Pre-, intra-, and post-treatment use of duplex ultrasound (thermal and non-thermal)
Joseph A. Zygmunt in Venous Ultrasound, 2020
The addition of duplex ultrasound to guide therapeutic intervention adds to the accuracy and also the safety of the procedures undertaken. This application is being used in many fields of medicine for biopsy, nerve blocks, regional anesthesia, and insertion of catheters and central lines, to name a few. In the following text, discussion points will focus upon concepts related primarily to thermal ablation procedures, specifically: (i) preoperative marking; (ii) access for intervention; (iii) placement and advancement (or positioning) of the catheter; (iv) administration of tumescent anesthesia; (v) monitoring treatment; and (vi) immediate post-treatment imaging. Of note, the current (second) edition of this book now includes content related to the newer non-thermal non-tumescent (NTNT) and non-thermal non-tumescent non-sclerosant (NTNTNS) techniques.
Venous anatomy and pathophysiology
Helane S Fronek in The Fundamentals of Phlebology: Venous Disease for Clinicians, 2007
The tumescent technique of infiltrative anesthesia involves the administration of a larger volume of a more dilute anesthetic solution. It has been shown that more local anesthetic can be used over a larger area with less risk of toxicity with these dilute, epinephrine-containing solutions. Tumescent anesthesia has become widely recognized for its safety and ability to produce excellent anesthesia of the subcutaneous tissue, skin, and underlying muscle. The increased distortion (swelling) and tissue tension create a favorable operative environment for surface hook phlebectomies. The large volume is advantageous during endovenous thermal ablation procedures, as it decreases vein diameter and produces a fluid layer that insulates the surrounding tissue from the heat generated during these techniques. Perivascular ultrasound-guided tumescent infiltration of the saphenous trunks has become the anesthetic technique of choice for endovenous thermal ablation procedures.
Tumescent Anesthesia
Marwali Harahap, Adel R. Abadir in Anesthesia and Analgesia in Dermatologic Surgery, 2019
Tumescent anesthesia (TA) is a distinct form of local anesthesia that employs a large volume of fluid (usually normal saline) containing a very dilute concentration of anesthetic (primarily lidocaine) and vasoconstrictor (epinephrine), as well as other additives (notably, sodium bicarbonate). Local anesthesia is defined as the loss of sensation within a confined area without alteration of the patient’s consciousness. Tumescent is derived from the Latin word tumescere, meaning to swell. It is the swelling and resultant firmness of the tissue that both contributes to the regional anesthetic effect and also facilitates the procedure for which it is now most commonly employed, liposuction. TA is local infiltration anesthesia and should not be confused with regional anesthesia as occurs with peripheral nerve blockade.
Liposuction-assisted circumferential trimming in treatment of axillary osmidrosis (AO)
Published in Journal of Dermatological Treatment, 2018
Xiaogen Hu, Bo Chen, Dingquan Yang
Tumescent anesthesia was used for local anesthesia (Video 1). Local anesthetic consisted of 500 ml of normal saline, 0.5 ml of 1:1000 epinephrine, 10 ml of 2% lidocaine, and 5 ml of 10% sodium bicarbonate. The tumescent fluid was injected into the subcutaneous layer of the operative area to minimize bleeding, make dissection easier, and reduce postoperative pain (Figure 2(a)). On average, approximately 200 ml solution was used on each side to fill up the axillary concavity. After local anesthesia, two 2 mm long stab incisions were made on the thoracic pole and the brachial pole (Figure 2(b)) through which a cannula 2 mm in diameter was inserted and extended to the marked edge of the axilla for superficial liposuction. The reciprocating action of subcutaneous liposuction was performed from all angles (Video 2). The liposuction was finished when the targeted axillary skin was almost separated from the underlying tissue. The amount of liposuction was not considered for the treatment.
Autologous fat transplantation for the treatment of abdominal wall scar adhesions after cesarean section
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Sheng-Hong Li, Yin-Di Wu, Yan-Yun Wu, Xuan Liao, Pik-Nga Cheung, Ting Wan, Li-Ling Xiao, Jian-Xing Song, Hai-Ling Huang, Hong-Wei Liu
Approval for autologous fat harvesting and transplantation was obtained from the Institutional Review Board of Medical Science, Jinan University, and written consent was obtained from the study participants. The liposuction sites were located in the lower abdomen, thigh, and knee. The incision for lower abdominal liposuction was made at the inner edge of the umbilicus. Lidocaine (0.125%) was used as a topical infiltrating anesthetic. A no. 11 scalpel was used to make an incision of approximately 3 mm in accordance with the preoperative plan. A no. 20 blunt-side-opening long needle was used to inject the tumescent anesthesia solution (25 ml of 2% lidocaine + 2 mg of adrenaline + 12.5 ml of 8.4% sodium bicarbonate + 1000 ml of normal saline). The amount of tumescent fluid injected depended on the amount of fat required and the range of liposuction. A side-opening liposuction needle with an inner diameter of 3 mm was inserted into the subcutaneous fat layer, a 20 ml syringe was connected, and subcutaneous fat was extracted using the syringe liposuction technique [14,15]. Uniform radioactivity extraction was conducted, and the amount of extracted fat depended on the amount of fat required to fill the subcutaneous tunnels of the scar. The contused tissue around the incision was trimmed, and the skin incision was sutured. The surgical area was bandaged under pressure. The collected fat was statically precipitated and filtered to remove the tumescent anesthetic fluid and was then placed in a 10 ml syringe for use.
Corneal Neurotization: Review of a New Surgical Approach and Its Developments
Published in Seminars in Ophthalmology, 2019
Natalie Wolkow, Larissa A. Habib, Michael K. Yoon, Suzanne K. Freitag
In 2018, Leyngold et al. described a feasibility study in cadavers of an endoscopic approach to corneal neurotization.15 This was followed by a description of the use of this approach in a patient.16 An ipsilateral nerve transfer was evaluated in the cadavers, while a contralateral nerve transfer was performed in the patient. In the case of the patient, tumescent anesthesia was instilled in the forehead. An eyelid creased incision was made through which dissection was carried up to the supraorbital rim where the supraorbital nerve was identified. Dissection was continued subgaleally in a superior direction for 1 cm to further expose the nerve. Two vertical incisions were made behind the hairline, as in an endoscopic brow lift. Subperiosteal dissection was performed with endoscopic visualization until the previously dissected area was encountered. The periosteum was incised to connect the dissection planes, and the supraorbital nerve branches were isolated using both the endoscopic and eyelid crease incisions. Seven centimeters of nerve were exposed, and the nerve branches were cut and tunneled to the contralateral eye. The nerve fascicles were passed through a blepharotomy incision to the superior fornix, where donor nerve branches were arranged around the cornea in sub-Tenon space and secured with 8-0 polyglactin sutures. The patient did well post-operatively, although follow-up was short. By 3 months postoperatively there was some return of corneal sensation and no synesthesia.
Related Knowledge Centers
- Adrenaline
- Burn
- Local Anesthesia
- Vascular Surgery
- General Anaesthesia
- Tumescent Liposuction
- Plastic Surgery
- Lidocaine
- Epinephrine
- Prilocaine