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Small intestinal perforation and necrotizing fasciitis after abdominal liposuction.

Liposuction, the most common aesthetic procedure performed in the United States, is not without risk, but the overall complication rate in the literature varies from less than 1% to 9.3%. A 55-year-old woman who had undergone abdominal liposuction with bilateral breast augmentation was hospitalized in a state of profound septic shock. A diagnosis of necrotizing fasciitis was made on the basis of findings that included abdominal skin discoloration, subcutaneous emphysema, and air in the subcutaneous plane seen on abdominal computed tomography (CT) scan. During the operative procedure for abdominal wall debridement, extensive necrosis of abdominal wall fascia with leakage of bilious fluid from defects in the rectus sheath was found. Subsequent peritoneal cavity exploration showed two perforations in the mid ileum with gross peritoneal cavity contamination.

Abdominal Fat↗
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Modified device for easy infiltration of tumescent solution in liposuction.

BACKGROUND: Managing large amounts of tumescent fluid may be cumbersome and a waste of time. To solve the problems of an easy, quick, reliable, and cost-effective jet infiltration technique for large tumescent volumes, the authors describe a simple handpiece that connects with standard air-driven wound irrigation systems. On the basis of former observations with a modified irrigation system previously published by our group, a newly developed multi-use irrigation infiltration cannula handpiece was used successfully for 63 patients without any complications. METHODS: An infiltration cannula with a handpiece and standard luer lock adapter that connects with an air-driven wound irrigation system required for liposuction procedures was developed and clinically tested. RESULTS: Between 2003 and 2005, a total of 63 patients with moderate- to large-volume suction (1,500-4,500 ml) were treated by subcutaneous infiltration of tumescent solution using the air-driven irrigation system and the newly developed infiltration cannula. The device proved to be reliable and efficient. No disconnection of the system was seen. The time savings and ease of use were most noticeable in cases of larger volume infiltration. Wiring and tubing of this device was facilitated in any case. No adverse side effects were noted. CONCLUSION: A simple infiltration cannula system that connects with standard wound irrigation systems facilitates the liposuction procedure in terms of cost effectiveness and time savings.

Equipment Design↗
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Fluid resuscitation in liposuction: a prospective analysis of infiltrate-to-total aspirate ratios lower than used for the superwet technique.

BACKGROUND: Fluid management during liposuction appears to as much an art as it is a science. Because of different infiltration practices such as wet, superwet, and tumescent techniques, different fluid management guidelines are required. This has assumed greater significance as surgeons have undertaken aspirations with larger volumes (>/=4 l) and the potential complications of hypovolemia and fluid overload have materialized. METHODS: In this prospective study, 580 consecutive patients underwent liposuction using an average infiltrate-to-total aspirate ratio of 0.38. For all the patients, noninvasive hemodynamic parameters were assessed to evaluate a clinically based guideline for fluid management in liposuction. RESULTS: The average infiltrate-to-total aspirate ratio was 0.38 +/- 0.18 (range, 0.24-0.8). Total urine output was 1.63 ml/kg per hour (range, 1.06-3.4 ml/kg/h). The average postoperative heart rate was 92.16 beats/min, and the average postoperative mean blood pressure readings were 70.41 mmHg. The intraoperative fluid ratio, defined as the ratio of intraoperative intravenous fluid plus subcutaneous infiltrate to total aspirate, ranged from 0.98 to 2.1 (average, 1.25). The average percentage of body weight aspirated was 5.2% (range, 1.76-7.02%) CONCLUSION: This article presents a safe fluid management guideline based on experimental data from 580 patients who underwent liposuction using average infiltration-to-aspirate rates of 0.38. However, the calculated volumes from all the formulas should be viewed as educated guesses of the appropriate fluid load, and clinical judgment is essential.

Adolescent↗
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Decision making in abdominoplasty.

BACKGROUND: Improvements and variations in abdominoplasty techniques have complicated patient and procedure selection. The authors describe their guidelines for selecting the ideal procedure to be used with patients by stratifying them into treatment groups according to the presence and location of excess skin and subcutaneous tissue, lipodystrophy, and abdominal wall laxity. METHODS: A prospective study analyzed 151 female patients treated for abdominal contour deformities from January 2004 to July 2005. The patients were systematically classified into five treatment groups: mini-abdominoplasty (5%), standard abdominoplasty (42%), abdominoplasty with liposuction and minimal midline undermining (10%), standard abdominoplasty with removal of deep fat (13%), and circumferential abdominoplasty (30%). RESULTS: The patients had a mean age of 42 years and a mean body mass index (BMI) of 26 kg/m(2). The prevalence of overweight (BMI, 25.0-29.9) was 37%, and that of obesity (BMI > 30.0) was 19%. Comparison of pre- and postoperative photographs included improved tension of the entire abdominal wall, enhancement of the waistline, and increased uniformity of the contour of the abdomen. There was a significant difference in mean BMI between preabdominoplasty (26 kg/m(2)) and postabdominoplasty (24 kg/m(2)) (p = 0.01). The prevalence of overweight and obesity decreased by 8% and 9%, respectively (p = 0.01), and a decrease in BMI occurred within each abdominoplasty subgroup (p = 0.01). The prevalence of complications was 11%. Seroma (4%) and delayed wound healing (4%) were the most common. One case of pulmonary embolus was encountered. Although there was a positive trend in complications with higher BMI, no statistically significant difference was found (p = 0.74). Half of the patients had additional procedures performed without a significant increase in complications (p = 0.5). CONCLUSIONS: The described algorithm for abdominoplasty selection is safe, effective, and flexible, with long-term improvement in abdominal contour and BMI.

Abdomen↗
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Histologic findings in axillary hydradenosuction.

Liposuction or its modifications have become accepted therapy for hyperhidrosis. During the nearly 20 years since its introduction, the actual anatomic removal of sweat glands has not been investigated. In this study, three patients underwent axillary liposuction and histologic examination of the aspirates. Apocrine sweat glands embedded in adipose tissue were found throughout the crosscuts. These results prove that the therapeutic effects are at least partially attributable to removal of glandular tissue.

Adult↗
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The thigh's lateral skin (saddle bags): histomorphometric study of interest to liposuction.

Study of the thigh's lateral skin ("saddle bags") in cadavers made it possible to evaluate its regional characteristics. Sex or race were not reported but the age group most appropriate to liposuction was considered. In this way, authors believed that as per standards established at the time, results as to the skin retraction in liposuction, will be able to be analyzed in a comparative way in the future.

Adult↗
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Morphological aspects of dorsum and sacrum skin as related to liposuction.

Analysis of the dorsum's skin and sacrum region allowed the authors to evaluate regional characteristics of cutaneous skin integument, taking into consideration the age group most subjected to liposuction. Thus, it was attempted to establish rules to facilitate, in a comparative form, the evaluation of results related to cutaneous retraction in plastic surgery.

Adult↗
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Systematic procedure for ultrasonically assisted lipoplasty.

It is well known that liposuction is the extraction of fat tissue from localized areas through small incisions with the use of a cannula and a vacuum pump. Since we began liposuction 18 years ago in our Department of Plastic and Reconstructive Surgery at the Clinica RUBER of Madrid, more than 1,300 patients have been treated with this procedure. During this time, instruments and techniques have been dramatically improved: there have been changes in methods (from the dry method to the wet and super-wet ones), in instruments (from the large caliber cannulae to the small caliber ones), and in application (from the deep aspiration plane to the superficial one) [1-5]. We presently have completely developed a systematic procedure for conventional liposuction (CL) which produces excellent results and provides a foreseen evolution in all patients, and that we have combined with the new ultrasonically assisted lipoplasty (UAL) to get very satisfactory results.

Adult↗
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External ultrasound-assisted lipoplasty from our own experience.

External ultrasound-assisted liposuction (XUAL) is a new technique that requires traditional aspirative liposuction after the application of high frequency ultrasonic fields delivered through the skin into a wetted tissue. Initial data suggest that it has some advantages over the traditional procedure, especially regarding the achievement of less traumatic surgery with superior clinical outcome. This preliminary report describes a comparative study between conventional liposuction and the external ultrasound-assisted technique as the modality of treatment for fat deposits in 65 bilateral anatomical areas. The results showed considerable superiority of the ultrasound-assisted series. We found less resistance to the canulla with more rapid removal of fat and the aspirated tissue showed less blood content with intact viable fat cells. Patients report less pain and discomfort on the ultrasound-treated sides and we found less swelling and bruising, with superior skin shrinkage. Clinical recovery was also enhanced by the external ultrasound and no complications were reported with the technique.

Adult↗
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Very superficial ultrasound-assisted lipoplasty for the treatment of axillary osmidrosis.

Treatment of axillary osmidrosis has been mainly concerned with surgical excision of glandular tissues and involved major surgical procedures with high morbidities and many complications. Search for a less invasive procedure for axillary osmidrosis resulted in the use of liposuction. However, there have been controversies over the efficacy of this method. The problem was that liposuction could not effectively remove the apocrine gland located in the dermis and dermosubcutaneous junction. A high rate of residual malodor and dissatisfaction were reported. The author used ultrasound-assisted lipoplasty (UAL) in the very superficial plane to remove the apocrine gland located in the dermis and dermosubcutaneous junction. The purpose of this study was to prove the efficacy of the very superficial UAL (VSUAL) for the treatment of axillary osmidrosis. From December 1998 to December 1999, 21 consecutive patients underwent UAL in their axilla for axillary osmidrosis. The follow-up period ranged from 2 to 12 months (mean: 8 months). UAL was performed in the very superficial plane with an amplitude of 40%. The very superficial UAL (VSUAL) was done mainly in a withdrawing manner with the tip of the cannula against the skin. The UAL (VSUAL) was done aggressively until the skin changed slightly erythematous. The results were assessed subjectively and objectively, and classified as excellent, good, fair, and poor. Nineteen patients were graded as excellent and one patient as good. The total satisfaction rate was 95.2%. One patient complained of residual malodor in her left axilla. There were no cases of skin necrosis, hematoma, or seroma. Histology showed partial removal of the subcutaneous layer and deep dermis, and degenerative epithelial changes in the apocrine glands in the residual deep dermis. These microscopic findings meant near-total functional ablation of the apocrine gland in the axilla comparable to "flap-to-graft conversion" or surgical excision of axillary skin. The UAL (VSUAL) for axillary osmidrosis has the advantages of a high success rate with minimal complications. Rapid recovery, less restriction of movement, and tiny scars were other major benefits of this technique. Therefore, UAL (VSUAL) is a viable option for treatment of axillary osmidrosis.

Adolescent↗
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Rapidly fatal necrotizing fasciitis after aesthetic liposuction.

Necrotizing fasciitis (NF) is a rapidly progressive soft tissue infection involving primarily the superficial fascia and subcutaneous tissue. The disease is caused by Streptococcus pyogenes or synergistic infection of anaerobic and facultative anaerobic bacteria. Further characteristics are severe, intolerable pain and a mortality rate of 30 to 50%. The NF can be initiated after surgical procedures, minor trauma, trivial scratches, in the setting of a chronic wound, or even in apparently intact skin. The age of the patient is not relevant for the prognosis of NF. As it is shown in this reported case, a young and previously healthy patient died after aesthetic liposuction in the course of a NF. Necrotizing fasciitis is a rare disease, therefore, it is important to review its diagnostic and clinical features, because only early diagnosis and prompt, radical surgery improves the survival rate.

Adult↗
PubMedDate not supplied

Comparative evaluation of traditional, ultrasonic, and pneumatic assisted lipoplasty: analysis of local and systemic effects, efficacy, and costs of these methods.

Recently ultrasound assisted liposuction (UAL) and pneumatic assisted liposuction (PAL) have been introduced as an attempt to improve the results and reduce the pitfalls of standard liposuction (SAL). Until now no studies comparing, at the same time, UAL, PAL, and SAL have been published. The aim of this study was to analyze these methods from the surgeon's point of view, focusing not only on aesthetic results but also on local and systemic trauma, efficacy, handling, and cost. Forty-five cosmetic patients affected by local lipodystrophy, divided into three equal groups, have undergone liposuction with the three above-mentioned techniques. Quantitative and qualitative analysis of lipoaspirates, together with blood chemistry, local and systemic complications, time to aspirate 100 cm3, distress, fatigue, and costs of the procedures, has been recorded. Our results showed bloodier lipoaspirates in SAL and a higher percentage of triglycerides in UAL lipoaspirates. Blood tests revealed a slight decrease in the postoperative Hb in SAL only. Early complications observed were four erythemas in PAL, three ecchymoses in SAL, and one long-lasting edema in UAL. Aesthetic results rated by independent viewers were similar for all methods. Efficacy was higher in the PAL group (4 min x 100 cm3 fat aspirated) than in SAL (7 min x 100 cm3 fat) and UAL (10 min x 100 cm3 fat). Surgeon's distress was higher in PAL than in SAL and UAL. Surgeon's fatigue was much lower in the PAL group than in the others. Costs expressed as multiples of 1 unit (1 unit = $500 U.S.) were highest for UAL, low for PAL, and lowest for SAL. In conclusion, PAL and UAL caused reduced vascular injury, UAL being more selective for adipocyte removal. Complications of UAL and PAL were mostly related to the longer learning curve of these methods. The UAL procedure was much more expensive than PAL and, especially, SAL. PAL proved to be a handy technique, with the most favorable cost/benefit ratio, and seems to be the best option for busy liposuction practices or fast office procedures, even though the choice of the ideal technique always depends on the surgeon's preference.

Cost-Benefit Analysis↗
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Lipoplastics of legs: our experience with a new cannula compared with classical technique.

The Authors compare the results obtained between two groups of patients suffering from leg lipodystrophy, who were subjected to a reducing lipoplasty. In the first group, surgeons made use of a new sort of cannula, deprived of the classical grip, whereas in the second group, they employed the traditional probe. The best results, achieved with the first group, prove this new operating system is really effective, particularly on legs, for the following reasons: (1) Higher precision and better control of the instrument (2) Swan-neck cannula abolition (3) Opportunity to operate with both hands (4) Halved operating time (5) No tiredness after the operation.

Adult↗
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Gluteus augmentation with fat grafting.

This study presents the authors' experience with gluteus augmentation with autologus fat grafts and liposuction methods, having recorded the evolution of gluteus reshaping with autologus intramuscular fat graft injections for the past 5 years. Preoperative shape is discussed and patient evaluations, operative techniques, postoperative management, and longterm results are emphasized.

Adipose Tissue↗
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The minimal facelift: liposuction of the neck and jowls.

We have used blunt liposuction for removing excess fat from the neck and jowls since 1983 with generally good results and few complications. Under local anesthesia with Valium and ketamine sedation and the use of the super-wet technique, and by using special precautions to avoid the complications of prominent platysmal bands, wrinkling of the neck, and salivary gland prominence, carefully performed liposuction to the neck and jowls has been shown to be a safe and dependable procedure with good results, and may delay or obviate the need for a facelift.

Adult↗
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Rhytidectomy assisted with ultrasound techniques: the ultra-lipo-lift technique.

Ultrasound-assisted liposuction has been practiced in Europe and South America for more than 10 years. This method was clinically introduced in 1989 for removal of fat by Dr. Zocchi, who developed the concept of applying ultrasound energy to adipose tissue [13,14]. Since 1992, we have been using ultrasound lipoplasty, first in body remodeling, then in face and neck surgery, after establishing working and safety rules in a study of 300 patients. In the beginning we were only looking to eliminate deposits of fat in oval faces with acne-scars, subdermal fibrosis, and thick skin, as these types of cases are not good candidates for rithidectomy. We found good skin retraction when we adjusted the superficial movements of the canula and had adequate machine power to avoid complications beneath the skin. Afterwards, we can break and release the adhesion zones of scarring and fibrosis, consequences of subdermic infiltrations or thread implants. Now we report our technique of rithidectomy assisted with ultrasound, which we have called ultra-lipo-lift (ULL). During the two last years we used this technique on 67 patients (48 females and 19 males) with good results and very few complications.

Adult↗