DERMATOLOGIC SURGERY Dermal tumescent local anesthesia in cutaneous surgery

T umescent local anesthesia was first described by Klein in 1987 when he detailed the infiltration of large volumes of a diluted solution of lidocaine with epinephrine into fat before liposuction. The tumescent technique revolutionized liposuction by eliminating the necessity of general anesthesia or intravenous sedation and the copious bleeding that had been associated with liposuction procedures. Since that time, the use of the tumescent technique has been expanded to include other dermatologic surgical procedures such as hair transplantation, laser surgery, face-lifts, abdominoplasty, brachioplasty, and breast augmentation. The benefits of the tumescent technique detailed by Klein are numerous: optimizing biochemical drug efficacy, targeting drug effects in local tissue compartments, maximizing drug concentration locally, delaying systemic drug absorption, prolonging local and systemic drug effects, decreasing systemic drug toxicity, increasing the safe upper limit of drug dosage, mechanically expanding a targeted compartment, and benefiting from augmented local hydrostatic pressure to reduce bleeding. In this report, we aim to describe the use of dermal tumescent anesthesia in cutaneous surgical procedures. It is the authors’ experience that dermal tumescent anesthesia produces superior local anesthesia by directly injecting larger amounts of diluted anesthetic solution into the dermis, and also a reduced amount of bleeding intraoperatively and postoperatively.