RESUMO
BACKGROUND: This study aims to explore the effectiveness of one-per-mil tumescent technique in hand surgery, which involves bone and joint. METHODS: This is a case series study on 14 patients with 15 operative fields. One-per-mil solution is formulated by mixing 0.05 mL of 1:1,000 epinephrine and 100 mg lidocaine in 50-mL saline solution. The solution was injected subcutaneously into the operative area until the skin turned pale. The surgery started 7-10 min after the last injection. We classified the operative field clarity into four categories: totally bloodless, minimum bleeding, acceptable bleeding, and bloody operative field. We also recorded the amount of tumescent solution, top-ups needed, length of surgery, type of anesthesia, and intraoperative pain reported by the patients under local anesthesia. RESULTS: Five patients were operated on under local anesthesia while the other ten were under general anesthesia. Eight cases yielded totally bloodless operative fields, while seven were classified as acceptable bleeding. There were no top-ups and conversion of anesthesia needed during surgery. CONCLUSIONS: We consider one-per-mil tumescent technique as a promising successor of pneumatic tourniquet in bone and joint surgery, especially for lengthy procedures on hand and upper extremity.
RESUMO
OBJECTIVE: The aim of this systematic review was to discuss the comparison of split-thickness skin graft (STSG) and full-thickness skin graft (FTSG) use as the treatment for volar digital and palmar burns in children. METHODS: We conducted PubMed and Cochrane Library searches using keywords "hand injuries", "contracture" and "skin transplantation". The search was limited to studies published from 1st January 1980 until 31st December 2013 and used English language. We selected the studies based on specific inclusion and exclusion criteria. We assessed the quality of the studies by using Newcastle-Ottawa Scale (NOS) for cohort studies. RESULTS: We included eight articles in our systematic review. One of those studies is a prospective cohort study and the others are retrospective cohort studies. Based on combined range of motion (ROM) evaluation in three studies, STSG group yielded poorer functional outcomes than FTSG group. However, there is no study which can fairly show that FTSG was significantly superior to STSG to achieve good functional outcomes. CONCLUSION: Currently, there is no strong, high-quality evidence to prove that FTSG is superior to STSG to cover pediatric palmar burns. Either FTSG or STSG can be utilized with consideration of several influential factors especially splinting and physiotherapy.
