Biomedical subjects
Publications and source records attributed to Robert A Ersek.
As the popularity of liposuction continues to increase, so have the variety of methods available to perform the procedure. One factor that remains the same regardless of how liposuction is performed is that there will always be a limit to how much fat can be removed in a single sitting. When amounts to be removed exceed safe quantities, serial suction offers a safe and effective approach to achieve the desired result.
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Metabolic modulation refers to the change in glucose metabolism that may be caused by the reduction in body fat after large-volume liposuction. Since the authors began doing liposuction in 1989, they have had several diabetic patients whose insulin or oral diabetic needs have been substantially reduced after liposuction. When the charts for these patients were reviewed, it was found that they had improved diets, increased exercise, and decreased weight. The authors were uncertain about the relation between fat removal and metabolic modulation. They recently had a patient whose fasting blood sugar went from 200 to 100 mg after large-volume liposuction, and has stayed that way for more than 1 year. In addition, this patient lost 60 more pounds in the year after liposuction. It appears that removal of fat may improve several metabolic parameters, so the authors have started a multicenter study to evaluate this finding.
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Recent discussions and proposed rules and regulations regarding outpatient surgery facilities have raised the question of the appropriateness of general anesthesia versus heavy sedation. The controversy is based mostly on anecdotal information and the prejudice of the authors. A recent article that describes the improved platelet function induced by ketamine adds patient safety to the rationale for sedation. Most of us have trained in university settings where an entire department was devoted to general anesthesia and little true outpatient surgery was performed. When ambulatory facilities were available, they were usually staffed by anesthesiologists. Indeed, the first free-standing outpatient surgery center in Phoenix, Arizona, was owned and operated by a local group of anesthesiologists. Properly administered, diazepam and ketamine dissociative sedation is safe and effective for every aesthetic procedure, regardless of size or duration, and it should be available for all aesthetic surgeons. In the author's experience, more than 30,000 procedures have been performed with this method since 1966 without a single case of deep vein thrombosis or pulmonary embolus. In contrast, a former associate, because of his lack of experience, chose to use general anesthesia for a few larger cases in another facility. One of those cases, an abdominoplasty, resulted in a serious case of deep vein thrombosis with subsequent alleged disability and litigation. Therefore, the author is writing to share his extensive experience with his colleagues in hopes that these safe systems will become more widespread and to spare future patients the attendant unnecessary increased morbidity and mortality associated with general anesthesia.
While abdominoplasty has a long history of development, we have recently had several cases where a lateral hip lift was requested. The goal is to raise and tighten the skin and subcutaneous tissue of the lateral thigh after weight loss or to improve cellulite. We have modified the excellent technique of Ted Lockwood by eliminating undermining and suturing the resulting flaps only to the deep dermal layers. The complications have been limited to the spreading of scars as a result of so much tension, and the occasional delayed healing of those tense wounds.