Prilocaine plasma levels and methemoglobinemia in patients undergoing tumescent liposuction involving less than 2,000 ml.

BACKGROUND: As a reaction to reported adverse outcomes after lidocaine infiltration in tumescent liposuction, prilocaine has gained increasing popularity. Previous studies investigating large-volume liposuction procedures found maximum prilocaine levels and methemoglobinemia up to 12 h postoperatively, suggesting that liposuction should be performed as a hospital procedure only. The aim of this study was to determine prilocaine plasma levels and methemoglobinemia in patients after low- to average-volume liposuction for the purpose of defining the required postoperative surveillance period. METHODS: In 25 patients undergoing liposuction involving less than 2,000 ml prilocaine levels and methemoglobinemia were measured over 4 h postoperatively. Liposuction was conducted after the tumescent technique using a 0.05% hypotonic prilocaine solution with epinephrine. RESULTS: The average prilocaine dose was 6.8 + 0.8 mg/kg, with a maximum dose of 15 mg/kg. The peak prilocaine plasma level of 0.34 mug/ml occurred 3 h after the infiltration. The mean methemoglobinemia at this time point was 0.65%. Only one patient demonstrated a slightly elevated methemoglobin level of 1.4%, but lacked any clinical signs of methemoglobinemia. The prilocaine recovery in the aspirate averaged 36 +/- 4%, indicating that a large amount is removed by suctioning. CONCLUSIONS: The patients did not experience high plasma levels of prilocaine or methemoglobinemia undergoing liposuction involving less than 2,000 ml using a 0.05% hypotonic prilocaine solution. The authors therefore conclude that this procedure can be performed safely with a monitoring period of 12 h.

[Results of interphalangeal joint arthrolysis in patients with Dupuytren disease]. / Ergebnisse von Mittelgelenkarthrolysen bei Patienten mit Dupuytren-Erkrankungen.

The results of 226 arthrolyses of the proximal interphalangeal joints of ring and small fingers in patients with Dupuytren's disease are presented in a retrospective study. 52% of cases involved first operations, 48% were operations of recurrent diseases. Proximal interphalangeal joints of small fingers were more frequently affected than those of the ring fingers. Arthrolysis was carried out stepwise in Buck-Gramcko's technique. In 13% of the cases an additional temporary transarticular Kirschner wire fixation was carried out. The results were graded according to extension deficits and the distance from fingertips to distal palmar crease. The average pre-operative extension deficit was 65 degrees. The average extension deficit three months after operation was 35 degrees. The post-operative distance from fingertips to distal palmar crease was 2.5 centimeters. Ring fingers yielded better results than small fingers. A temporary transarticular Kirschner wire fixation did not lead to better results. In unfavourable cases however, this fixation seems to be indicated. Complications occurred in 27% of the cases, mainly involving wound healing.

[Description of Dupuytren disease by the Basel physician and anatomist Felix Plater in 1614]. / Die Beschreibung der Dupuytren-Erkrankung durch den Baseler Arzt und Anatomen Felix Plater im Jahre 1614.

Plater's description of Dupuytren's disease in 1614 is explained with regard to his understanding of the anatomy. The current view that Plater believed the disease to be caused by dislocation and shortening of the flexor tendons is based upon misinterpretation of the original Latin text. With the help of his anatomical studies, Plater had proven that subcutaneous ligamentous extensions of the palmar aponeurosis and not the flexor tendons were responsible for Dupuytren's disease. Felix Plater realised more than one hundred and fifty years before Cline, Cooper, and Dupuytren the palmar aponeurosis as the anatomical substrate of the disease.