[Breast implants and connective tissue diseases].
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Biomedical subjects
Publications and source records attributed to E Dillerud.
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A questionnaire was sent to 1339 consecutive patients who had undergone blunt suction lipectomy during the period between April 1984 and April 1987. Seventy-four percent replied, thus providing information about the results of 1929 procedures. The overall reported rate of satisfaction was 76 percent, with no significant difference between males and females. Highest satisfaction referred to pseudogynecomastia, submental area, iliac crest, and lower extremities on females. The rate of dissatisfaction was 6 percent. Dissatisfaction was associated most frequently with lipectomy of the buttocks. Underresection was reported for 30 percent and over-resection for 2.2 percent of the procedures. The latter, in particular, seemed to lead to dissatisfied patients. Asymmetry was reported for 19 percent of the procedures. Recurrence ("return") of fatty tissue was reported for 29 percent at the resection site. Thirty percent of the patients reported compensatory increase ("came back elsewhere") in fat deposits in nontreated locations. Self-reported weight gain was found to be a significant risk factor for both types of "regrowth." Irregularities were the most frequently reported permanent changes to skin. There were twice as many negative as positive changes to skin. Most of the patients had benefited personally from the surgery and were willing to consider undergoing lipoplasty again. All in all, the long-term results of blunt suction lipectomy are satisfactory.
Bilateral buttock flaps were raised in 13 Yorkshire pigs, and the viability and superficial blood flow were assessed by injection of fluorescein and laser Doppler flowmetry. One flap was then chosen at random from each pig to be defatted by blunt suction lipectomy. The opposite flap served as the control. Five and 30 minutes after lipectomy, the experimental flaps showed a 31% and 37% decrease in laser Doppler values (p < 0.05 and p < 0.01, respectively), measured 6 cm proximal to the margin of the fluorescein dye. There was no reduction in the values in the controls. One week after liposuction, the median area of flap necrosis in treated flaps was 4,615 mm2 (range 735-6,748) and in controls 4,104 mm (1,576-5,879). This difference was not significant (p = 0.24). Blunt suction lipectomy of the skin flaps did not significantly decrease the viability. The decreased skin circulation shown by laser Doppler soon after lipectomy may be a minor or temporary phenomenon.
Suction lipoplasty, comprising 3,511 procedures in 2,009 patients, was followed up prospectively for six to 12 months over a five-year period. 88% of the procedures led to patient satisfaction and 3.4% of dissatisfaction. Males were more dissatisfied than females. The most common general complications were excessive bleeding and complications from anaesthesia. The most common local complications were hypertrophic scarring and skin problems caused by external factors. 379 undesired results were registered at the six-month or 12-month follow-up. The results and rate of complications showed medial thigh, buttock, ankle and face to be the most difficult locations for suction. The age group 20 to 49 years emerged as the group with least complications.
Most mobile suction devices specially designed for blunt suction lipectomy are to some degree noisy and several of them could be considered expensive. Their exhaust goes out in the operating room (OR). The potential contamination by aerosoles and fumes favor the use of special outlet filters. The author describes the suction equipment he made in 1984. An industrial high-power vacuum pump is placed outside the OR. The suction tubing goes out of the ceiling in the OR. The machine has double remote pedal control. The exhaust vents out at a hidden place in the clinic's garden, where eventually any AIDS or hepatitis virus will die promptly. This equipment has been used in more than 4200 suction lipoplasty procedures with no technical or surgical complications related to the device.
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The author presents his experience from 292 augmentation mammaplasties: 368 polyurethane and 203 textured silicone implants. At follow-up after one year, 251 of 271 patients were satisfied with the result. Postoperative complications occurred in 18 breasts. The overall capsular contracture rate was 23%. At the one year follow-up the author assessed five of the breasts (hereof four revised) as hard. A questionnaire survey among 135 patients with polyurethane implants who were followed up for at least two years shows that 244 of 268 breasts were considered soft by the patients. Sensory changes in the nipple-areola complex and periodical pain in the breasts seem to be common after such surgery.
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Suction lipoplasty comprising 3511 procedures in 2009 patients was followed up prospectively for 6 to 12 months over a 5-year period. Eighty-eight percent of the procedures led to patient satisfaction and 3.4 percent led to dissatisfaction. Males were more dissatisfied than females. No mortality, deep thrombosis, pulmonary embolism, hypotension, or respiratory distress (fat emboli syndrome) was registered. Excessive bleeding and complications from anesthesia were the most common general complications. No hematoma, skin slough, or damage to adjacent organs occurred. Hypertrophic scarring and skin problems caused by external factors were the most common local complications. Only one clinical bacterial infection occurred. Three hundred and seventy-nine undesired results were registered by the 6-month follow-up, and 213 revisions because of asymmetry, underresection, or skin problems were performed. A total of 121 procedures unexpectedly required secondary suction, skin excision, or fat grafting. Forty-five sequelae were not corrected by revisions. Medial thigh, buttock, ankle, and facial suction emerged as the most difficult locations with regard to the results and complication rate. The age group 20 to 49 years emerged as the least troublesome.
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The records of 487 patients undergoing abdominoplasty combined with closed liposuction of flap and flanks were reviewed regarding complications, revisions, and certain risk factors related to flap necrosis. Six patients developed general nonfatal complications including 1 deep phlebitis and 1 pulmonary embolism. Thirty-nine local complications occurred including 24 cases of flap necrosis, 4 hematomas, 2 dehiscences, 1 abdominal perforation, 1 infection, and 5 cases of seroma. Wide undermining and the "opposite T" incision emerged as significant risk factors related to flap necrosis. Neither the suction procedure nor obesity nor age had significant influence on the slough incidence. Although the present study does not include controls, liposuction does not appear to represent any significant additional risk when performed in connection with abdominoplasty.
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Postoperative complications from 7,552 cosmetic surgical procedures were studied retrospectively. 22 general and 60 local complications occurred. Five of the most serious were three complications from anaesthesia, one peripheral nerve damage and one prolonged psychiatric situation. Two patients required hospitalization. Correction of protruding ears gave the relatively largest incidence of local complications, and Suction lipectomy the largest incidence of general complications. The most common complications were hematoma, skin slough and problems related to anaesthesia. The most common cosmetic surgical procedures such as mammaplasty, face lift, blefaroplasty, liposuction, rhinoplasty and hair transplantation, were rarely associated with complications.
417 abdominoplasties performed by the author during five years were studied retrospectively, with special reference to indications, technique and especially complications. Some publications from other countries were reviewed and their results compared with the present study. Six patients developed general complications. Two of these patients were hospitalized. 34 patients developed local complications. 33 of these patients were treated as outpatients. These numbers do not differ significantly from those found in comparable foreign studies. Different alternatives in the treatment of postoperative skin slough are discussed. Morbidity was not increased in obese patients. Both the primary procedure and revisions of local complications can be performed without hospitalization. The author advocates early mobilisation and emphasises the importance of selection.
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