Article

Fatal Outcomes from Liposuction: Census Survey of Cosmetic Surgeons

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Abstract

Troubling reports of adverse outcomes after liposuction prompted a census survey of aesthetic plastic surgeons. All 1200 actively practicing North American board-certified ASAPS members were polled by facsimile, then mail, regarding deaths after liposuction. Patient initials together with case summaries precluded data replication yet assured patient anonymity and preserved surgeon privacy. Incomplete returns or ambiguous findings were authenticated, where feasible, by direct follow-up. Total number of lipoplasties performed by plastic surgeons was interpolated from the ASPRS procedure database for the survey time frame of 1994 to mid-1998. Lacking reliable annual case volume estimates, deaths from lipoplasties performed by non-ABPS surgeons were excluded from the actual mortality rate computation but were included in cause-of-death ranking statistics. Responding aesthetic plastic surgeons (917 of 1200) reported 95 uniquely authenticated fatalities in 496,245 lipoplasties. In this census survey, the mortality rate computed to 1 in 5224, or 19.1 per 100,000. A virtually identical 20.3 per 100,000 mortality rate was obtained in a 1997 random survey commissioned by the parent society. Pulmonary thromboembolism remains as the major killer (23.4+/-2.6 percent); lacking consistent medical examiners' toxicology data, the putative role of high-dose lidocaine cardiotoxicity could not be ascertained. Where so stated, many deaths occurred during the first night after discharge home; prudence suggests vigilant observation for residual "hangover" from sedative/anesthetic drugs after lengthy procedures. Taken together, these two independent surveys peg the late 1990s mortality rate from liposuction at about 20 per 100,000, or 1 in every 5000 procedures. Set beside the 16.4 per 100,000 fatality rates of U.S. motor vehicle accidents, liposuction is not an altogether benign procedure. We do not have comparable mortality data for lipoplasties performed by non-ABPS-certified physicians.

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... [3][4][5] However, studies have revealed that deaths secondary to this procedure are as high as 1 in 5,000 surgeries. [6][7][8][9] Therefore, a review was conducted to identify the leading serious complications of liposuction and to provide the surgeon with the tools to reduce the risks of such complications occurring. ...
... 13,14 The most frequent major complications that can lead to death in a patient undergoing liposuction is pulmonary thromboembolism, which represents more than 23% of deaths. 6 The risk factors should be analyzed for each patient to determine the risk of deep vein thrombosis (DVT), 15,16 to assign a prophylaxis protocol for the patient or, if necessary, to postpone or cancel the surgi-cal event. The incidence of thromboembolism in plastic surgery procedures ranges from 0.5% to 9% in different studies performed by the American Society for Aesthetic Plastic Surgery. ...
... 27 Abdominal visceral lesion is a significant complication that can cause death. 6 The incidence of abdominal perforation and visceral damage secondary to liposuction is unclear, and it is therefore important to avoid these complications during surgical procedures. 28,29 Perforation of the ileum is the most common, followed by perforation of the jejunum and spleen and, to a lesser extent, the transverse colon, cecum, and sigmoid colon. ...
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Background:. Liposuction has become one of the most common cosmetic surgical procedures, and severe complications secondary to this procedure have also increased significantly. That is why we carry out a research work to know the most frequent severe complications reported in the scientific literature to indicate criteria for prevention. Methods:. English-language scientific publications about liposuction and its complications were analyzed using the PubMed.gov, from the beginning of PubMed's history through June 10, 2017. Five terms were used to define liposuction and its complications: "liposuction," "liposuction AND complications," liposuction AND major complications," "liposuction AND complications AND death," and "liposuction AND death." The quantities of results for the 5 phrases were analyzed, along with their contents. Results:. One thousand sixty-three results were obtained from 1973 through June 10, 2017 for the phrase "Liposuction and Complications" in humans; for "Liposuction and Major Complications," 153 articles were found; for "Liposuction and Deaths," 89 articles were found; and 42 articles were obtained with the terms "Liposuction and Major Complications and Deaths." After final depuration, all those that were not specific to severe liposuction complications were eliminated, leaving a total of 39 articles that were included in our study. Five problems proved to be the most serious complications when performing liposuction: Thromboembolic disease, fat embolism, pulmonary edema, lidocaine intoxication, and intraabdominal visceral lesion. Conclusions:. The 5 most important complications that can cause death in liposuction are easily preventable using simple measures and proper safety protocols that are described in this work.
... Autologous fat grafting, further liposuction or skin excision should be performed as needed (21). In January 2000, Grazer published an article in which he reported the fatal outcomes of liposuction using a census survey of cosmetic surgeons (21,34,35). Of those surveyed, 917 surgeons reported that from 1994-1997, 95 fatalities occurred after 496,245 lipoplasties (21,35). ...
... In January 2000, Grazer published an article in which he reported the fatal outcomes of liposuction using a census survey of cosmetic surgeons (21,34,35). Of those surveyed, 917 surgeons reported that from 1994-1997, 95 fatalities occurred after 496,245 lipoplasties (21,35). This yields a mortality rate of 1 in 5224 (<0.5%). ...
... This yields a mortality rate of 1 in 5224 (<0.5%). This is similar to rates quoted elsewhere (35) Pulmonary thromboembolism was the major cause of death in 23.4 (±2.6%) of these deaths (35). The American Society of Plastic Surgeons recommends that outpatient lipoplasty be limited to 5000 ml of total aspirate, irrespective of the technique (21). ...
Article
Background and aim of the work: Adipose tissue is an organ of energy storage, an endocrine organ, a soft tissue filler and a cosmetically unnecessary tissue discarded by liposuction. Liposuction was designed to correct unaesthetic deposits of subcutaneous fat; it produces satisfactory silhouette contouring when performed by appropriately trained operators using properly selected technologies. However, from lipoaspirate it is possible to obtain autologous fat graft and adipose-derived stem cells (ASCs) for reconstructive surgery and regenerative medicine. Autologous fat transplantation uses include the correction of body contour, malformations and post-surgical outcomes. The regenerative properties of ASCs allow treating damaged tissues such as wounds, burns, scars and radiodermatitis. The aim of this study was to perform a literature review highlighting the crucial role of adipose tissue in plastic and reconstructive surgery, from liposuction to lipofilling and ASCs, exposing the indications, procedures and complications of these surgical techniques. Methods: Literature review of publications concerning liposuction, lipofilling and adipose-derived stem cells (ASCS). Results: The introduction of liposuction allowed the use of adipose tissue for many clinical uses. The adipose tissue filling properties have been highlighted by the advent of lipofilling. The regenerative properties evidence of autologous fat transplantation encouraged the research on the clinical use of ASCs. Conclusions: Adipose tissue is not only the main energy storage of our body but also an important source of stem cells that can be used in various fields of regenerative medicine and tissue engineering with encouraging results for the future.
... Various studies state minor revision rates of 2-10% [48]. In January 2000, Grazer published an article in which he reported the fatal outcomes of liposuction using a census survey of cosmetic surgeons [60]. Of those surveyed, 917 surgeons reported that from 1994-1997, 95 fatalities occurred after 496,245 lipoplasties [60]. ...
... In January 2000, Grazer published an article in which he reported the fatal outcomes of liposuction using a census survey of cosmetic surgeons [60]. Of those surveyed, 917 surgeons reported that from 1994-1997, 95 fatalities occurred after 496,245 lipoplasties [60]. This yields a mortality rate of 1 in 5224 (<0.5%). ...
... This yields a mortality rate of 1 in 5224 (<0.5%). This is similar to rates quoted elsewhere [60]. Pulmonary thromboembolism was the major cause of death in 23.4 ( ± 2.6%) of these deaths [60]. ...
Article
BACKGROUND: Autologous fat grafting can be considered an ideal filler to correct breast contour deformities, scars and loss of volume. The major advantage was the presence of virtually limitless donor tissue that was soft and malleable. Moreover, autologous fat is rich on adipose tissue-derived stem cells (ADSCs) that can be differentiate in various cell types and have also a lot of biological property like secretion of trophic factors, low immunogenicity and immunesuppression, which make them an important resource for many clinical applications. METHODS: We performed a conventional liposuction using a centrifuge with a closed-circuit pump system. The aspiration was carried out with appropriate 50-mL disposable syringes, FPU (Fat Processing Unit calls), which have inside a particular piston containing a filter from 50-100 microns and a metallic weight, which function to exert a greater pressure on the adipose tissue during the centrifugation process. After infiltration with Klein solution with a 2.5×260-mm cannula, we proceed to the liposuction of adipose tissue with a 4×260-mm tube, without the need to change the tools. Finally, the syringes containing the fat collected were centrifuged at 3000 rpm for 3 minutes. After that, the layer of intact, viable and concentrate adipocytes were injected into areas of interest with a 4×170-mm cannula. RESULTS: 80% of patients considered themselves satisfied with the result after the first intervention of lipofilling and saw no need to undergo further treatment. In 15% of cases, a second surgery to achieve a functional and aesthetic effect more than acceptable for the patients it was necessary to run. In a small percentage of cases (5%), we were practiced three interventions of lipofilling before being able to achieve the desired improvement. CONCLUSIONS: The proposed surgical technique gives perfect filling results and definition, high-satisfaction on the part of patients after the first intervention by lipofilling.
... Various studies state minor revision rates of 2-10% [48]. In January 2000, Grazer published an article in which he reported the fatal outcomes of liposuction using a census survey of cosmetic surgeons [60]. Of those surveyed, 917 surgeons reported that from 1994-1997, 95 fatalities occurred after 496,245 lipoplasties [60]. ...
... In January 2000, Grazer published an article in which he reported the fatal outcomes of liposuction using a census survey of cosmetic surgeons [60]. Of those surveyed, 917 surgeons reported that from 1994-1997, 95 fatalities occurred after 496,245 lipoplasties [60]. This yields a mortality rate of 1 in 5224 (<0.5%). ...
... This yields a mortality rate of 1 in 5224 (<0.5%). This is similar to rates quoted elsewhere [60]. Pulmonary thromboembolism was the major cause of death in 23.4 ( ± 2.6%) of these deaths [60]. ...
Article
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The massive weight loss often resulted in an excess of loose skin mainly in the abdomen, upper arms, thighs, chest, back, and laterally on the back. Consequently, most patients sought for a solution, provided by the plastic surgery through the body-contouring surgery. Abdominoplasty, arm lift, tight lift, breast lift, and liposuction are all body contouring procedures that aim to reshape the patients' body. Furthermore, body-contouring surgery can improve the patients' physical discomfort in daily life, also helping in the maintenance of normal BMI (body mass index) in formerly obese patients, thus having a positive aesthetic and psychosocial outcome. A key component of body contouring after massive weight loss is managing patient expectations. Understanding the risks of body contouring's procedures is important for patient counseling and the informed consent process. The goal of this study was to perform a literature review concerning the indication, surgical technique, outcomes and complications of body-contouring surgery.
... Ten studies provided information on the operating setting. 4,14,[16][17][18][19][20][26][27][28] Two studies described procedures that were exclusively performed in the ambulatory surgery center setting. 14,28 Commons and colleagues reported an SAE ratio of 7.9/1,000, and Saad and colleagues described an SAE ratio of at least ($) 22/1,000 solitary procedures. ...
... Three studies that included different treatment settings performed subanalyses on mortality and/or SAE ratios. 18,26,27 Grazer and de Jong 26 found that 23% of the fatalities after liposuction occurred in the hospital, 30% in an ambulatory surgery center, and 48% in an office-based setting. This study did not analyze SAEs and included combined procedures. ...
... Three studies that included different treatment settings performed subanalyses on mortality and/or SAE ratios. 18,26,27 Grazer and de Jong 26 found that 23% of the fatalities after liposuction occurred in the hospital, 30% in an ambulatory surgery center, and 48% in an office-based setting. This study did not analyze SAEs and included combined procedures. ...
Article
Background: There is an increasing demand for safety standards for cosmetic treatments. With regard to liposuction, interdisciplinary consensus is lacking, especially regarding treatment setting and physician specialty. Objective: A solid, independent interpretation of scientific data on safety requires a systematic approach, which is the aim of this study. Methods: A systematic literature search was conducted for safety studies about liposuction through April 2017. Fatalities and/or reported serious adverse events served as outcome measures for safety. Results: Twenty-four studies were included. Factors that contributed to increased serious complication and mortality risk were: use of the (super)wet technique; use of systemic anesthetics, especially general anesthesia and intravenous sedation; execution by a plastic surgeon; execution in an operating room; and combination with other procedures. Conclusion: Liposuction using tumescent local anesthesia has been shown to be the safest method of fat removal, especially if no or only minimal systemic anesthesia is used. Performance of this technique in an office-based setting has been proven to be safe beyond doubt. When systemic anesthesia is used, an outpatient or ambulatory surgery facility seems also safe. Regardless of the physician specialty, knowledge and training on the execution of the tumescent procedure are vital to ensure optimal safety.
... Liposuction is considered a high-risk officebased procedure. [1][2][3] Reported perioperative deaths have been attributed to anesthetic complications, abdominal viscous perforation, fat embolism, hemorrhage, and unknown causes. 3 The tumescent technique, developed by Dr. Klein, uses a special instrument to efficiently anesthetize the subcutaneous space with a very dilute solution of lidocaine/epinephrine. ...
... [1][2][3] Reported perioperative deaths have been attributed to anesthetic complications, abdominal viscous perforation, fat embolism, hemorrhage, and unknown causes. 3 The tumescent technique, developed by Dr. Klein, uses a special instrument to efficiently anesthetize the subcutaneous space with a very dilute solution of lidocaine/epinephrine. 4 The tumescent technique is nowadays the most common of all liposuction techniques. ...
... 10,11 Some experts state that 35 mg/kg is a more reasonable threshold of toxicity noting that the hepatic metabolism of lidocaine using CyP3A4 is saturable and once saturation occurs, absorption exceeds elimination and plasma lidocaine concentrations increase precipitously. 3 One study addressed the question of safe dosing limits for tumescent lidocaine infiltration with and without subsequent liposuction. 12 Preliminary estimates for maximum safe dosages of tumescent lidocaine were 28 mg/kg without liposuction and 45 mg/kg with liposuction. ...
Article
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We report a case of a patient presenting to the emergency department in cardiac arrest following a liposuction procedure, which was performed in a physician office using lidocaine anesthesia. During liposuction of the thighs, using the power-assisted technique, the patient was given a subcutaneous dose of lidocaine equal to 71 mg/kg without any noticeable intraoperative complication. Two hours later, the patient experienced dizziness, a rapid decline in mental status, tonic-clonic seizure, and cardiac arrest. The patient was successfully resuscitated in the emergency department with the return of spontaneous circulation after 22 minutes of continuous advanced cardiovascular life support resuscitation. The patient suffered from subsequent severe hypoxic-ischemic brain injury, and a complicated hospital stay, including brain edema, electrolytes disturbances, and nosocomial infections contributed to her death two months later due to septic shock.
... En México, en 2014, en la literatura, encontramos el reporte de 17 muertes relacionadas con la liposucción. 11,[27][28][29] Opinión: los procedimientos de lipoaspiración y lipoinyección son seguros, pues la mortalidad en EUA es menor a 20 muertes por cada 100,000 lipoaspiraciones; en México, ésta es de 14 por cada 100,000. Los pacientes sometidos a lipoaspiración aceptan el riesgo y firman una carta de consentimiento informado. ...
... La embolia grasa relacionada con la lipoaspiración no se ha podido diagnosticar categóricamente por la dificultad que se presenta tanto en los estudios clínicos como en los post mortem, que identifiquen los glóbulos grasos y los diferencien de los ácidos grasos libres, para que se puedan correlacionar con el efecto embólico o inflamatorio. 11,21,27,28,[38][39][40][41][42] Opinión: en el caso estudiado, a la paciente se le realizó una lipoaspiración y lipoinyección en los glúteos. Estos procedimientos impulsan los glóbulos grasos hacia la circulación sanguínea. ...
... Reportes previos mencionan que del 29 al 31% de las muertes relacionadas con la liposucción no se puede establecer la causa. 27,54 Rao, en varios estudios post mortem de pacientes a los que se les había realizado liposucción, encontró los siguientes factores comunes: los pacientes presentaron en forma súbita hipotensión, bradicardia y desaturación. No se pudo identificar la causa de muerte. ...
... However, there is still ample literature on the complications and morbidities accompanying liposuction with calls for awareness and more regulations. The mortality rate reported is 19-20 per 100,000 comparably higher to the 16 per 100,000 reported for motor vehicle accidents [1]. The most commonly reported complication is sepsis from necrotizing fasciitis. ...
... In Grazer et al. [1] performed a census survey of all 1250 plus ASAPS members of which 917 responded. The census revealed a mortality rate of 19.1 per 100,000 which is comparable to a rate of 20.3 per 100,000 reported from a random survey commissioned by the American Society of Plastic and Reconstructive Surgery in 1997 [2]. ...
... Grazer and De Jong [94] reported a fatality rate of 19.1 per 100,000 liposuction procedures. The most frequent potentially lethal complications associated with liposuction are pulmonary embolism, fat embolism, sepsis, necrotizing fasciitis, and perforation of abdominal organs. ...
... Abdominal and bowel perforations are reported as the second commonest lethal event (14.6%). To reduce the risk of perforation, the cannula tip has always to be accompanied by the palm, in particular in obese patients, in whom it is difficult to visualize the cannula, and the position should be hyperextension of the abdomen and severe abdominal pain should always suggest the occurrence of a possible perforation, which may require a laparotomy [2,93,94]. ...
Article
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Introduction Nowadays, liposuction is the most frequently performed aesthetic surgery procedure in Western Countries. This technique has had rapid development since the 1970s, when it was experimented for the first time by A. and G. Fischer. It is currently widely used in clinical practice for many different situations in aesthetic, reconstructive and functional fields. Materials and methods This review aims to describe the historical evolution of liposuction by analyzing the transformation of the method in function of the introduction of innovative ideas or instruments. We have also focused on reporting the major clinical applications of this surgical technique, applicable to almost the entire body surface. We finally analyzed the complications, both major and minor, associated with this surgical technique. Results Liposuction is mainly used to correct deep and superficial fat accumulations and remodel the body contour. It has become an essential complementary technique to enhance the aesthetic result of many other aesthetic procedures such as reduction mammoplasty, abdominoplasty, brachioplasty, thigh lift and post bariatric body contouring. However, it can be largely used for the treatment of innumerable pathologies in reconstructive surgery such as lipomas, lipedema, lipodystrophies, pneudogynecomastia and gynecomastia, macromastia e gigantomastia, lymphedema and many others. The complication rate is very low, especially when compared with conventional excisional surgery and the major, complications are generally associated with improper performance of the technique and poor patient management before and after surgery. Conclusion Liposuction is a safe, simple and effective method of body contouring. It has enormous potential for its application in ablative and reconstructive surgery, far from the most common aesthetic processes with a very low complication rate.
... 9 Public perception of these surgeries as minor procedures contributes to risks for major complications with potentially fatal consequences, with reported mortality of 1 per 5000 procedures. 5,[10][11][12] Emergency clinicians should be ...
... VTE is the leading cause of postoperative mortality in cosmetic surgery, accounting for up to 21% of postoperative deaths. 10 Deep vein thrombosis (DVT) and pulmonary embolism (PE) incidence in liposuction is reported at less than 1%, but there is a marked increase in DVT incidence when liposuction is combined with other surgeries, especially abdominoplasty. 32,38,87 Abdominoplasty has the highest incidences of DVT and PE in cosmetic surgery, up to 0.8% and 1.3%, respectively. ...
Article
The number of aesthetic surgical procedures performed in the United States is increasing rapidly. Over 1.5 million surgical procedures and over three million nonsurgical procedures were performed in 2015 alone. Of these, the most common procedures included surgeries of the breast and abdominal wall, specifically implants, liposuction, and subcutaneous injections. Emergency clinicians may be tasked with the management of postoperative complications of cosmetic surgeries including postoperative infections, thromboembolic events, skin necrosis, hemorrhage, pulmonary edema, fat embolism syndrome, bowel cavity perforation, intra-abdominal injury, local seroma formation, and local anesthetic systemic toxicity. This review provides several guiding principles for management of acute complications. Understanding these complications and approach to their management is essential to optimizing patient care.
... 20 Some studies have found that lidocaine reduces postoperative pain as well as the amount of systemic anesthetics used intraoperatively. [13][14][15]67,[90][91][92] However, because of its potential for serious neurologic and cardiac side effects, some have questioned its use in liposuction. 20,[67][68][69][70][93][94][95] Hatef and colleagues performed a study comparing postoperative pain control and intraoperative systemic anesthetic use in patients who had wetting solution with variable concentrations of lidocaine infiltrated. ...
... 44,130 The mortality rate after liposuction is approximately 0.02%, most commonly caused by VTE. 44,74,92 Kaoutzanis et al performed a multi-variate analysis demonstrating an increased risk of complications in patients undergoing liposuction of multiple areas, combined procedures, and in those who are obese. In patients undergoing liposuction of 2 areas, the complication rate increased to 3.2% (from 0.7%), and in those undergoing liposuction of more than 2 areas, the complication rate rose to 4.5%. ...
Article
Since its advent in the early 1980s, liposuction has made tremendous advancements, making it the most popular aesthetic surgery performed today. The goal of this Continuing Medical Education (CME) article is provide a foundation of knowledge of the relevant anatomy, preoperative evaluation, intraoperative technique, and postoperative management for surgeons performing liposuction. Finally, the prevention and management of potential complications, will be reviewed along with measures to optimize patient safety and outcomes.
... However, there is still ample literature on the complications and morbidities accompanying liposuction with calls for awareness and more regulations. The mortality rate reported is 19-20 per 100,000 comparably higher to the 16 per 100,000 reported for motor vehicle accidents [1]. The most commonly reported complication is sepsis from necrotizing fasciitis. ...
... In Grazer et al. [1] performed a census survey of all 1250 plus ASAPS members of which 917 responded. The census revealed a mortality rate of 19.1 per 100,000 which is comparable to a rate of 20.3 per 100,000 reported from a random survey commissioned by the American Society of Plastic and Reconstructive Surgery in 1997 [2]. ...
Article
Full-text available
Background: Liposuction is one of the most commonly performed aesthetic procedures. It is performed worldwide as an outpatient procedure. However, the complications are underestimated and underreported by caregivers. We present a case of delayed diagnosis of bilothorax secondary to liver and gallbladder injury after tumescent liposuction. Methods: A 26-year-old female patient was transferred to our emergency department from an aesthetic clinic with worsening dyspnea, tachypnea and fatigue. She had undergone extensive liposuction of the thighs, buttocks, back and abdomen 5 days prior to presentation. Results: A chest X-ray showed significant right-sided pleural effusion. Thoracentesis was performed and drained bilious fluid. CT scan of the abdomen revealed pleural, liver and gall bladder injury. An exploratory laparoscopy confirmed the findings, the collections were drained; cholecystectomy and intraoperative cholangiogram were performed. The patient did very well postoperatively and was discharged home in 2 days. Conclusion: Even though liposuction is considered a simple office-based procedure, its complications can be fatal. The lack of strict laws that exclusively place this procedure in the hands of medical professionals allow these procedures to still be done by less experienced hands and in outpatient-based settings. Our case serves to highlight yet another unique but potentially fatal complication of liposuction. Level of evidence v: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
... La qualità del risultato estetico ottenuto si basa su una padronanza della tecnica chirurgica, ma anche su una rigorosa selezione dei pazienti. Atto molto diffuso (245 000 nel 2008 e 225 000 nel 2016 negli Stati Uniti, 200 000 nel 2003 in Germania [3,4] ), la liposuzione è una tecnica chirurgica erroneamente banalizzata dal grande pubblico con i suoi rischi e le sue complicanze. Deve rimanere il risultato di un rigoroso apprendimento chirurgico per la sicurezza dei pazienti ed è essenziale per l'arsenale terapeutico di qualsiasi chirurgo plastico. ...
... Se la conoscenza dei volumi lipoaspirati è essenziale per l'anestesista al fine di stabilire al meglio un riequilibrio idroelettrolitico postoperatorio, deve anche essere informato dei volumi di infiltrazione iniettati, che possono causare, se eccessivi, un edema acuto polmonare [4,18] . ...
Article
Riassunto La chirurgia del tessuto adiposo comprende una serie di procedute specifiche. Se la liposuzione è la più antica, il trasferimento di tessuto adiposo, più recente, è arrivata a completarla, e queste procedure possono ora essere combinate tra loro, specialmente con le dermolipectomie più classiche. Oltre alle indicazioni estetiche, le richieste di chirurgia ricostruttiva sono esplose negli ultimi dieci anni in relazione all’aumento degli interventi di chirurgia bariatrica, generando un grande afflusso di pazienti nei reparti di chirurgia plastica. Sul territorio, questo chirurgia ha, attualmente, superato la sua omologa sul suolo americano, con 8,4 pazienti operati per 10 000 contro 6,1 per 10 000 negli Stati Uniti: 450 000 obesi operati in Francia dal 2006, l’80% dei quali rappresentato da donne. La domanda è colossale. Inoltre, il tessuto adiposo non è più considerato come un semplice serbatoio energetico, ma come un vero e proprio organo endocrino attivo, ricco di oltre 600 fattori che agiscono in modo autocrino e paracrino. La scoperta di cellule mesenchimali stromali suscita, inoltre, una grande infatuazione per la chirurgia rigenerativa a causa delle loro proprietà antinfiammatorie e proangiogeniche. Il tessuto adiposo può, quindi, essere prelevato e innestato in una posizione in cui è carente e, al momento, costituisce uno dei migliori filler utilizzabili per diverse perdite di sostanza, con la caratteristica di essere l’unico a essere autologo e attivo. Inoltre, sono apparse nuove tecniche volte a trasferire le cellule dalla frazione vascolare stromale. Lo scopo di questo articolo è di riassumere tutte le tecniche utilizzate in chirurgia plastica per modificare o utilizzare il tessuto adiposo.
... The incidence of symptomatic VTE was reported to be high after post-bariatric body contouring surgery, especially when combined with circumferential abdominoplasty (7.7%), abdominoplasty (5.0%) and breast or upper body contouring (2.9%) procedures 4 . An overall rate of 1.1 % of PE was reported in abdominoplasty patients, mostly those with a combined intra-abdominal procedure 5 , while 23% of deaths following liposuction were attributable to PE 6 . Furthermore, VTE also has significant financial healthcare costs partly due to the high rates of recurrence and morbidity associated with the disease 7 . ...
Article
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Background A reliable venous thromboembolism (VTE) risk assessment model (RAM) can assist surgeons in identifying patients that would benefit from VTE prophylaxis. This systematic review was aimed at summarising the current available evidence on VTE RAMs used in aesthetic plastic surgery. Methods A comprehensive search was performed in the Pubmed, EMBASE and Cochrane databases to include primary studies describing VTE RAMs in aesthetic plastic surgery from 1946 to February 2019. The objective was to compare the different VTE RAMs described for aesthetic plastic surgery to recommend a reliable model to stratify patients. Results Of the 557 articles identified in the PubMed, EMBASE and Cochrane databases, six articles were included in the final review. Five different RAMs were used in the included studies: Caprini 2005 RAM, Caprini 2010 RAM, Davison-Caprini 2004 RAM, American Society of Anaesthesiologist's Physical Status (ASA) grading system and a tool developed by Wes et. al. The difference in risk weightage among the tools along with the VTE incidences for different categories were compared. The Caprini 2005 RAM was the most widely reported tool and validated in plastic surgery patients. Conclusion Amongst the five different tools currently used, the Caprini 2005 RAM was the most widely reported. This tool was validated in plastic surgery patients and reported to be a sensitive and reliable tool for VTE risk stratification, therefore current data supports its use until further higher quality evidence becomes available. Due to the heterogeneity of the data and low quality of the current evidence, a definitive recommendation cannot be made on the best VTE RAM for patients undergoing aesthetic plastic surgery. This paper highlights the need for randomised controlled trials evaluating the various RAMs which are essential to support future recommendations and guidelines.
... 156,158 Moreover, deaths secondary to lipoaspiration procedures are as high as one death in 5000 surgeries. 155,[159][160][161][162][163][164][165][166][167][168][169][170] Thus, lipoaspiration alone may not be safe for patients with heart problems or blood clotting disorders, women who are pregnant, 156 or patients with a body mass greater than 35 kg/m 2 and thus is associated with a very high risk of secondary complications. 155,[171][172][173] More importantly, combined procedures of lipoaspiration for ADSC harvesting and implantation for bone regeneration, particularly with obese or geratiric individuals, will significantly increase the complication rates and often lead to critical safety concerns. ...
Article
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A plethora of both acute and chronic conditions, including traumatic, degenerative, malignant, or congenital disorders, commonly induce bone disorders often associated with severe persisting pain and limited mobility. Over 1 million surgical procedures involving bone excision, bone grafting, and fracture repair are performed each year in the U.S. alone, resulting in immense levels of public health challenges and corresponding financial burdens. Unfortunately, the innate self‐healing capacity of bone is often inadequate for larger defects over a critical size. Moreover, as direct transplantation of committed osteoblasts is hindered by deficient cell availability, limited cell spreading, and poor survivability, an urgent need for novel cell sources for bone regeneration is concurrent. Thanks to the development in stem cell biology and cell reprogramming technology, many multipotent and pluripotent cells that manifest promising osteogenic potential are considered the regenerative remedy for bone defects. Considering these cells' investigation is still in its relative infancy, each of them offers their own particular challenges that must be conquered before the large‐scale clinical application. A plethora of both acute and chronic conditions, including traumatic, degenerative, malignant, and congenital varieties, often play key roles in reducing the quality of life for many people. This is particularly true in the case of critical‐size defects where the innate self‐healing capacity of bone is inadequate for a reunion. To date, a diversity of novel multipotent/pluripotent cell sources are regarded as regenerative medicine, particularly for bone regeneration, in virtue of continued worldwide collaboration. Although their potential is irrefutable, each of the cell sources mentioned has its own drawbacks, which must be entirely understood and overcome before they are released for human clinical application.
... Hay reportados 14 casos de perforación por cada 100,000 liposucciones; es la segunda o tercera causa reportada de muertes en lipoaspiración. [2][3][4][5] Varios autores mencionan que existe un subregistro de esta complicación, por lo que no conocemos su verdadera incidencia. Las complicaciones y las muertes deben reportarse, incluso aquéllas que ocurren dentro de los 30 días posteriores a la liposucción. ...
... Common adverse events for liposuction include postoperative nausea and vomiting, local nerve damage and paresthesias, intra-and postprocedural bleeding and hematomas, persistent edema, surgical wound infection, skin necrosis, and unplanned hospitalization or increased length of stay [117]. The risk of fatality of liposuction is conservatively estimated to be 1/5000 with deaths being attributable to pulmonary embolism, visceral perforation, cardiorespiratory complications associated with anesthesia, and hemorrhage (in order of decreasing frequency) [118]. Abdominoplasty is a more invasive procedure with higher rates of surgical complications, including wound dehiscence and necrosis, infection, and a fatality rate approaching 1/600 [119]. ...
Article
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As a result of over five decades of investigation, mesenchymal stromal/stem cells (MSCs) have emerged as a versatile and frequently utilized cell source in the fields of regenerative medicine and tissue engineering. In this review, we summarize the history of MSC research from the initial discovery of their multipotency to the more recent recognition of their perivascular identity in vivo and their extraordinary capacity for immunomodulation and angiogenic signaling. As well, we discuss long-standing questions regarding their developmental origins and their capacity for differentiation toward a range of cell lineages. We also highlight important considerations and potential risks involved with their isolation, ex vivo expansion, and clinical use. Overall, this review aims to serve as an overview of the breadth of research that has demonstrated the utility of MSCs in a wide range of clinical contexts and continues to unravel the mechanisms by which these cells exert their therapeutic effects.
... Летальные исходы, обусловленные выполнением ЛС, возникающие по причине таких ее осложнений, как некроз кожи, развитие генерализованных бактериальных инфекций, некротизирующего фасциита (НФ), тромбоэмболии легочной артерии (ТЭЛА), тромбоза глубоких вен нижних конечностей, констатируются в 0,02-0,25 % случаев [13; 15-17]. Показатель послеоперационной летальности при выполнении ЛС составляет 1 случай на 5000 вмешательств [15]. ...
... S egún las estadísticas de International Society of Aesthetic Plastic Surgery (ISAPS), en el año 2017 se realizaron 802,234 abdominoplastias en el mundo y en México 36,386. 1 La abdominoplastia es el procedimiento estético con el mayor número de complicaciones cuya incidencia aumenta cuando se combina con liposucción o algún otro tipo de procedimiento; la complicación más severa es la trombosis. [2][3][4][5][6][7][8][9][10] La mujer presenta cambios en todos sus órganos y sus funciones durante el embarazo. Existe un incremento en el fibrinógeno y en los factores VII, VIII, X y XII, estos cambios representan una protección contra la hemorragia al momento del parto, pero también conllevan el riesgo de trombosis. ...
... As with any surgical procedure, liposuction still imparts potential morbidity and mortality. Major potentially life-threatening complications of liposuction include necrotizing fasciitis, TSS, pulmonary embolism, toxicity or drug interactions, and visceral organ perforation [4][5][6]13]. TSS and necrosis fasciitis commonly are severe infections. Compared with the common postoperative complications after liposuction, TSS is very rare and relatively unknown to most plastic surgeons. ...
Article
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Background Liposuction is one of the most commonly performed aesthetic procedures. Toxic shock syndrome(TSS) is a rare, life-threatening complication. The incidence rate of TSS is very low in the plastic surgery field, especially after liposuction and fat transfer. Case presentation A 23-year-old female patient was transferred to our emergency department from an aesthetic clinic with sepsis shock features after received liposuction and fat transfer. The patient underwent TSS, disseminated intravascular coagulation(DIC), multiple organ dysfunction syndrome (MODS), symmetrical peripheral gangrene (SPG), and necrotizing soft tissue infection of the buttocks in the next 10 days. Authors used a series of debridement and reconstructive surgery including vacuum sealing drainage (VSD) treatment, artificial dermis grafts,split-thickness skin grafts, amputation surgeries when her vital signs were stable. The patient experienced desquamation of the hand on the 26th day. The skin grafts survived and the function of both fingers and toes recovered. She was discharged 2 months after admission and was in good health. Conclusion TSS is extremely rare in the field of liposuction and autologous fat transfer. The mortality rate of TSS is very high. Early diagnosis and operative treatment, as well as correction of systemic abnormalities, are the important keys to save a patient's life.
... In general, fluid replacement follows this rule: "0.25 mL of aspirate over 5 L." We prefer using super wet rather than tumescent infiltration, as the blood loss is the same, but the stresses are less. 5 The liposculpture procedure lasts around 3-4 hours, which might increase the risk of deep venous thrombosis, and eventually pulmonary embolism. To avoid this, compression stockings are applied in perioperative period, together with early ambulation for all our patients, plenty of fluid intake (both orally and intravenous). ...
... We believe using PAL in a superficial layer may have widely compromised the subdermal plexus, causing extensive skin necrosis. Corroborating this fact, the only area preserved with no signs of ischemia was the midline, which is known as a non-superficial liposuction area in HDL, as described by Hoyos [6,32]. ...
Article
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Although liposuction is one of the most sought-after surgical procedures in the world, there are plenty of acknowledged complications associated with it. There are, however, no case reports such as this one regarding severe complications deriving from the high-definition technique. We describe the management of a patient with massive necrosis following a high definition power-assisted liposuction. A 37-year-old woman, who presented an overweight body mass index and no other comorbidities, had a liposuction with abdominoplasty done in 2012. In early 2019, she underwent a high definition liposuction, being transferred 8 days after the procedure into a tertiary and university-related hospital with necrotizing fasciitis and sepsis. The patient received treatment for a life-threatening condition at the ICU and several interventions for debridement and skin replacement. She was discharged 2 months after admission. High definition liposuction is a new technique that has recently become widespread. However, it is not fail-safe, as the present case shows. It should be restricted to selected cases and its technique should be reviewed and trained extensively to reduce its possible risks. Level of evidence: Level V, risk/prognostic study.
... 8 Minor complications following liposuction include seroma, hematoma, hyper-pigmentation and penile or vulvar swelling. The serious major complications include sepsis, 9 perforation of abdominal or thoracic viscera, 10,11 hemorrhage, hypotension, 12 pulmonary embolism, 13 fat embolism, 14 pulmonary edema and cardiac arrest 15 . In the case reported here, the plastic surgery hospital used the wetting solution technique in liposuction, which destroys the cytomembrane of the subcutaneous fat cell using the injection of isotonic or hypotonic normal saline into the operative site prior to liposuction. ...
... Nowadays literature reports a low incidence of both local and systemic complications of liposuction, among the latter the most severe include: deep venous thrombosis, pulmonary embolism, cavities perforation, necrotizing fasciitis, sepsis and heart attack [1]. ...
Article
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Introduction Liposuction is one of the most performed procedures in aesthetic plastic surgery worldwide, and its spectrum of applications covers almost all body areas. Systemic or visceral complications following liposuction are rare, but unfortunately, they can be very serious. Presentation of case We discuss the case of a 69 y.o. woman who underwent abdominal contouring surgery consisting in flank pseudohernia correction, liposuction and short scar abdominoplasty, which was complicated by intestinal perforation. Bowel perforation was suspected on the 3rd day following surgery after a CT-scan and was treated with exploration through a median laparotomy, resection of the perforated bowel and subsequent ileo-ileal anastomosis. The 10 cm-long resected segment of the small intestine presented multiple 2 mm-large holes at the microscopic examination. Discussion We assume that patient position on the operating table and abdominal wall laxity during surgery as well as the timing of each specific procedure played an important role in the occurrence of bowel perforation. Conclusion To our knowledge, this is the first case report of an accidental visceral perforation during a combined procedure of flank bulging correction and abdominal liposuction. Overall the increased risk of combined procedures in plastic surgery is linked to increased operative time. In the current case timing of surgery sequence more than operative time itself was relevant in increasing anterior abdominal wall pressure and thus setting the patient at a higher risk of bowel perforation.
... Although liposuction is often performed as a day case procedure, significant fluid shifts from extensive liposuction can lead to significant morbidity, and even death in rare cases. 21 Liposuction can also be combined with body tightening procedures through the use of radiofrequency; however, if there is skin excess then surgery is the only true way of addressing this. ...
Article
Social pressure to look good is part of the reason almost 1 in 10 cosmetic surgery procedures in the UK are performed in men. However, they are not without risk. Here the authors consider what is on offer to men as well as the dangers to be aware of.
... The most common procedures received by female consumers include breast augmentation (i.e., breast implants), liposuction, rhinoplasty (i.e., nose reshaping), and tummy tucks. Although some cosmetic procedures are less invasive (e.g., lip filler injections, eyebrow microblading) and therefore carry fewer physical complications, undergoing more invasive cosmetic surgery procedures may pose significant health risks and can, at times, be fatal (Grazer & de Jong, 2000;Yoho, Romaine, & O'Neil, 2005). Despite these risks, cosmetic surgery is becoming increasingly common. ...
Article
Across three studies, we explore the relationship between cosmetic surgery, which functions as a costly appearance-enhancement tactic, and women's short-term mating effort. Study 1 demonstrates that women who exert increased short-term mating effort are more accepting of costly appearance-enhancement techniques (i.e., cosmetic surgery), but not relatively low-cost appearance-enhancement techniques (i.e., facial cosmetics). Study 2 and 3 further show that both men and women use information regarding a female targets' cosmetic surgery usage to infer increased short-term mating effort. Moreover, Study 3 demonstrates that inferences of short-term mating effort do not differ as a function of whether the target received facial or body cosmetic surgery. The findings of the current research demonstrate that women's engagement in extreme beautification procedures can influence others' perceptions of their short-term mating effort.
... В 1994-98 гг. в США было зарегистрировано 95 летальных исходов на 496245 липосакций, т.е. 1 случай на 5224 липосакции, или 19,1 на 100 000 [59]. Для сравнения, в тот же временной период частота ДТП со смертельным исходом в США составляла 16,4 : 100 000. ...
Article
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The review is devoted to the questions of prophylaxis and treatment of postoperative pain in plastic surgery. The pain in plastic surgery remains a serious problem in particular after major reconstructive-reparative operations. It impedes patient timely discharge from hospital in same-day surgery. Postoperative pain in plastic surgery may become chronic in 10-40% cases especially after operations on mammary glands. The basis of postoperative analgesia in plastic surgery is combined using of nonopioid analgesics (NSAIDs, paracetamol, gabapentin) and different variants of regional analgesia. Opioid analgesics are considered as reserve drugs for cases when nonopioid analgesia isn't effective.
... Although liposuction is a safe procedure when it is performed properly, some complications, such as skin irregularities, extended edema, ecchymosis, hyperpigmentation, changes to skin sensitivity, seromas, hematomas, ulcers, skin necrosis, visceral perforations, systemic infection, fat embolism, sepsis, and even death, may occur [2]. The estimated mortality rate of liposuction is 1 in every 5000 procedures performed [3]. ...
Article
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Introduction: Liposuction is the most performed surgical procedure in Brazil and the second in the world. In recent years, new technologies have been developed in an attempt to improve liposuction, such as laser. The objective of this study is to evaluate the efficacy and safety of laser-assisted liposuction (LAL) compared to traditional liposuction through a systematic review of the literature. Method: The search strategy used was the combination of the descriptors [lasers (MeSH Terms)] and (lipectomy [MeSH Terms]) in the PubMed database. Two independent researchers carried out the reading of the abstracts and selection of the studies according to the eligibility criteria. The risks of study bias were evaluated using an instrument similar to that used by the Cochrane Collaboration. Results: Initially, 80 studies were obtained and, after evaluating the eligibility criteria, seven remained. Five of them observed that LAL has benefits when compared to traditional liposuction, and the main outcomes were compared with regard to histological analysis (2 products), further reduction of subcutaneous fat (2), better retraction of the skin (3), and higher personal satisfaction of the patient (2). The qualitative assessment identified high risks of bias in various areas in the studies. Conclusion: Although studies have concluded that LAL promotes greater fat reduction, better skin retraction, and greater patient satisfaction compared to traditional liposuction, the high bias impedes a more reliable conclusion. Level of evidence iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
... (4) T.P. (5) Não houve (6) T.P. (3) Intoxicação anest. D0 Cirurgião plástico (7) Desconhecida Maioria associada D0 Consultório (15) E.G. (12) E.P. (trombo ou gordura) Maioria associada Consultório (9) Infecção Maioria associada Consultório (11) Para os 102 casos investigados, não foram encontradas evidências de óbitos ocorridos com o uso de anestesia local tumescente, conforme descrito por Klein. 16 Também não houve citação nas certidões de óbito de intoxicação por lidocaína como causa mortis ou processo que a tenha levado. ...
Article
Introdução: A lipoaspiração está entre as cirurgias estéticas mais realizadas no Mundo. Sua mortalidade varia; 2,6 (6) a 19 (7) mortes/100 mil. Dados são obtidos por questionários a membros de sociedades médicas (4-10) e retrospectivo, obtidos em IML, (3, 11) ambos falhos. O primeiro pelo viés profissional e duplicidade, o segundo pela falta da causa mortis. Objetivos. Identificar o número e causas das mortes relacionadas à lipoaspiração por registros documentais das notícias veiculadas na imprensa e estudo das certidões de óbito. Métodos. Estudo documental, descritivo-quantitativo. Com a ciência, dos nomes e cidade do óbito, obtivemos certidões nos cartórios civis. Resultados. 102 mortes e 86 certidões de óbito. Tromboembolia pulmonar foi a causa mortis mais citada em 17,44%, 45% no mesmo dia da cirurgia; 53,6% realizadas em hospitais e 61,76% isoladas. Especialidade dos médicos responsáveis: cirurgião plástico (74%), None registrado na qualificação de especialista em dermatologia no CFM. 12,98% dos atestados preenchido por médicos que participaram da cirurgia. Limitações. A impossibilidade ética no acesso aos prontuários médicos e o preenchimento inadequado das certidões de óbitos. Conclusão. A notificação compulsória deve ser instaurada por lei para formação de um banco de dados que auxiliará na construção de diretrizes para prevenção desses óbitos.
... Eight of the included studies used subcutaneous adipose tissue and three, bone marrow aspirate as the source of MSCs. Current lipoaspiration procedures are less painful than harvesting bone marrow stem cells and with less ethical considerations [63]; however, they are not without morbidity [64][65][66][67]. Other sources may be more suitable and translatable for use in animal and human models of AL to allow delivery of a mixed cell population in a single operation; for example, omentum during laparotomy [68,69]. ...
Article
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Aim: Anastomotic leak is the most feared complication of gastrointestinal surgery. Mesenchymal stem cell technology is used clinically to promote wound healing, however the safety and efficacy of this technology on anastomotic healing has yet to be defined. To investigate whether mesenchymal stem cells confer any benefit when applied to animal models of gastrointestinal leak and identify methodology and how efficacy is assessed. Method: The MEDLINE, EMBASE, WebofScience and Cochrane Library databases were interrogated between 01/01/1947-01/05/2020. All studies where mesenchymal stem cells were applied to laboratory animal leak models to demonstrate a healing effect were considered. All experimental and histological outcomes were examined. Compliance to ARRIVE and current International Consensus was assessed. Results: 1205 studies were screened. 12 studies reported on 438 gastrointestinal anastomoses in 4 species using 11 models; 7 in the colon. No studies utilised a model with a known leak rate. Significant variance was observed in histological outcomes with efficacy demonstrated in 5/12 studies. One study demonstrated a benefit in leak rate. Colorectal studies had a greater median ARRIVE compliance, 60.8% (IQR 63.2-64.5) compared to non-colorectal 45.4% (IQR 43.8-49.0). Conclusion: Mesenchymal stem cell delivery to an animal anastomosis is safe and feasible. Use may confer benefit but findings are currently limited to surrogate histological outcomes. There is consistency in outcome measures reported but variance in how this is assessed. Poor compliance to ARRIVE but good compliance to current international consensus in leak models of the colon was observed.
Article
Liposuction is currently the most popular surgical procedure for body contouring requested by patients in many parts of the world. Since its first published description in 1976, continuous evolution in concepts, techniques, and instrumentation has occurred, enhancing its safety and efficacy. Tumescent anesthesia, microcannulas, and good patient selection have enhanced safety. Assisted liposuction techniques utilizing innovative devices as adjuncts to traditional suction‐assisted lipectomy have enhanced efficacy. Three assisted liposuction techniques, which the author has adopted in her practice, namely, ultrasound‐assisted liposuction, power‐assisted liposuction, and laser‐assisted liposuction are reviewed. Methodology for this review consists of literature search from available liposuction textbooks and journal publications in English language, personal communication with liposuction surgeon colleagues, as well as the author's personal experience. This review aims to help dermatologic surgeons make intelligent equipment choices by presenting the evolution of liposuction concepts, instrumentation, and techniques and allow a better understanding of three methods of assisted liposuction.
Article
Despite the favorable safety profile of liposuction, complications occur that need to be appropriately managed. In the second article in this continuing medical education series, the range of complications that may arise from liposuction are described, and the latest best practices to manage them are discussed. Specific technical strategies to prevent and minimize the risk of complications are also presented. Early recognition, accurate diagnosis, and proper clinical management can ensure an optimal outcome and patient satisfaction in individuals who are investing in fat reduction procedures.
Article
BACKGROUND In 2015, North Carolina became the 5th state to pass legislation requiring women to undergo state-mandated counseling 72 hours prior to abortion. Whether this legislation has changed the timing of abortion decision-making or receipt of care is not known.METHODS This is a cross-sectional study using anonymous survey data from women presenting for abortion at a hospital-based abortion clinic in North Carolina. Data were collected for 8 weeks immediately before and after implementation of the new waiting period.RESULTS 26/48 (54%) of eligible patients participated. More than half (56%) of women made their abortion decision relatively quickly (less than or equal to 3 days), but had a median time-to-care of almost a week.LIMITATIONS This small study is the 1st recent evaluation of abortion decision-making and receipt of care immediately before and after implementation of a 72-hour waiting period in a Southern state. Only women presenting for care at a single hospital-based clinic were surveyed. Data were self-reported.CONCLUSION In our clinical setting, most women decided to have an abortion quickly but still waited 10-15 days before receiving care. Extended waiting periods provide no medical benefits and the potential for harm and delay of care remains.
Article
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Background: The circumferential thigh lift (CTL) with vertical scar is a more extensive and effective procedure compared to the traditional lift, but the scar is not aequally concealed. Negative pressure treatment (NPT) is considered to have a beneficial effect on the physiological process of wound healing and early scar formation. A comparison study was therefore carried out in order to evaluate the effect of NPT on scar quality. Methods: All postobese patients consecutively treated for thigh laxity in the period January 2012 to April 2013 were recruited in a prospective cohort study. All patients underwent CTL. In group A, NPT was applied on the sutured wound in the immediate postoperative phase for a period of one week. In Group B traditional dressings were used. The quality of scars was evaluated by means of the Stony Brook Scar Evaluation Scale (SBSES) at 7, 15, 30 and 365 days postoperatively. Results: 91 patients were included in the period defined, of whom 48 in group A and 43 in group B. In group A, the mean SBSES score was 4.4 at 7 days, 4 at 15 days, 4.6 at 30 days and 4.8 at 365 days. In group B the SBSES score was 3.2 at 7 days, 3 at 15 days, 3 at 30 and 365 days. At all postoperative stages the quality of the scar showed to be significantly improved by the use of NPT (p<0.05). Conclusions: NPT is a useful adjunct to the postoperative wound healing after circumferential thigh lift, when compared to a hostile cohort of patients whose wounds are not treated with NPT. Key words: Thigh lift, Negative Pressure Therapy.
Article
Background: Liposuction is one of the most common cosmetic surgical procedures performed worldwide. Despite previous citation analyses in plastic surgery, the most-cited works in liposuction have not yet been qualitatively or quantitatively appraised. We hypothesized that use of validated outcome measures and levels of evidence would be low among these articles. Thus, we performed a bibliometric analysis aiming to comprehensively review the most-cited liposuction literature, evaluating characteristics and quality of the top 100 articles. Methods: The 100 most-cited articles in liposuction were identified on Web of Science, across all available journals and years (1950-2020). Study details, including the citation count, main subject, and outcome measures, were extracted from each article by 2 independent reviewers. The level of evidence of each study was also assessed. Results: The 100 most-cited articles in liposuction were cited by a total of 4809 articles. Citations per article ranged from 602 to 45 (mean, 92). Most articles were level of evidence 4 (n = 33) or 5 (n = 35), representative of the large number of case series, expert-opinion articles, and narrative reviews. Ten articles achieved level of evidence 3, 22 articles achieved level of evidence 2, and none reached level 1. The main subject was operative technique in 63 articles, followed by outcomes in 32 articles. Five articles assessed the metabolic effects of liposuction. Only 1 article used a validated objective cosmetic outcome measure, and none used validated patient-reported outcome measures. Conclusions: This analysis provides an overview of the top cited liposuction literature. Overall, level of evidence was low, and no articles achieved the highest level of evidence. Improving the quality of literature requires prioritization of better-designed studies and incorporation of validated outcome measures, which will increase patient satisfaction and ensure provision of excellent, reproducible clinical care.
Chapter
Female Genital Cosmetic Surgery - edited by Sarah M. Creighton February 2019
Article
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Cambridge Core - Obstetrics and Gynecology, Reproductive Medicine - Female Genital Cosmetic Surgery - edited by Sarah M. Creighton Link: https://www.cambridge.org/se/academic/subjects/medicine/obstetrics-and-gynecology-reproductive-medicine/female-genital-cosmetic-surgery-solution-what-problem?format=PB
Article
Learning objectives: After studying this article and viewing the video, the participant should be able to: 1. Accurately describe the relevant aesthetic anatomy and terminology for common female genital plastic surgery procedures. 2. Have knowledge of the different surgical options to address common aesthetic concerns and their risks, alternatives, and benefits. 3. List the potential risks, alternatives, and benefits of commonly performed female genital aesthetic interventions. 4. Be aware of the entity of female genital mutilation and differentiation from female genital cosmetic surgery. Summary: This CME activity is intended to provide a brief 3500-word overview of female genital cosmetic surgery. The focus is primarily on elective vulvovaginal procedures, avoiding posttrauma reconstruction or gender-confirmation surgery. The goal is to present content with the best available and independent unbiased scientific research. Given this relatively new field, data with a high level of evidence are limited. Entities that may be commonly encountered in a plastic surgery practice are reviewed. The physician must be comfortable with the anatomy, terminology, diagnosis, and treatment options. Familiarity with requested interventions and aesthetic goals is encouraged.
Article
Liposuction surgery has traditionally been performed under systemic anaesthesia since its invention in mid 1970s. The concept of liposuction under tumescent local anaesthesia by Jeffrey Klein MD, USA, using a dilute mixture of lidocaine, adrenaline and sodium bicarbonate in normal saline has radically modified the outcomes of the procedure making it very safe and at the same time effective to conduct the procedure. Tumescent anaesthesia is very well accepted by dermatologists performing liposuction around the world. Not a single death has been recorded when the principles of tumescent anaesthesia have been followed strictly during liposuction. The article is a review of different types of anaesthesia and issues specific to their use in liposuction surgery. It is the end result of an extensive search and compilation of facts from scientific publications (articles and chapters form textbooks) in the dermatologic, plastic surgery, pharmacology and anaesthesia fields.
Article
Background: Although abdominoplasty is a mainstay of the plastic surgeon, the safety of the Brazilian butt lift (BBL) has been questioned, effectively being prohibited in some countries. The central rationale for the safety concern over the BBL stems from a publication stating a mortality rate of one in 3000. The question remains: What is the real safety of these procedures? Methods: Focusing on mortality, literature searches were performed for BBL and for abdominoplasty. The 2017 Aesthetic Surgery Education and Research Foundation survey data and publication were examined and analyzed. Additional data from the American Association for Accreditation of Ambulatory Surgical Facilities were obtained independently. Results: Abdominoplasty and BBL appear to have similar safety based on mortality; however, the nature of their mortalities is different. Although most abdominoplasty deaths are secondary to deep venous thrombosis/pulmonary embolism-inherent circulatory thrombotic abnormality-BBL mortality is associated with iatrogenic pulmonary fat embolism. BBL mortality rates from more recent surveys on BBL safety demonstrate a mortality of one in 15,000. Conclusions: Although deep venous thrombosis/pulmonary embolism will always remain an abdominoplasty risk, intraoperative BBL pulmonary fat embolism has the potential to be reduced dramatically with a better understanding of dynamic anatomy, surgical instrumentation, and technique. The authors are now presented with a better lens with which to view a more accurate safety profile of BBL surgery, including its place among other commonly performed aesthetic procedures.
Article
Background: Orthostatic hypotension (OH) is a major obstacle to standing liposculpture. Aims: To investigate the feasibility of a novel "interactive standing liposculpture" procedure under local anesthesia to avoid possible general anesthesia-related complications and overcome standing-associated OH. Methods: A total of 68 subjects undergoing IsLipo were divided into three groups: Individuals with normal body weight (18 ≤ BMI < 23, n = 21, Group 1), overweight or mildly obese subjects (23 ≤ BMI < 30, n = 29, Group 2), and those with moderate-to-severe obesity (BMI ≥ 30, n = 18, Group 3). A 4-area liposculpture technique was adopted with alternate change in position from recumbent to standing for each area. Subjects with symptoms of OH (ie, dizziness or/and nausea) were allowed to rest in a supine position before resuming the procedure. Incidence of OH and duration of liposculpture for each area were recorded and analyzed. Results: The incidence of OH was 15 (four subjects experienced two episodes during the same procedure). All OH episodes occurred in Group 3 subjects. The total liposuction time significantly increased from Group 1 to Group 3 (all P < .001). The IsLipo time in Group 3 was also substantially longer than that in Group 1 and Group 2 (P < .001). Mean arterial blood pressure dropped and heart rate increased significantly in all subjects experiencing OH without fluctuation in arterial oxygen saturation. All subjects with OH recovered after a 10-minute rest and resumed the IsLipo procedure. Successful liposculpture were performed in all subjects. Conclusion: Orthostatic hypotension associated with interactive standing liposculpture, which predominantly occurred in subjects with moderate-to-severe obesity, could be resolved with an intraoperative resting strategy.
Article
Objective To describe the author’s experience with the high definition lipoabdominoplasty technique for the treatment of abdominal flaccidity and lipodystrophy, with correction of muscle diastasis and definition of body contours.Methods This is a retrospective study analyzing the results of 146 patients operated on with the high definition lipoabdominoplasty procedure.ResultsThe average age was 37.93 years (25 to 58). The average body mass index was 25.68 kg/m2 (19.6 to 29.9 kg/m2). Combined surgeries were associated in 76 cases (52%). The results obtained are demonstrated by comparing the pre and postoperative photos.DiscussionWith the advent of high definition liposuction, the results improved significantly, reaching a higher degree of definition and giving a more athletic and aesthetically pleasing contour. However, this procedure is not free of complications, and should be performed cautiously, while following specific protocols. With proper patient selection, this technique provides excellent outcomes when combined with abdominoplasty. Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Article
Context: Tumescent local anesthesia is a form of local anesthesia, which is a technique in which a dilute local anesthetic solution is injected into the subcutaneous tissue until it becomes firm and tense. Originally developed to facilitate liposuction, the use of tumescent anesthesia has expanded to other dermatological and plastic surgery procedures, as well as to other disciplines, including endocrine and vascular surgeries. For infiltration local anesthesia, the conventional dosage of lidocaine is up to 4.5 mg/kg, and that with adrenaline is up to 7 mg/kg; however, in liposuction using tumescent anesthesia, the recommended maximum dose of lidocaine with adrenaline is up to 55 mg/kg. There are several important pharmacological, pharmacokinetic, and pharmacodynamic factors that need to be considered in the administration of tumescent anesthesia leading to considerable interdisciplinary differences of opinion with respect to the maximum dose of local anesthetic permissible. Although several studies and publications have studied these issues in liposuction extensively, the role of tumescent anesthesia in other indications has not been reviewed adequately. Aims and objectives: The aim of this study was to discuss the science behind tumescent anesthesia, its applications, and safety considerations in different dermatosurgical procedures other than liposuction. Materials and methods: For this review, a systematic literature search in PubMed, Embase, Web of Science, Cochrane Library, Central, Emcare, Academic Search Premier, and ScienceDirect was conducted for safety studies on tumescent anesthesia. Conclusion: Tumescent anesthesia is generally very well accepted by patients and is relatively safe at the recommended doses. Nonetheless, one must be vigilant about the signs and symptoms of LAST, as they may not manifest until several hours after the procedure. Lipid emulsion therapy should be readily available and could prove life-saving in such situations.
Chapter
Liposuction remains one of the most common aesthetic surgical procedures performed in the United States. Both the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) rank liposuction as the second most common surgical procedure performed by their members, and each society reported more than 250,000 cases in 2018. Numerous advances in liposuction techniques and equipment have taken place since their introduction in the early 1980s; however, none of them have had the impact of combining ultrasound for adipose tissue fragmentation. Vibration amplification of sound energy at resonance (VASER), the third generation of ultrasonic liposuction devices, is associated with less blood in the aspirate and less postoperative bruising, and allows for greater precision in contouring. Gluteal augmentation via fat grafting is a powerful body-contouring technique that can create impressive results not obtainable with implants or liposuction alone. The procedure is very technique-dependent. It is recommended that surgeons avoid intramuscular injection and graft only into the subcutaneous space. The subcutaneous space is a thin, curving dome that ranges in thickness from 1 cm at the outer hips to 3–4 cm at the central gluteal dome. In certain patients, the anatomy can present a difficult target for subcutaneous injections. Real-time intraoperative ultrasound-guided fat grafting during a Brazilian butt lift (ultraBBl) allows the surgeon to accurately target either the deep or superficial gluteal subcutaneous spaces while avoiding intramuscular injections. The technique also allows for precise control of the fat graft volume and distribution. Recent advances in ultrasound technology have made real-time intraoperative ultrasound an affordable tool that can not only make a Brazilian butt lift more anatomically accurately, but also safer as well.
Article
BACKGROUND Tumescent liposuction is a new method of liposuction under local anesthesia that has been developed by dermatologic surgeons. OBJECTIVE To determine the safety of tumescent liposuction in a large group of patients treated by dermatologic surgeons. METHODS A survey questionnaire was sent to 1,778 Fellows of the American Society for Dermatologic Surgery in February 1994. The comprehensive questionnaire requested information on numbers of patients treated with tumescent liposuction and complications that occurred. RESULTS Sixty-six dermatologic surgeons provided data on 15,336 patients. The complications that were reported were infrequent and minor. There were no serious complications such as death, embolism (pulmonary or fat), hypovolemic shock, perforation of peritoneum or thorax, or thrombophlebitis. Blood transfusions were not required in any of the 15,336 patients and there were no admissions to the hospital for treatment of complications. CONCLUSIONS Tumescent liposuction is an exceptionally safe method of liposuction under local anesthesia that eliminates the necessity of general anesthesia and blood transfusions. Tumescent liposuction is safer than liposuction under general anesthesia and results in fewer complications.
Article
Metabolites of lidocaine have been detected in human urine which on reduction with titanious trichloride reagent produced lidocaine and monoethylglycinexylidide (MEGX). It is suggested that the metabolites are the N-hydroxy derivatives of lidocaine and MEGX. Results of comparing the amounts of these metabolites excreted either under conditions of fluctuating urinary pH or acid urinary pH indicate that hydroxylation occurs on the aromatic nitrogen of both lidocaine and MEGX.
Article
Plasma levels of lidocaine and the main binding proteins of lidocaine in plasma α1-acid glycoprotein (AAG) and albumin were measured in 10 otherwise healthy women during and after breast augmentation. A total dose of 825 to 1280 mg of 0.2% and 0.5% lidocaine with epinephrine corresponding to 16.3 to 21.8 mg/kg (mean 18.2 mg/kg) was injected in the spatium between the pectoralis muscle and the mammary gland. The peak plasma concentrations of lidocaine varied between 0.96 and 3.12 μg/ml (mean 1.49 μg/ml) and occurred between 4 and 12 hours (mean 7.3 hours) postoperatively. The plasma concentration of AAG varied between 0.42 and 1.73 g/liter (mean 0.49 g/liter, normal range 0.54 to 1.17 g/liter). There was a significant correlation between the plasma concentration of AAG and lidocaine. The mean concentration of albumin was 37.2 g/liter, ranging from 33 to 42 g/liter (normal range 35 to 50 g/liter). No patient showed signs of lidocaine toxicity. These data indicate that a dose of 20 mg/kg of lidocaine with epinephrine probably is safe in breast augmentation when the drug is administrated as described in this study. There are significant individual differences in the plasma concentration curves between patients, partly explained by different concentrations of AAG. Further studies with a larger number of patients are needed to establish definitive recommendations of safe maximal doses.
Article
“Managing Your OR” focuses on various aspects of aesthetic surgery in the ambulatory surgical setting.
Article
Intraoperative blood loss and postoperative anemia have been a concern when more than 1500 ml of lipoplasty material is aspirated. Blood loss is minimal when the targeted area is infiltrated with large volumes of dilute lidocaine and epinephrine. However, little quantitative data are available regarding the intraoperative blood loss and postoperative hemoglobin drop. In this prospective study 38 consecutive women were investigated with preoperative measurement of hemoglobin, platelet count, prothrombin time, activated partial thromboplastin time, and postoperative measurement of hemoglobin. Hemoglobin and whole blood volume were calculated from the infranatant portion of the lipoplasty aspirate. All procedures were done with the patient under general anesthesia. The mean (+/-SD) volume of lipoplasty aspirate material was 2900+/-14702.8 ml (range 1000 to 5800 ml). The mean (+/-SD) whole blood volume in lipoplasty aspirate per case was 36+/-50.82 ml (range 1.2 to 251 ml). The mean (+/-SD) fall in hemoglobin was 0.93+/-0.92 gm/dl (range 0.2 to 4.3 gm/dl). The volume of whole blood loss was estimated to be 12.4 ml in each 1000 ml of lipoplasty aspirate. No blood transfusions were required. Data show that blood loss with the tumescent technique is remarkably low. Use of this technique permits large-volume lipoplasty aspirate and minimizes the need for blood transfusion.
Article
Some 958 surgeons replied to a survey designed to determine the complications of abdominoplasties. The results appear in this paper. We believe that the patient contemplating an abdominoplasty and the surgeon planning it should be aware of the unpleasant reality of these complications, which range from the annoying to the lethal. It is of some solace, however, that despite the inevitability of readily visible scars, nearly all of these patients are quite satisfied with their results.
Article
The tumescent technique for local anesthesia permits regional local anesthesia of the skin and subcutaneous tissues by direct infiltration. The tumescent technique uses large volumes of a dilute anesthetic solution to produce swelling and firmness of targeted areas. This investigation examines the absorption pharmacokinetics of dilute solutions of lidocaine (0.1% or 0.05%) and epinephrine (1:1,000,000) in physiologic saline following infiltration into subcutaneous fat of liposuction surgery patients. Plasma lidocaine concentrations were measured repeatedly over more than 24 hours following the infiltration. Peak plasma lidocaine levels occurred 12-14 hours after beginning the infiltration. Clinical local anesthesia is apparent for up to 18 hours, obviating the need for postoperative analgesia. Dilution of lidocaine diminishes and delays the peak plasma lidocaine concentrations, thereby reducing potential toxicity. Liposuction reduces the total amount of lidocaine absorbed systemically, but does not dramatically reduce peak plasma lidocaine levels. A safe upper limit for lidocaine dosage using the tumescent technique is estimated to be 35 mg/kg. Infiltrating a large volume of dilute epinephrine assures diffusion throughout the entire targeted area while avoiding tachycardia and hypertension. The associated vasoconstriction is so complete that there is virtually no blood loss with liposuction. The tumescent technique can be used with general anesthesia or IV sedation. However, with appropriate instrumentation and surgical method, the tumescent technique permits liposuction of large volumes of fat totally by local anesthesia, without IV sedation or narcotic analgesia.
Article
In March of 1988, a survey form was sent to all 2695 U.S. and Canadian members of the American Society of Plastic and Reconstructive Surgeons. Nine-hundred and thirty-five members responded, for a response rate of 34.7 percent. The purpose of the survey was to ascertain the total number of major liposuction, dermatolipectomy, and abdominoplasty procedures performed from January of 1984 to January of 1988 and to compare nine specific complications that are associated with these three procedures. The 935 surgeons reported a total of 112,756 procedures performed: major liposuction (75,591), dermatolipectomy (10,603), and abdominoplasty (26,562). Nine major complications were surveyed: mortality, myocardial infarction, cerebrovascular accident or transient ischemic attack, pulmonary thromboembolism, fat embolism, major skin loss, anesthesia complication, transfusion complications, and deep venous thrombosis. The findings in this survey showed, when comparing these three procedures and the nine types of complications, that the complication rate for major suction lipectomy was 0.1 percent, for dermatolipectomy 0.9 percent, and for abdominoplasty 2.0 percent. Fat emboli did not prove to be a significant factor associated with any of the three procedures. However, of the 15 reported deaths (major liposuction 2, dermatolipectomy 2, and abdominoplasty 11), pulmonary thromboembolism was the causative factor in 9 deaths (60 percent). Based on these analyzed data, we feel that major suction lipectomy has a low complication rate and is a reasonably safe procedure.
Article
In October of 1983, we sent a questionnaire on suction lipectomy to 2524 U.S. and Canadian members of the American Society of Plastic and Reconstructive Surgeons. Six-hundred and twelve plastic surgeons returned questionnaires (24.2 percent response rate). One-hundred and seven responding surgeons reported 1573 operations in which suction lipectomy with or without skin excision was used for 2685 procedures on various parts of the body. In the subset of 1249 operations in which suction lipectomy only was used to treat 2261 anatomic areas, surgeons reported greater than 80 percent good or excellent aesthetic results. The overall complication rate was 9.3 percent. The most frequent complications were persistent hypesthesia (2.6 percent), seroma (1.6 percent), and persistent edema (1.4 percent). Skin pigmentation, pain, hematoma, infection, and slough each occurred with an incidence of 1.0 percent or less. Based on the results of this survey, suction lipectomy is a valuable new modality for surgical improvement of body contour.
Article
The authors sought to determine whether advances in the surgical sciences have led to a reduction in mortality rates for diseases treated by surgery during the past 25 years. They also wished to study changes in health care manpower for perioperative care during this period. Surgical operations requiring general anesthesia in the United States have risen to 25 million per year at an annual cost of approximately $125 billion. During the period 1968 to 1988, the number of anesthesiologists per 100,000 persons in the United States increased 98%, although the number of surgeons remained relatively constant. Between 1980 and 1989, the number of radiologists per 100,000 persons decreased to 29% below the figure for 1965. Membership in specialized nursing societies increased dramatically. The authors used vital statistics data from the National Center for Health Statistics (NCHS) to examine the mortality rates for diseases of the prostate, appendix, and gallbladder; hernia and intestinal obstruction; and ulcerative disease of the stomach and duodenum for the years 1968, 1978, and 1988. NCHS hospital discharge data were used to derive the rates of hospitalization and surgery for these conditions. Information on changes in health care manpower was obtained from published and other sources. The mortality rates for the five diseases studied decreased from 40% to 69% between 1968 and 1978. Between 1978 and 1988, the mortality rates caused by benign prostatic hyperplasia declined an additional 54% and by appendicitis, an additional 43%. Deaths attributable to the other conditions remained relatively constant. The rates of hospitalization and surgery for these conditions varied. Advances in surgery, anesthesiology, and information transfer and the availability of intensive care units and specialized hospital personnel have resulted in reduced mortality rates for diseases treated by surgery.
Article
Tumescent liposuction is a new method of liposuction under local anesthesia that has been developed by dermatologic surgeons. To determine the safety of tumescent liposuction in a large group of patients treated by dermatologic surgeons. A survey questionnaire was sent to 1,778 Fellows of the American Society for Dermatologic Surgery in February 1994. The comprehensive questionnaire requested information on numbers of patients treated with tumescent liposuction and complications that occurred. Sixty-six dermatologic surgeons provided data on 15,336 patients. The complications that were reported were infrequent and minor. There were no serious complications such as death, embolism (pulmonary or fat), hypovolemic shock, perforation of peritoneum or thorax, or thrombophlebitis. Blood transfusions were not required in any of the 15,336 patients and there were no admissions to the hospital for treatment of complications. Tumescent liposuction is an exceptionally safe method of liposuction under local anesthesia that eliminates the necessity of general anesthesia and blood transfusions. Tumescent liposuction is safer than liposuction under general anesthesia and results in fewer complications.
Article
Liposuction, like many other plastic surgical procedures, is often performed under local anesthesia. Drug toxicity is the most serious complication and the factor that limits the use of this form of anesthesia. Toxic effects are related to the peak concentration in plasma and depend on the type of local anesthetic, the drug concentration, total dose, site of injection, injection speed, and whether vasoconstrictors are used or not. This study evaluates the use of large volumes of subcutaneously injected 0.1% lidocaine with epinephrine 1:1,000,000 as the local anesthetic procedure in 12 patients undergoing suction-assisted lipectomy of the abdomen, flanks, and/or lower extremities. A total dose of 1260 to 2880 mg lidocaine corresponding to 10.5 to 34.4 mg/kg was administered with an injection speed of 60 to 78 ml/min. The peak concentration of lidocaine varied between 0.9 and 3.6 micrograms/ml and occurred between 6 and 12 hours postoperatively. For the given dose range, a linear correlation (r = 0.83) was found between the total dose of lidocaine and the peak concentration in plasma. A dose increase of 1 mg/kg raised the peak concentration approximately 0.1 microgram/ml. Our data clearly demonstrate that when using pH-adjusted 0.1% lidocaine with epinephrine subcutaneously for suction-assisted lipectomy, lidocaine can be administrated safely in significantly higher doses than recommended. When such high doses are used, the patient probably should be observed for at least 18 hours postoperatively.
Article
The tumescent technique for local anesthesia improves the safety of large-volume liposuction ( > or = 1500 ml of fat) by virtually eliminating surgical blood loss and by completely eliminating the risks of general anesthesia. Results of two prospective studies of large-volume liposuction using the tumescent technique are reported. In 112 patients, the mean lidocaine dosage was 33.3 mg/kg, the mean volume of aspirated material was 2657 ml, and the mean volume of supernatant fat was 1945 ml. The mean volume of whole blood aspirated by liposuction was 18.5 ml. For each 1000 ml of fat removed, 9.7 ml of whole blood was suctioned. In 31 large-volume liposuction patients treated in 1991, the mean difference between preoperative and 1-week postoperative hematocrits was -1.9 percent. The last 87 patients received no parenteral sedation. In a second study, a 75-kg woman received 35 mg/kg of lidocaine on two separate occasions, first without liposuction and 25 days later with liposuction; peak plasma lidocaine concentrations occurred at 14 and 11 hours after beginning the infiltration and were 2.37 and 1.86 micrograms/ml, respectively.
Article
The safety of lidocaine dosing in the tumescent technique has been well documented, but there is little evidence regarding the safety of combining tumescent lidocaine infiltration with subcutaneous lidocaine infiltration required in other aesthetic surgery. The safety of lidocaine and epinephrine dosing was investigated in 10 patients undergoing tumescent technique liposuction alone and in 10 patients undergoing tumescent liposuction with concurrent facial and aesthetic breast surgery by determining serum lidocaine and epinephrine levels at 3, 12, and 23 hours following infiltration of the tumescent solution and the subcutaneous lidocaine. The mean lidocaine dose of all patients was 22.3 mg/kg. All patients demonstrated safe lidocaine levels at all intervals, with the highest levels occurring in patients who received intravenous lidocaine at the induction of anesthesia. The peak epinephrine levels occurred at the 3-hour blood draw and were approximately four times physiologic. No patient demonstrated any subjective or objective signs of lidocaine or epinephrine toxicity.
Article
In tumescent liposuction, large volumes of dilute lidocaine and epinephrine are infused subcutaneously to prepare fat for extraction. Reported cardiopulmonary complications of tumescent liposuction have been few, and the anesthetic and hemodynamic advantages are several. We report an instance of pulmonary edema in a healthy 55-year-old male body-builder who received 7900 cc subcutaneous and 2200 cc intravenous fluid. With normal cardiopulmonary and renal function, the patient responded promptly to intravenous diuretics without sequelae. Out of over 900 patients who have had tumescent liposuction with up to 15 liters infused parenterally, this is the first case of pulmonary edema.
Article
The safe upper limit of lidocaine dosage in tumescent anesthesia for liposuction has been reported to be 35 mg/kg. This study was undertaken to: 1) evaluate the safety of tumescent anesthesia in liposuction when lidocaine doses greater than 35 mg/kg are required, 2) determine the time interval when the peak plasma lidocaine level occurs following administration of tumescent anesthesia, and 3) assess if the safety of large volume tumescent anesthesia is due to significant lidocaine removed by liposuction. Sixty patients who underwent liposuction with a mean lidocaine dose of 57 mg/kg were prospectively evaluated for development of any signs or symptoms of lidocaine toxicity by multiple interviews over a 24-hour period. In addition, another 10 patients who received a mean lidocaine dose of 55 mg/kg had serial plasma lidocaine level measurements over a 24-hour period following liposuction. The lidocaine level of the aspirate was also measured to assess any significant lidocaine removed by liposuction. No evidence of lidocaine toxicity was found based on subjective evaluation of 60 patients as well as determined by plasma sampling of 10 patients. The peak plasma lidocaine concentration occurred at approximately 4 or 8 hours after infusion of tumescent anesthesia. The 24-hour plasma lidocaine level suggests that residual lidocaine is present in the subcutaneous tissue allowing for postoperative analgesia beyond this time. A negligible amount of lidocaine was removed by liposuction as determined by the lidocaine level of the aspirate. This study suggests that tumescent anesthesia with a total lidocaine dose of up to 55 mg/kg is safe for use in liposuction.
Article
The medical profession is besieged by concerns about cost containment. This in turn has focused attention on the use of ambulatory surgical facilities. However, the costs of hospital outpatient surgery programs usually prevent them from being competitive when compared with the costs of using office surgical facilities. To address the question of patient safety in office surgical facilities, the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) sent a questionnaire to its accredited facilities. Two-hundred and forty-one (57.7 percent) of the 418 accredited facilities returned the anonymous questionnaires, a very high response rate. Or interest are the following findings: 400,675 operative procedures were reported during a 5-year period. Significant complications (hematoma, hypertensive episode, wound infection, sepsis, hypotension) were infrequent, occurring in 1 in every 213 cases. Return to the operating room within 24 hours and preventive hospitalization were less frequent. A death occurred in 1 in 57,000 cases (0.0017 percent). The overall risk is comparable in an accredited office (plastic surgical facility) and in a free-standing or hospital ambulatory surgical facility. This study documents an excellent safety record for plastic surgery done in accredited office surgical facilities by board-certified plastic surgeons.
Article
There is no agreement as to appropriate fluid resuscitation in patients undergoing liposuction. This has assumed greater significance, as surgeons have undertaken larger volume aspirations (> or = 4 liters) and the potential complications of hypovolemia and fluid overload have materialized. This prospective study of 53 consecutive healthy patients undergoing liposuction using a superwet technique served to develop general guidelines for safe perioperative fluid management, especially in regard to large-volume aspirations. In this context, "aspirate" is defined as the total fat and fluid that is removed during liposuction. All patients were monitored using standard noninvasive hemodynamic monitoring. Thirty-six patients were monitored perioperatively with Foley catheters. The 53 patients underwent liposuction alone. We did not include patients who underwent concurrent aesthetic surgical procedures because our intention was to establish fluid administration guidelines for the liposuction patient. There were no significant complications in our series. The intraoperative fluid ratio, defined as (intravenous fluid + infiltrate)/aspirate, was 2.1 for the small-volume group and 1.4 for the large-volume group. These values were significantly different (p < .001, t test). Average urine output in the operating room and recovery room and on the floor was satisfactory (> 0.5 to 1 cc/kg/hr) and did not relate to volume aspirated (p = 0.21, 0.91, and 0.6, respectively, t test). Four patients who underwent "large-volume" aspirations (> or = 4 liters) had transient hypotension, which was immediately responsive to crystalloid fluid boluses in the first postoperative hours. All other patients required only maintenance intravenous crystalloid postoperatively until oral intake had been resumed. There were no statistically significant differences in postoperative fluid administration between the small- and large-volume groups. Ninety-three percent of patients were discharged within 24 hours of surgery. Our suggested guidelines for fluid resuscitation based on this retrospective study are as follows: (1) small volume (< 4 liters aspirated): maintenance fluid + subcutaneous wetting solution; (2) large volume (> or = 4 liters aspirated): maintenance fluid + subcutaneous wetting solution + 0.25 cc of intravenous crystalloid per cc of aspirate removed after 4 liters. This formula has since been used in the care of 94 patients who have undergone liposuction exclusively. All patients have had unremarkable hospital courses. These guidelines do not replace sound clinical judgment. Good communication between the surgeon and anesthesiologist is critical to optimal patient care and safety.
Article
Fifteen hundred and twenty cases of liposuction/liposculpture were performed at Dr. M. Erfan & Bagedo Hospitals and King Abdulaziz University Hospital in Jeddah from January 1983 to December 1994. These cases were mostly females. The age group was from 16-65 years. Multiple procedures were performed in 11.68% of these cases. The change in hemoglobin and the hematocrit ratio pre- and post-operatively, and the incidence of complications, were studied. The percentage of surface area operated upon rather than the amount of fat removed was the most important relevant factor.
Article
Plasma levels of lidocaine and the main binding proteins of lidocaine in plasma alpha1-acid glycoprotein (AAG) and albumin were measured in 10 otherwise healthy women during and after breast augmentation. A total dose of 825 to 1280 mg of 0.2% and 0.5% lidocaine with epinephrine corresponding to 16.3 to 21.8 mg/kg (mean 18.2 mg/kg) was injected in the spatium between the pectoralis muscle and the mammary gland. The peak plasma concentrations of lidocaine varied between 0.96 and 3.12 microg/ml (mean 1.49 microg/ml) and occurred between 4 and 12 hours (mean 7.3 hours) postoperatively. The plasma concentration of AAG varied between 0.42 and 1.73 g/liter (mean 0.49 g/liter, normal range 0.54 to 1.17 g/liter). There was a significant correlation between the plasma concentration of AAG and lidocaine. The mean concentration of albumin was 37.2 g/liter, ranging from 33 to 42 g/liter (normal range 35 to 50 g/liter). No patient showed signs of lidocaine toxicity. These data indicate that a dose of 20 mg/kg of lidocaine with epinephrine probably is safe in breast augmentation when the drug is administrated as described in this study. There are significant individual differences in the plasma concentration curves between patients, partly explained by different concentrations of AAG. Further studies with a larger number of patients are needed to establish definitive recommendations of safe maximal doses.
Article
The technique of tumescent liposuction involves the subcutaneous infusion of a solution containing lidocaine, followed by the aspiration of fat through microcannulas. Although the recommended doses of lidocaine are as high as 55 mg per kilogram of body weight, few safety data are available. Since reporting of adverse events associated with tumescent liposuction is not mandatory, the incidence of complications and deaths is unknown. We identified 5 deaths after tumescent liposuction among 48,527 deaths referred to the Office of Chief Medical Examiner of New York City between 1993 and 1998. The patients' records and postmortem examination results were reviewed to identify common contributory factors. The five patients had received lidocaine in doses ranging from 10 to 40 mg per kilogram. Other drugs, such as midazolam, were also administered. Three patients died as a result of precipitous intraoperative hypotension and bradycardia with no definitively identified cause. Postmortem blood lidocaine concentrations in two of the patients were 5.2 and 2 mg per liter. One patient died of fluid overload, and one died of deep venous thrombosis of calf veins with pulmonary thromboembolism after tumescent liposuction of the legs. Tumescent liposuction can be fatal, perhaps in part because of lidocaine toxicity or lidocaine-related drug interactions.
Article
There is increasing national dialogue on who should perform liposuction and where it should be performed. To determine the effect of the location of liposuction surgery and the specialty of the physician on the incidence of malpractice claims. Physicians Insurance Association of America malpractice data from 1995-1997 was analyzed. Hospital-based liposuction had more than 3 times the rate of malpractice settlements than office-based liposuction. Dermatologists accounted for less than 1% of malpractice claim settlements in liposuction. Dermatologic liposuction education has emphasized small volume cases performed under local anesthesia using the tumescent technique. The safety of this approach appears to be validated in terms of decreased malpractice settlements.
Complications associated with the tumescent formula
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Meister, F. Complications associated with the tumescent formula. Aesthetic Surg. J. 17: 1, 1997.
Physician's Desk Reference
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Anonymous. Physician's Desk Reference, 52nd Ed. Montvale, N.J.: Medical Economics, 1998. Pp. 582–
Lidocaine and epinephrine levels in tumescent technique liposuction Plasma lidocaine levels during suction-assisted lipectomy using large doses of dilute lidocaine with epinephrine
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Burk, R.W., III, Guzman-Stein, G., and Vasconez, L. O. Lidocaine and epinephrine levels in tumescent technique liposuction. Plast. Reconstr. Surg. 97: 1379, 1996. Vol. 105, No. 1 / FATAL OUTCOMES FROM LIPOSUCTION 445 28. Samdal, F., Amland, P. F., and Bugge, J. F. Plasma lidocaine levels during suction-assisted lipectomy using large doses of dilute lidocaine with epinephrine. Plast. Reconstr. Surg. 93: 1217, 1994.
Deaths and Death Rates for the 10 Leading Causes of Death in Specified Age Groups: United States, Preliminary
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Historical Perspective Atlas of Suction Assisted Lipectomy in Body Contouring
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Grazer, F. M. Historical Perspective. In F. M. Grazer (Ed.), Atlas of Suction Assisted Lipectomy in Body Contouring. New York: Churchill Livingstone, 1992. Pp. 1– 4.
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Brief Statement Arlington Heights, Ill.: American Society of Plastic and Reconstructive Surgeons
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ASPRS Task Force on Lipoplasty, J.G. Bruner (Chair). Brief Statement. (Revised 3/31/98). Arlington Heights, Ill.: American Society of Plastic and Reconstructive Surgeons, 1998.
Louis: Mosby-Year Book
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de Jong, R. H. Local Anesthetics. St. Louis: Mosby-Year Book, 1994. Pp. 304 –344.
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American Academy of Cosmetic Surgery. 1996 National Cosmetic Surgery Statistics. Chicago: AACS Executive Office, 1997.
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