■ Tumescence is then performed without blurring the marked borders. Approximately 200 ml of tumescence solution without the addition of triamcinolone acetonide is injected manually per side (0.9% NaCl, 500 ml, 1% prilocaine 250 mg = 25 ml, epinephrine 0.5 mg,
■ Tumescence is carried out in the layer where dissection will later be done, i. e., on the fascia of the upper arm, so that the skin/fat flap is separated from the fascia by the injection itself. During tumescence the surgeon can feel the thickness of the flap and can therefore carry out dissection quickly and with almost no bleeding. The tumescence also predetermines the level of dissection, so that no deeper vessels or nerves are damaged.
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