Jakarta, October 7th 2023. Prof. Dr. dr. Theddeus O.H. Prasetyono, Sp.B.P.R.E., Subsp.T.(K) was inaugurated as a Permanent Professor in the field of Plastic Surgery, Faculty of Medicine (FK) University of Indonesia (UI), this morning at the FKUI IMERI Hall, UI Salemba Campus. During the ceremony, he delivered his inauguration speech entitled “Hand Surgery Without Tourniquets as a Model for the Development of Surgical Service Innovation for Competitive Excellent Service Readiness”.
Prof. Theddeus said that hand and upper limb operations are usually carried out with the help of a tourniquet (tourniquet or a band, usually made from synthetic rubber that can stretch), through the installation of a cuff that ensnares the upper arm with high pressure to stop blood flow towards the tip of the hand. However, the use of a tourniquet results in an ischemic effect due to stopping blood flow to all tissues distal from the cuff. On the other hand, the development of a tumescent technique which utilizes epinephrine in an injection mixed with the local anesthetic lidocaine, can replace tourniquets, where ischemic effects on the tissue do not occur.
Currently, the National Central Public Hospital Dr. Cipto Mangunkusumo (RSCM)—FKUI has developed applications for hand and upper limb surgery without tourniquets with expanded indications. “At that time, a tourniquet operation was carried out on a child, which was quite surprising for the surgical public, considering that the strong belief that vasoconstrictors, such as epinephrine, were prohibited from being injected into the finger, which is known as an arterial end organ. However, epinephrine is actually safe for the fingers. Moreover, the tissue that is made to swell due to the infiltration of tumescent fluid actually allows for an increase in the width of the safe margin for tissue dissection to avoid injury to important structures,” said Prof. Theddeus.
He further said, RSCM—FKUI also presents a tumescent solution using a one-per-mile liquid which contains epinephrine in a concentration of 1: 1,000,000. This epinephrine concentration is the lowest concentration used with high effectiveness to replace the role of a tourniquet. Likewise, the local anesthetic lidocaine contained in it is only 0.2%. Starting from research using small flaps on animal subjects that represent perforator flaps, the one-per-mil solution has succeeded in becoming a powerful “weapon” in clinical work since 2010. In addition, the presence of lidocaine allows operations to be carried out with the patient fully conscious.
Full Awake Hand Surgery (FAHS) is a tumescent technique approach without a tourniquet for surgery with the patient fully awake for clinical conditions of the hand and upper limb (for example, lacerations accompanied by rupture of flexor and extensor tendons, bone fractures and joint dislocations, nerve injuries , fingertip injuries, finger amputations, ganglion lumps or tumors, etc. which in normal medical practice are carried out under general anesthesia or regional (block) anesthesia). The use of tumescentone-per-mil fluid can produce a clear operating field and adequate local anesthetic effect.
The advent of FAHS has changed surgical practice dramatically by simplifying surgery without general anesthesia or blocks so that patients do not need to undergo all the preparatory screening tests for general anesthesia. Patients also do not need to experience nausea, vomiting, and various side effects due to the use of sedation (general anesthesia) and opioids. FAHS makes the “production costs of surgery” cheaper because there is no need for a main operating room and only using a polyclinic operating room.
In this way, FAHS allows various operations to be transformed into ODC (one day care) service-based operations or office-based surgery. FAHS can also reduce the need for full sterility to field sterility so that waste product from operational work is reduced. Apart from that, FAHS is also safe for patients with comorbid conditions as it does not require sedation and general anesthesia. This is in line with the adage less sedation is safer than more sedation and thus the safest sedation is no sedation. It is estimated that in the next 1-2 decades, the majority of hand surgical operations will be performed using the FAHS mode.
“FAHS services can be placed in line with the development of aesthetic plastic surgery services. The FAHS procedure, with its various advantages as an example of all medical services, needs to be delivered and carried out with excellence in service accompanied by shared awareness to generate patient trust and satisfaction. The FAHS procedure carried out by a communicative doctor with full engagement with the patient can produce comfort and is expected to provide a high level of satisfaction,” said Prof. Theddeus.
During the inauguration, was also present the Head of the Indonesian National Army (TNI) Health Center (Kapuskes), Major General TNI Guntoro, dr., Sp.B.P.R.E., Subsp.L.B.L.(K), MH; Dean of the Faculty of Medicine and Health Sciences, Universitas Pertahanan, Major General TNI dr. Prihati Pujowaskito, Sp.JP (K), FIHA, MMRS; and Head of the Central Naval Hospital (Ka RSPAL) dr. Ramelan Surabaya, Admiral TNI dr. Benny Jovie, Sp.JP., FIHA.
Prof. Theddeus completed his medical education at Faculty of Medicine Airlangga University in 1991. Then, he continued his education at FKUI and successfully graduated as a Specialist in Plastic, Reconstructive, and Aesthetic Surgery in 2000. At the same campus, he graduated as a Doctor of Medical Science in 2018. Several of his scientific works have been published, including the titles The impact of the COVID-19 pandemic on reconstructive education and practice: a qualitative study of Indonesian surgeons (2023); A randomized controlled trial: Comparison of one-per-mil tumescent technique and tourniquet in surgery for burn hand contracture in creating clear operative field and assessment of functional outcome (2022); and Cutaneous perforators and their clinical implications on intrinsic hand flaps: A systematic review.
