Does the Tumescent Technique Require Tumescence?

Abstract

The “tumescent technique” developed by Klein is a lipoplasty technique characterized by the infusion of large volumes of dilute lidocaine and epinephrine solution into the subcutaneous space of the treatment area. Klein recommended infusing this solution until the tissue became “swollen and firm,” hence the name, “tumescent.” Less blood loss has been reported with this technique than with earlier “wet” techniques, including those also using epinephrine in the subcutaneous infusate solution. In his published experience with the tumescent technique, Samdal concluded that this decreased blood loss was related more to subcutaneous vascular compression from the infusate volume than to the vasoconstrictive effect of the dilute (1:1,000,000) epinephrine. This study compares blood loss among three comparable lipoplasty patient populations, groups A, B, and C, after each group received a different volume range of infused anesthetic solution. Each patient in group A received an infusate volume of 100% to 199% of the estimated volume (Estvol) of fat to be removed. Patients in group B received 200% to 299%, and patients in group C received 300% to 400%. Blood loss was assessed using hematocrit determinations preoperatively and postoperatively on days 1, 5, and 10 for each patient. At day 1 and 5, the mean hematocrit difference between any of the three groups was less than 1.5%. At day 10, this difference was less than 1%. Statistical analysis failed to demonstrate a correlation between the volume of infusate and the decrease in hematocrit at 1, 5, or 10 days postoperatively. In this study, the anesthetic solution infused into the subcutaneous space in a volume of approximately 1.5 times the Estvol was as effective in decreasing blood loss as were volumes greater than three times the Estvol. The study suggests that decreased blood loss with the tumescent technique is a result of the remarkable vasoconstrictive effect of very dilute epinephrine solution bluntly infused uniformly through both the deep and superficial subcutaneous spaces. Effective vasoconstriction from this solution can be achieved with much less volume than that required to cause the tissues to become “swollen and firm.” The requirement to produce marked “tumescence” appears to be unnecessary.