications, and this strategy is worthy of clinical promotion.

Application and safety of bupivacaine undergoing tumescent liposuction in general anesthesia / 中华医学美学美容杂志

Objective To explore the safety,composition and effectiveness of bupivacaine in swelling fluid and to understand the safe use of the swelling fluids contained bupivacaine as local anesthetics in liposuction.Methods The liposuction was completed in 149 patients,aged 18-63 years with the swelling fluid contained bupivacaine in different proportions by negative pressure liposuction for exploring the method and safe use of the swelling fluid contained bupivacaine in general anesthesia.Results The dose range of bupivacaine at 1.14-1.87 mg/kg did not show toxicity.Bupivacaine combined with lidocaine as a part of swelling fluid was suitable for all range of liposuction in general anesthesia.There was no pain sensation first day after the operation.The pain was obvious on the day after surgery in lidocaine group.The advantage using bupivacaine as swelling fluid was that the postoperative recovery was fast,the healing was good,and the complications were few.Conclusions Bupivacaine as the main anesthetic agent for swelling fluid shows the advantages of long analgesic effect,good anesthetic effect,and no pain after operation.It is worth further application.

A Study of Application of Tumescent Technique for Liposuction Surgery in Tertiary Care Centre

The tumescent technique of liposuction is a modification of the wet technique. A large volume of very dilute epinephrine is infiltrated into a targeted fat compartment prior to liposuction, producing a swelling and firmness. This tumescence of fat permits an increased accuracy in liposuction and minimizes postsurgical irregularities or rippling of the skin. Epinephrine- induced vasoconstriction minimizes blood loss, bruising, and postoperative soreness. Safe, rapid infiltration of large volumes of solution is achieved using a closed sterile system featuring a newly designed blunt-tipped, 30-cm-long, 4.7-mm-diameter needle having a hollow handle that accommodates a 60-cc syringe. Attached to a liter bottle of anesthetic solution by an intravenous line, the needle is inserted via the same incision and deposits the solution along the same path as that intended for the liposuction cannula. Thus, the solution is infiltrated exactly where it is needed for hemostasis or local anesthesia. Used in conjunction with general anesthesia, the tumescent technique saves time in achieving maximal vasoconstriction of the targeted fat compartment. If dilute lidocaine (0.1%) is added to the solution, the technique permits liposuction of more than 2 liters of fat totally by local anesthesia. Twenty-six patients, having received a mean lidocaine dose of 1250 mg (18.4 mg/kg or 8.5 mg/kg/hr) infiltrated into subcutaneous fat, had a mean serum lidocaine level of less than 0.36 ųg/ml 1 hour after completion of the infiltration.

Effect of glutathione on autologous fat graft survival of the rabbits / 中华整形外科杂志

Objective@#To investigate the effect of adding glutathion(GSH) to tumescent solution on autologous fat graft survival.@*Methods@#14 male and female New Zealand rabbits were divided into experimental group and control group randomly, 7 in each group. Experimental group: The donor areas of the rabbits were injected with 3 ml of tumescent solution with GSH. Control group: The donor areas of the rabbits were injected with 3 ml regular tumescent solution. DCFH-DA probe was used for fluorescent staining of harvested fat cells. Then stained fat cells were measured for the intracellular reactive oxygen species(ROS)content by fluorescence microplate. The grafts were harvested at 3 months after transplantation and assessed by general observation, volume measurement, wet weight measurement, HE staining for the number of fat cells, and CD34 immunohistochemical staining for the measurement of micro-vascular density. T test was performed by using SPSS 24.0.@*Results@#The intracellular ROS content of harvested fat cells in experimental group was lower than that in control group, and the difference was statistically significant (P<0.05). At 3 months after transplantation, the wet weight of fat grafts in experimental group was (1133.21±87.97) mg and that in control group was (718.79±79.27) mg. The volume of fat grafts in experimental group was (1.00±0.04) ml and that in control group was (0.59±0.03) ml. The number of fat cells in experimental group was (746.6±15.7)/10 high magnification vision and that in control group was (350.1±32.4)/10 high magnification vision. The density in group experimental was (8.1±2.0)/high magnification vision and that in control group was (6.7±2.4)/high magnification vision. The grafts′ volume, wet weight, and the number of fat cells in experimental group were higher than those in control group, and the differences were statistically significant (P<0.05). The difference of micro-vascular density between experimental group and control group had no statistical significance (P>0.05).@*Conclusions@#The addition of GSH to tumescent solution optimizes the process of autologous fat harvest, thereby improving the survival of fat graft.

Anatomical, imaging and histological observations of the circumferential full-length of superficial fascia structure of the upper limb / 中华整形外科杂志

Objective@#To describe the general and histological features of the full-length superficial fascia of the circumferential upper limb.@*Methods@#Fresh frozen arm specimens were dissected, and then MRI imaging in vivo, enhanced CT angiography and HE histological staining were used to describe the characteristics of the full-length superficial fascia of the circumferential arm and its relationship with important blood vessels.@*Results@#The four typical structures of the superficial fascia of the arm were divided into subcutaneous superficial fat, membrane-like substance, deep fat and deep fascia from superficial to deep. The thickness and stratification, fusion degree and histological characteristics of the superficial fascia of these four layers were obviously different in different levels and regions of the arm. MRI confirmed that the total thickness of superficial fascia gradually decreased from shoulder to wrist. Venography showed that the cephalic vein ran below the second layer of superficial fascia and above the deep fascia. The basilic vein originated from the dorsal vein network of the hand and always lied below the second layer of membranous material until the basilic vein penetrates below the deep fascia of the upper arm.@*Conclusions@#The deep understanding of the circumferential full-length of superficial fascia structure of the upper limb provides an important theoretical basis for improving the surgical safety and fine operation for the Dynamic Arm Circumferential Liposuction.

Application of liposuction in treating the primary end-stage lymphedema of lower extremities / 中华整形外科杂志

Objective@#To investigate outcome and clinical value of liposuction in primary lymphedema of lower extremities.@*Methods@#Thirty patients with primary lymphedema in unilateral lower extremity were recruited in this study from July 2016 to August 2017 in Beijing Shijitan Hospital. There were 13 male and 17 female patients, with the average age of (36±16.3) years. All the patients were underwent liposuction. The volume of hemorrhage and lipid, operation time and the volume changes of affected extremity were recorded. The subjective evaluation of the patients were also proceed. The patients were divided into different groups according to gender, stage and erysipelas history.@*Results@#Total lipid volume is 900-3 900 ml. The hemorrhage volume is 160-1 100 ml during liposuction. The ipsilateral-contralateral percent volume of lower extremity was decreased immediately after surgery (6.6%±10.0%, t=7.050, P=0.000), and 3 months postoperatively (12.2%±10.7%, t=5.365, P=0.000), when compared with preoperative (31.4%±16.4%). However, the percent volume was increased 3 months after surgery, compared to immediately postoperative measurements (t=-2.088, P=0.041). Female patients had more lipid volume and higher liposuction rate than males, whereas male patients show more affected extremities volume before, after and in 3-month follow-up. The hemorrhage volume was also higher in male than female patients. Patients with erysipelas had higher volume of hemorrhage, with lower lipid volume and liposuction rate. Stage Ⅱpatients show higher lipid volume and liposuction rate than stage Ⅲ patients in operation, with lower hemorrhage and affected extremity volume changes in before, after and 3-month follow-up. In subjective assessment, the experienced heaviness and fatigue was alleviated in all patients, while the pain and tightness was increased.@*Conclusions@#Liposuction is an effective therapy for primary lymphedema in lower extremity. It is necessary to combine with other therapies to improve lymph circulation. Patients′ gender, stage and the history of erysipelas are the main influencing factors of operation difficulty and prognosis.

Laboratory Study on Injection Force Measurement on Syringe and Needle Combinations

@#Background: This study aimed to measure the least initial and maintenance forces of syringe and needle combinations to provide a reference for local anesthetic injection. Methods: An experimental study was conducted in our Physics Laboratory during September 2015. A series of syringes sized 1 mL, 3 mL, 5 mL, 10 mL and 20 mL were paired with the original needles, 27G, 27G spinal and 30G. Each combination was tested three times using a compression testing Instron 5940 Series to measure initial and maintenance forces. Statistical analysis was performed using One-way ANOVA. Results: The lowest initial force was shown by the combination of 1 mL syringe and 27G spinal needle. However, the 1 mL syringe showed no significant difference across the needles [F(3, 8) = 3.545; P < 0.068]. The original and 27G needle showed mean difference 0.28 (95%CI: −0.19, 0.75; P = 0.420). The lowest maintenance force was measured in the combination of 1 mL syringe and its original 26G needle. On the contrary, both the highest initial and maintenance forces were shown by the combination of 10 mL syringe and 30G needle. Conclusion: The 1 mL syringe with original 26G needle shows the best combination.

A Novel Comparative Study of Phlebectomy with Invagination Stripping of the GSV Done Under Tumescent and Spinal Anaesthesia: A Prospective Cohort From Tertiary Centre In South India

Background: Varicose veins are commonly encountered vascular disease with wide variety of surgical and minimally invasive /interventional modes of treatment .we put forth a novel economical and efficient technique of performing high ligation, long saphenous vein stripping and Muller's hook phlebectomy in tumescent local anaesthesia compared with spinal anaesthesia. AIM &OBJECTIVE: The purpose of the study was to compare a novel technique of performing phlebectomy and invagination stripping of the GSV using tumescent anesthesia and spinal anesthesia in terms of post operative pain, complications. Methods: A total of 200 patients (100 patients in each arm of spinal anaesthesia group, and tumescent anaesthesia group) diagnosed cases of varicose vein lower limb being operated with phlebectomy and invagination stripping of the GSV at Surgery Department of Government Medical College and Hospital, Kozhikode, Kerala were considered in this study. Consecutive sampling was done. Results: Of these patients, 120 (60%) were female and 40 were male (40%) with a mean age of 35.4 ± 8 and 47.4 ± 14 years, respectively No statistically significant difference with respect to the wound infection, local discomfort, postoperative recurrence rates of varicosity and patients satisfaction score was observed (P > 0.05. Conclusion: Tumescent local anesthesia is a novel, economical and efficient technique of performing high ligation, long saphenous vein stripping and Muller's hook phlebectomy when compared to doing under spinal anaesthesia with similar results.

Application of tumescent anaesthesia in laparoscopic cholecystectomy / 实用医学杂志

Objective To explore the clinical effect of tumescent anaesthesia in laparoscopic cholecystectomy(LC). Methods We analyzed the data of 71 patients who underwent LC for gallbladder benign disease. Anesthesia swelling fluid was injected in 37 cases before the operation in the gallbladder triangle( group D)and another 34 cases received no injection(group C). SBP,DBP,HR and Spo2 were monitored at 4 min before gallbladder traction(T1),1 min(T2),6 min(T3)and 11 min after gallbladder traction(T4),and when the gallbladder was dissected from gallbladder bed completely(T5). The operation time,intraoperative blood loss,postoperative exhaust time,time of getting out of bed after the surgery and length of stay were recorded. The gallbladder rupture, vascular injury ,bile duct injury ,intestinal injury ,placement of drainage tube ,intra-abdominal hemorrhage , intraoperative use of atropine or ephedrine and nausea and vomiting 24 hours after the operation were recorded. Results In group C,SBP,DBP and HR were significantly decreased at T2-T4 when compared with those at T1, and were significantly lower when compared with those in group D(P < 0.05). There was no significant difference in oxygen saturation between the two groups(P > 0.05). There were shorter operation time and less intraoperative blood loss in group D when compared with those in group C and the difference was statistically significant (P <0.05). The anus exhaust time,time of getting out of bed after the surgery,length of stay,intraoperative intra-abdominal hemorrhage and nausea and vomiting in the two groups indicated no statistical significance (P > 0.05). Gallbladder damage,vascular injury,placement of drainage tube and the incidence of adverse event were less in group D than those in group C. Conclusion Swelling anesthesia in LC can shorten the operation time ,induce less postoperative complications and maintain blood circulation stability.

Research Progress of Tumescent Anesthesia / 中国微创外科杂志

[Summary] Tumescent anesthesia is mainly used in liposuction operation and has produced an exemplary safety record for this technique to date .Now surgical applications for the technique widely vary ranging across vascular surgery , breast surgery , plastic surgery and so on .It can be used in both hospital-and day-case environments .In this review we summarized the research progress of tumescent anesthesia in respect with indications , selection and maximum dose of local anesthetics , additives use , and safety .

Tumescent local anesthetic technique for inguinal hernia repairs

PURPOSE: We evaluated the adequacy and feasibility of a tumescent solution containing lidocaine and bupivacaine for inguinal hernia repairs. METHODS: The medical records of 146 consecutive inguinal hernia patients with 157 hernia repairs using the tumescent local anesthesia technique performed by a single surgeon between September 2009 and December 2013 were retrospectively reviewed. RESULTS: The mean operation time (+/-standard deviation) and hospital stay were 64.5 +/- 17.6 minutes and 2.7 +/- 1.5 days. The postoperative complication rate was 17.8%. There were four cases of recurrences (2.5%) at a mean follow-up of 24 +/- 14 months. CONCLUSION: Our results suggest that local anesthesia with the tumescent technique is an effective and safe modality for inguinal hernia repairs.

Epinephrine in the tumescent technique for hypospadia surgery.

The use of tumescent technique, which contains epinephrine, in penile surgery has not been reported previously. Two patients with hypospadias had reconstructive operation using tumescent technique with a ”One-per-Mil” tumescent solution containing epinephrine intra-operatively. The results was a clear operation field, almost bloodless during dissection, and no complication on the penis after epinephrine injection with minimal edema. Apparently, the “One-per-Mil” tumescent solution acts as a natural hydro-dissector creating avascular anatomic tissue planes for easier and more rapid dissection in surgery for hypospadias. We suggest that epinephrine is safe to be injected in penis as a future area of clinical practice.

Gynecomastia Treated with Tumescent Liposuction and the Pull-Through Technique / 대한피부과학회지

Gynecomastia is the most common condition affecting the male breast due to enlargement of both ductal and stromal tissue. Growth of the male breast can be manifested at any age, but 40% of cases present in adolescent boys. The condition depends mainly on the balance between serum estrogens and androgens. Gynecomastia represents a source of embarrassment, and optimal correction is difficult to achieve. Numerous methods of gynecomastia repair are available. Our method is a combination of liposuction and the pull-through technique. The purpose of this treatment is to resect excess tissue and restore the normal chest contour with minimal scarring. We report a case of gynecomastia treated with a combination of tumescent liposuction and the pull-through technique.

Comparative Analysis of Tumescent Liposuction according to the Dermal Curettage Level for the Treatment for Axillary Osmidrosis / 대한피부과학회지

BACKGROUND: The efficacy of tumescent liposuction in the treatment of axillary osmidrosis has been widely established. But there have been few studies that have conducted a comparative analysis according to the level of dermal curettage with respect to the efficacy and safety. OBJECTIVE: The aim of this study was to evaluate the clinical efficacy and complications of tumescent liposuction according to the degree of dermal curettage. METHODS: From September 2004 through August 2009, a total of 33 patients with axillary osmidrosis (66 axillae) were included in this study. Twelve patients (24 axillae) were treated by tumescent liposuction with dermal curettage at the level of the mid-dermis (the classical technique group), and the other 21 patients (42 axillae) were treated by tumescent liposuction with dermal curettage at the level of the dermo-subcutis junction (the modified technique group). The preoperative and postoperative disease severity was measured as 0, 1, 2 and 3. The improvement of symptoms was graded by the patient as excellent, good, fair and poor. We also evaluated the postoperative complications, including skin necrosis, scar, hematoma, sensory disturbance and infection. Biopsies of the axillary skin were performed in 7 patients to confirm the level of dermal curettage and the reduction of apocrine glands after treatment. RESULTS: The follow-up ranged from 6 to 60 months. Six months after treatment, 95.8% (23/24) of the axillae in the classical technique group and 95.2% (40/42) of the axillae in the modified technique group had reduced disease severity below 1. Among the 12 patients treated with the classical technique, 11 (91.7%) had excellent to good results, while 95.2% (20/21) of the patients treated with the modified technique had excellent to good results by the patients' own grading. The complications included skin necrosis, scar and hematoma. In the classical technique group and the modified technique group, the incidence of skin necrosis was 12.5% (3/24) and 2.4% (1/42), respectively, the incidence of scar formation was 4.2% (1/24) and 0%, respectively, and the incidence of hematoma was 8.3% (2/24) and 0%, respectively. The postoperative histologic examinations confirmed that the dermal curettage level was at the mid-dermis in the classical technique and at the dermo-subcutis junction in the modified technique. Interestingly, the histologic examination from the classical technique group revealed vacuolar alteration of keratinocytes and partial separation of the dermo-epidermal junction. CONCLUSION: The efficacy of the modified technique is compatible with that of the classical technique, but the modified technique offers fewer complications. So, the modified technique may improve the cosmetic outcome without reducing the treatment efficacy for the patient with axillary osmidrosis.

Regra dos quatro: uma fórmula simples e segura para anestesia intumescente em procedimentos cirúrgicos dermatológicos / Rule of four: a simple and safe formula for tumescent anesthesia in dermatologic surgical procedures

Os autores descrevem uma regra fácil para fazer e utilizar uma solução anestésica local intumescente em procedimentos cirúrgicos dermatológicos. Atestam a segurança e a simplicidade da regra, baseados em prática cirúrgica ambulatorial superior a 20 anos e uso por 8 anos da solução em mais de mil procedimentos.

The authors describe an easy to make and apply rule for local tumescent anesthetic solution in dermatologic surgical procedures. They attest the safety and simplicity of the rule, based on ambulatory surgery practice for over 20 years and 8 years usage of the solution in more than a thousand procedures.

Tension pneumothorax occurred by tumescent solution injection during delay extended latissimus dorsi flap : A case report

Tension pneumothorax is known as a rare complication of breast augmentation surgery, but can occur more than expected. This is a case of a 34-year-old woman who was to receive delay extended latissimus dorsi flap under general anesthesia. The patient was injected the tumescent solution by 25 gauge spinal needle preoperatively. In the course of operation, the peak inspiratory pressure was increased gradually. At the moment of changing the position from supine to sitting position, the blood pressure decreased to 75/45 mmHg. We took the chest radiography, which showed typical findings of tension pneumothorax of right side. Prompt needle aspiration and chest tube insertion relieved tension pneumothorax. The patient's vital signs got stabilized and there was no visible remained pneumothorax at following chest radiography taken. We should pay attention to the possible occurrence of devastating pneumothorax during breast augmentation surgery, especially local infiltration using long needle is performed.

A Case of Breast Reduction with Pure Tumescent Liposuction / 대한피부과학회지

Patients with macromastia have physical discomfort including head, neck, and shoulder pain, wet skin fold/eczema, intractable mastalgia, and restricted exercise. They also have cosmetic problems and psychiatric discomfort. In Korea, excisional breast reduction is the main treatment option for macromastia, but breast reduction with pure tumescent liposuction is becoming a new treatment option in western society. Breast reduction with pure tumescent liposuction has multiple advantages including safety, no general anesthesia, outpatient procedure, minimal scaring, no loss of nipple sensation and the possibility of breast feeding. We report a case of macromastia treated by pure tumescent liposuction without any sedation. We hope that this article may help Korean dermatologists to understand about breast reduction using pure tumescent liposuction and expand the field of dermatologic surgery in Korean society.

Treatment of Axillary Hyperhidrosis; Manual Subdermal Excision Combined with the Tumescent Liposuction and Subcutaneous Tissue Shaver

BACKGROUND: Axillary osmidrosis is a distressing problem characterized by unpleasant odor, profuse sweating, and occasional wetting of clothes that may handicap those affected both socially and psychologically. A variety of surgical methods have been developed for the treatment of axillary osmidrosis. OBJECTIVE: To introduce the manual subdermal excision combined with the tumescent liposuction and subcutaneous tissue shaver for axillary osmidrosis. METHODS: Twenty-five patients with axillary osmidrosis were treated by the manual subdermal excision combined with the tumescent liposuction and subcutaneous tissue shaver. RESULTS: Twenty-one(84%) patients had good results, four(16%) fair, and none had a poor result or recurrence. Complications included one case of hematoma, two cases of partial skin necrosis. The wound complication rate was 6.0%(3/50) for the axilla and 12%(3/25) for patients. CONCLUSION: The manual subdermal excision combined with the tumescent liposuction and subcutaneous tissue shaver is effective surgical procedure for the treatment of axillary osmidrosis with a low complication rate and recurrence.

Ambulatory Phlebectomy Using the Tumescent Anesthesia / 대한피부과학회지

BACKGROUND: Ambulatory phlebectomy is a cosmetically elegant outpatient procedure for the removal of varicose veins. One of the keys to its success is the ability to perform the procedure under local anesthesia. Tumescent anesthesia is applied in dermatologic surgery and now being expanded for use in phlebectomy. OBJECTIVE: To evaluate the efficacy and safety as well as advantages of 0.1% tumescent anesthesia with epinephrine in ambulatory phlebectomy. METHODS: Twenty-two patients(twenty-seven legs) without reflux at the SFJ were treated with ambulatory phlebectomy using the tumescent(0.1%) technique. In all patients, we monitored blood pressure, heart rate, and O2 saturation before, during, and after procedure. All patients were asked to rate the pain, both intraoperatively and postoperatively. They visited in hospital to record complications at one day, one week, and various monthly intervals (1, 3, 6, 12 months) following the initial treatment. RESULTS: The volume of anesthetic fluid ranged from 90 to 650ml, with an average of 320.7ml of fluid. Blood pressure, heart rate, and O2 saturation measured did not significantly change before, during, or after procedure. The average reported intraoperative pain for all interviewees was from 0 to 2. For postoperative pain, patients reported pain rate less than one. During operation, significant surgical blood loss is eliminated. There were minimal hematoma, purpura, and hyperpigmentation after operation. CONCLUSION: 0.1% Tumescent anesthesia provides a very safe, comfortable technique of anesthetizing patients for ambulatory phlebectomy and may decrease the incidence of complications.

Ambulatory Phlebectomy Using the Tumescent Anesthesia / 대한피부과학회지

BACKGROUND: Ambulatory phlebectomy is a cosmetically elegant outpatient procedure for the removal of varicose veins. One of the keys to its success is the ability to perform the procedure under local anesthesia. Tumescent anesthesia is applied in dermatologic surgery and now being expanded for use in phlebectomy. OBJECTIVE: To evaluate the efficacy and safety as well as advantages of 0.1% tumescent anesthesia with epinephrine in ambulatory phlebectomy. METHODS: Twenty-two patients(twenty-seven legs) without reflux at the SFJ were treated with ambulatory phlebectomy using the tumescent(0.1%) technique. In all patients, we monitored blood pressure, heart rate, and O2 saturation before, during, and after procedure. All patients were asked to rate the pain, both intraoperatively and postoperatively. They visited in hospital to record complications at one day, one week, and various monthly intervals (1, 3, 6, 12 months) following the initial treatment. RESULTS: The volume of anesthetic fluid ranged from 90 to 650ml, with an average of 320.7ml of fluid. Blood pressure, heart rate, and O2 saturation measured did not significantly change before, during, or after procedure. The average reported intraoperative pain for all interviewees was from 0 to 2. For postoperative pain, patients reported pain rate less than one. During operation, significant surgical blood loss is eliminated. There were minimal hematoma, purpura, and hyperpigmentation after operation. CONCLUSION: 0.1% Tumescent anesthesia provides a very safe, comfortable technique of anesthetizing patients for ambulatory phlebectomy and may decrease the incidence of complications.