TechniquesNo Tourniquet Technique of Surgery for MacrodactylyPrasetyono, Theddeus O.H. MD, PhD; Santoso, Timothy A. MD Author Information Division of Plastic Surgery, Department of Surgery, Cipto Mangunkusumo Hospital/Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia T.O.H.P. report in addition that he has a patent of one-per-mil tumescent formula for surgery field licensed. T.A.S. declares no conflict of interest. Address correspondence and reprint requests to Theddeus O.H. Prasetyono, MD, PhD, Division of Plastic Surgery, Department of Surgery, Cipto Mangunkusumo Hospital/Faculty of Medicine, Universitas Indonesia, Medical Staff Building 4th Floor, Jl. Diponegoro 71, Jakarta 10430, Indonesia. E-mail: [email protected]. Techniques in Foot & Ankle Surgery 21(3):p 158-162, September 2022. | DOI: 10.1097/BTF.0000000000000337 Buy SDC Metrics Abstract The tourniquet technique in limb surgery has traditionally been performed to produce bloodless operative fields. Nevertheless, there are limitations derived from the tourniquet itself; either the complications that may occur because of the ischemic effects, or the constraint of time because of the ischemic time. As no surgeon expects dreadful adverse events in their practices, an alternative technique may fill up the demand. The implementation of epinephrine, which was previously believed to be dangerous, has been performed in end-artery organs such as toes and fingers. In this article, the authors apply the tumescent technique with the use of 1:1,000,000 epinephrine or shortly termed as one-per-mil solution, without using the pneumatic tourniquet. The technique presents relatively clear operative fields, yet safe. Although the risk of bleeding is higher because of the enlarged vascular caliber and all structures around the affected digits, the technique facilitates clear visualization of important structures. In addition, the long action of the one-per-mil tumescent solution notably provides a much longer surgery duration, which facilitates complex surgery for macrodactyly. Level of Evidence: Treatment level of evidence IV—case series. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.