Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore. Electronic address: christopher.ho2@mohh.com.sg. Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore. Electronic address: yeeonn.kok@mohh.com.sg. Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore. Electronic address: chong_si_jack@hotmail.com.
Burns : journal of the International Society for Burn Injuries. 2018;44((8):):2018-2025.
BACKGROUND Tumescent infiltration is a technique to reduce skin graft donor site bleeding, however there are no studies comparing tumescent solutions with different concentrations of adrenaline on donor site blood loss. We sought to evaluate the effect on skin donor site bleeding of different adrenaline concentrations in adrenaline-containing tumescent solutions in a prospective randomised trial. METHODS Donor sites were marked
into thirds and each segment randomised to receive tumescent infiltration containing no adrenaline, adrenaline 1:500,000, or adrenaline 1:250,000. Donor sites were photographed 10s after skin graft harvest. A laparotomy sponge was then placed onto the wound for a further 20s and photographed. These photographs were divided into their corresponding thirds and each scored on a scale of 0 (no bleeding) to 5 (severe bleeding) by a blinded independent panel of plastic surgeons. RESULTS 11 patients (15 donor sites) were recruited. Donor site segments infiltrated with adrenaline 1:250,000 had significantly lower wound bleeding and sponge staining mean rank scores compared with segments infiltrated with adrenaline 1:500,000 (9.47 vs 21.57; p=0.035 and 9.63 vs 21.37; p<0.043 respectively). Segments infiltrated with adrenaline 1:500,000 had significantly lower wound bleeding and sponge staining mean rank scores compared with segments that were not infiltrated with adrenaline (21.5 7 vs 37.97; p=0.002 and 21.37 vs 38; p<0.002 respectively). There were no local or systemic complications. CONCLUSIONS We demonstrate that donor site infiltration with different adrenaline-containing tumescence solutions cause significantly different photographic bleeding scores. Adrenaline 1:250,000 tumescence resulted in significantly lower bleeding scores than lower concentrations of adrenaline without compromising safety or wound healing. These findings suggest that adrenaline tumescence reduces donor site blood loss in a dose-dependent manner.
