• Theddeus O H Prasetyono and Johannes A Biben.
• Division of Plastic Surgery, Department of Surgery, Cipto Mangunkusumo Hospital/Faculty of Medicine, University of Indonesia, Jakarta, Indonesia. Electronic address: teddyohprasetyono@yahoo.com.
• J Hand Surg Am. 2014 Jan 1; 39 (1): 3-12.e7.

PurposeWe studied the effect of 1:1,000,000 epinephrine concentration (1 per mil) to attain a bloodless operative field in hand and upper extremity surgery and to explore its effectiveness and safety profile.MethodsThis retrospective observational study enrolled 45 consecutive patients with 63 operative fields consisting of various hand and upper extremity problems. One-per-mil solution was injected into the operative field with tumescent technique to create a bloodless operating field without tourniquet. The solution was formulated by adding a 1:1,000,000 concentration of epinephrine and 100 mg of lidocaine into saline solution to form 50 mL of tumescent solution. Observation was performed on the clarity of the operative field, which we described as totally bloodless, minimal bleeding, acceptable bleeding, or bloody. The volume of tumescent solution injected, duration of surgery, and surgical outcome were also reviewed.ResultsThe tumescent technique with 1-per-mil solution achieved 29% totally bloodless, 48% minimal bleeding, 22% acceptable bleeding, and 2% bloody operative fields in cases that included burn contracture and congenital hand and upper extremity surgeries.ConclusionsOne-per-mil tumescent solution created a clear operative field in hand and upper extremity surgery. It proved safe and effective for a wide range of indications.Type Of Study/Level Of EvidenceTherapeutic IV.Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

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