Clinical Parameters of Tumescent Anesthesia in Skin Cancer Reconstructive Surgery

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Abstract
Objective: To describe and define the viability of using tumescent anesthetic technique (TAT) in skin cancer reconstructive surgery with good results and without adverse reactions. Design: Phase 3 clinical trial. Setting: The National Institute of Cancer in Bogotá, Colombia, is a national referral center with an institutional practice. Patients: From June 1992 to June 1994, 86 ambulant patients, who were of low to middle socioeconomic class, were referred from oncology to dermatology for moderately complicated surgery. As outpatients, they underwent skin cancer surgery using the TAT. The 2-year, post-operative follow-up included only 81 patients, because 5 patients (5.85%) could not be reached. Interventions: The following formula was used: 0.5 L of 0.9% sodium chloride, 0.025 L of 2% lidocaine (epinephrine 1:200 000), and 5-mmol/L of sodium bicarbonate. Main Outcome Measures: The primary study outcome measures were planned before the data collection began. Relevant age and sex data, skin cancer characteristics, and the type of reconstruction performed were tabulated for these patients. Photographs of the patients were taken. Patients were asked to rate the level of pain during the injection, during the surgery, and after the surgery. The amount of bleeding and the cosmetic results, were also evaluated. Results: Anatomical distortion before surgery was present in all the patients. The level of pain and bleeding (no patients experienced severe pain or bleeding) was minimal, and visualization of the surgical planes was good during the reconstruction using the TAT. On average, the size of the surgical specimen was 6.12 cm2. On the first day after surgery, tumescence decreased by 90% in each patient. Only 1 patient had a complication, which was a hematoma, attributable to trauma rather than to the TAT. The cosmetic results were good in 90% of the patients. Conclusion: The TAT in skin cancer reconstructive surgery offers good results and minimal complications. Arch Dermatol. 1997;133:451-454

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