Surgical technique
blood loss, bleeding
BLOOD LOSS, BLEEDING, CREST, PERIOSTEUM
All surgeries were performed under general anesthesia by a single surgeon after nasal packing of oxymetazoline 0.025%.The different mixtures were prepared in coded 20 mL syringes before surgery. The coding list was opened only after the completion of the study. The surgeon and the patient did not know the type of the mixture that was used (Fig. a 20 mL syringe containing either combined tranexamic acid (100 mg/ml) and epinephrine 1:200,000 or epinephrine 1:200,000 alone, as well as fixed size gauzeIn group A, soaked gauzes (standard size 4X4 cm) of combined TXA (100 mg/ml) and epinephrine 1:200,000 were used to control bleeding. A time of two minutes was fixed for each application of soaked gauze (Fig. Surgical field in group A External DCR was performed with the standard technique. A skin incision was performed and blunt dissection to the periosteum overlying the anterior lacrimal crest was made. The periosteum was then incised and elevated. Osteotomy was made approximately 10 mm in front of the anterior lacrimal crest and inferiorly to expose the upper part of the nasolacrimal duct. A large flap was performed, a long vertical top to bottom incision was made with blade No. 11 on the medial sac wall. A vertical long top to bottom incision with the blade was made on the nasal mucosa opposite to that of the sac. Both the upper and the lower puncta were dilated with a punctal dilator, then each limb of the bicanalicular Crawford silicone stent was passed through the corresponding canaliculus and were drawn out of the nose. Both the lacrimal sac and the nasal mucosal flaps were sutured using a 5/0 vicryl suture. Finally, the orbicularis was sutured back with 6-0 vicryl followed by skin with 6-0 silk.In group B, the same procedure was performed except for the application of soaked gauze of only epinephrine 1:200,000. A time of two minutes was fixed for each application of soaked gauze (Fig. The amount of blood loss in each case was measured at the end of the DCR operation from the suction bowel and calculated using a large 50 cc syringe. To determine the amount of bleeding, the amount of saline utilized for irrigation is deducted from the overall amount of bleeding. The duration of surgery was calculated by registering the time of operation start and end.