The use of Lidocain-Epinephrine reduces blood loss and operating time with free TRAM breast reconstruction
Camilla Hellevuo, Asko Salmi, Esa Muuronen
Eur J Plast Surg vol 25: 5, 2002, 243-246
Middle Finland Central Hospital
Free Tram breast reconstruction should be a safe routine operation because of vast need of breast reconstructions. Lidocain-epinephrine injection is in common use with breast reductions because it has proved to decrease blood loss during the operation. The aim of this study was to evaluate if Lidocain-epinephrine injection could be safely used with free TRAM breast reconstruction to reduce blood loss and operating time.
15 consecutive free TRAM operations operated on in Middle Finland Central Hospital earlier were compared to 14 consecutive free TRAM operations operated on by the same surgeons with the new technique from Jan 1 to Jun 15 2000 (experimental group). In the experimental group we used 0.5% Lidocain-Adrenalinâ which were infiltrated in the lower abdomen (60 ml) before elevating the TRAM flap, 20 ml in the chest wall before exicing the scar and 20 ml in the other breast if reduction mammoplasty or mastopexy was needed.
Results:
| Control group | Experimental group | |||
| Mean | Range | Mean | Range | |
| Blood loss during the operation (ml) | 990 | 170-2500 | 380 | 140-610 p<0.001 |
| Blood loss after the operation (ml) | 750 | 170-1680 | 660 | 130-1370 |
| Need of blood (units of red cells) | 2.2 | 0-6 | 1.5 | 0-4 |
| Operating time (min) | 188 | 137-270 | 142 | 100-185 p<0.001 |
Discussion:
This study shows that Lidocain-epinephrine reduces blood loss during a free TRAM operation by 60%. Also the operating time is reduced by 25% mainly because of less bleeding. Lidocain-epinephrine did not have effect on the patient haemodynamics during the operation. It also seems that patients in the control group have less postoperative bleeding and need fewer transfusions. Vasoconstrictive agents have been thought to be contraindicated in microsurgery, however, this study shows that the combination of Lidocain-Adrenalinâ can be safely used in free TRAM breast reconstructions. Since this study we have performed a total of 45 free TRAM reconstructions with this technique without postoperative thrombosis or flap loss. (Learning curve cannot explain our results since both of the surgeons have more than seven years experience with free TRAM flap surgery).
Abstract:
1. XXXVIII Nordiska Plastikkirurgiska kongressen Reykjavik, Iceland 28.6.-1.7.2000
2. Kirurgipäivät 2000, Helsinki
3. European Asociation of Plastic Surgeons 31.5.-2.6.2001 Helsinki
4. American Society for Reconstructive Microsurgery Cancun, Mexico 12-15.1.2002
5. ISAPS Istanbul Turkey 29.5-1.6.2002
