| Ischemia of postmastectomy skin after infiltration of local anesthetic with epinephrine: a case report and review of the literature. | |
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MedLine Citation:
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PMID: 20464394 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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BACKGROUND: The goals of this study were to review the literature regarding the use of local anesthetic with epinephrine and to report an observation of prolonged ischemia and necrosis in postmastectomy skin. METHODS: A PubMed literature review was performed and the patient's medical record was reviewed. RESULTS: Prior skin necrosis with epinephrine use in acral areas was often due to physician or manufacturing overdose. Many large studies have confirmed subsequently epinephrine's safety in acral areas. There are reports of prolonged ischemia in the dermatology literature when used in areas with impaired venous and lymphatic drainage. Our case report suggests that the impaired clearance mechanisms in postmastectomy skin with an underlying implant can lead to ischemia when using local anesthetic with epinephrine. CONCLUSIONS: The addition of epinephrine to local anesthetic increases the duration of analgesia and provides for a relatively bloodless operating field. In the past many surgeons were reluctant to use it because of concerns about arterial vasospasm and tissue necrosis. However, perceptions have recently changed as large reviews have documented its safe use in acral areas. Based on our review of the literature and this case, epinephrine use may not be appropriate in patients with compromised venous and lymphatic drainage. |
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Authors:
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Tristan L Hartzell; Naveen F Sangji; Mary C Hertl |
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Publication Detail:
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Type: Journal Article Date: 2010-05-13 |
Journal Detail:
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Title: Aesthetic plastic surgery Volume: 34 ISSN: 1432-5241 ISO Abbreviation: Aesthetic Plast Surg Publication Date: 2010 Dec |
Date Detail:
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Created Date: 2010-11-30 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7701756 Medline TA: Aesthetic Plast Surg Country: United States |
Other Details:
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Languages: eng Pagination: 782-4 Citation Subset: IM |
Affiliation:
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Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA. thartzell@partners.org |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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