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Panniculectomy--an option for people who are morbidly obese.

Obesity is becoming a major health issue across the nation. Surgical procedures to alleviate problems of severely limited ambulation, development of open wounds, and overeating may be an option for people who are morbidly obese. A gastric bypass procedure and panniculectomy are among the surgical options available. In this article, the preoperative, intraoperative, and postoperative care of a patient undergoing a panniculectomy are presented. A safe, complication-free procedure can be performed with preplanning; a precise, detailed team effort; and an informed, motivated patient.

Adipose Tissue↗

Body contouring with ultrasound-assisted lipoplasty.

Lipoplasty (i.e., liposuction) is the most commonly performed cosmetic surgical procedure in the United States. During the past 20 years, there have been dramatic technological advancements in both surgical technique and equipment used to improve postoperative outcomes. As a result, perioperative nurses are faced with the challenge of providing quality care for this patient population in a variety of ambulatory surgical settings with highly specialized equipment. Perioperative team members play significant roles in the coordination of individualized patient-focused care, which includes detailed instructions and education, appropriate use and care of equipment, and postoperative follow-up. The efforts of the team members contribute to positive surgical outcomes, as well as to overall patient satisfaction.

Adult↗

Body contouring. Suction-assisted lipolysis and fat transplantation techniques.

Suction lipolysis is a technique of blunt aspiration of fat that allows contouring and shaping of fatty distributions in a variety of areas of the body. Sufficient experience with the technique exists so that it may be considered an acceptable and safe procedure in the armamentarium of the plastic and reconstructive surgeon. It is a basically low-risk surgical procedure that usually is performed on an outpatient basis, and its results are permanent. Autologous fat transplantation or microlipoinjection is a recent outgrowth of liposuction surgery. It involves gentle aspiration of free fat cells from one area of the body and reinjection of these cells into other areas to accomplish either cosmetic or reconstructive soft-tissue augmentation. It is still investigational in nature, and accurate, reproducible data demonstrating its prolonged efficacy are not yet available.

Adipose Tissue↗

Liposuction-assisted nerve-sparing extended radical hysterectomy: oncologic rationale, surgical anatomy, and feasibility study.

OBJECTIVE: Our purpose was to improve the therapeutic index of radical hysterectomy by extending the resection of parametrial tissue without further impairing pelvic autonomic nerve functions. STUDY DESIGN: We studied the topographic anatomy of the parametrial tissue with high-resolution magnetic resonance imaging and by dissection of fresh human cadavers. We then performed a clinical feasibility study of the liposuction-assisted nerve-sparing extended radical hysterectomy. RESULTS: Magnetic resonance imaging demonstrated that the perispinous adipose tissue is retained after type III radical hysterectomy and is a frequent site of tumor recurrence. The perispinous adipose tissue contains the pelvic plexus, the pelvic splanchnic nerves, small blood vessels, and lymphatic tissue. We developed the liposuction-assisted nerve-sparing extended radical hysterectomy and applied it to seven consecutive patients with cervical or vaginal cancer. No intraoperative or postoperative complications occurred. Postoperative magnetic resonance imaging assured us that perispinous adipose tissue was cleared in all cases. A metastatic lymph node was found in the perispinous adipose tissue removed by liposuction from one patient. Suprapubic cystostomies could be removed after a median period of 12 days. CONCLUSION: The nerve-sparing removal of perispinous adipose tissue by liposuction is a feasible addition to wide en bloc parametrectomy in anatomically defined planes.

Adipose Tissue↗

A systematic approach to the surgical treatment of gynaecomastia.

Numerous techniques have been described for the correction of gynaecomastia, and the surgeon is faced with a wide range of excisional and liposuction procedures. There is a paucity of literature describing an integrated approach to the management of this condition and the roles of the different treatment modalities. A review of all gynaecomastia patients operated on by one surgeon over a 2-year period was undertaken. Patient satisfaction was assessed using a linear analogue scale with a maximum score of 10. In total, 48 breasts in 29 patients were treated--31 breasts by liposuction alone (19 by conventional liposuction, 12 by ultrasound-assisted liposuction), eight breasts by liposuction and open excision, and nine breasts by liposuction, open excision and skin reduction (concentric or Lejour mastopexy). There were no early postoperative complications, such as haematoma, seroma or infection, and 91% of patients were very satisfied (score: 8-10) with their cosmetic outcome. The most frequently encountered complication was a residual subareolar lump (five breasts), all in patients treated by conventional liposuction alone. In order to avoid the common complication of an uncomfortable residual subareolar nodule, the threshold for open excision in patients undergoing conventional liposuction should be low. Ultrasound-assisted liposuction extends the role of liposuction in gynaecomastia patients. Although skin excess remains a challenge, it can be satisfactorily managed without excessive scarring. A practical approach to the surgical management of gynaecomastia, which takes into account breast size, consistency, skin excess and skin quality, is proposed.

Adolescent↗

The effect of ultrasound-assisted liposuction and conventional liposuction on the perforator vessels in the lower abdominal wall.

Scientific reports of clinical in vivo research into the effects and side-effects of ultrasonic-assisted liposuction (UAL) are scarce. Advocates of UAL claim that the damage to vascular and nervous structures is limited and even less than with conventional and/or tumescent liposuction (CL). The effect of tumescent infiltration alone and combined with either CL or UAL was assessed by performing injection studies of the panniculus adiposus of the lower abdominal wall of 20 fresh cadavers and five abdominoplasty specimens. Besides the control and infiltration groups (n=5 in each), there was an additional group of ten cadaver flaps and five abdominoplasty flaps that underwent infiltration followed by UAL in the right half of the flap and infiltration followed by CL in the left half of the flap. Radiographs of these flaps were shown to a blinded panel of ten plastic surgeons, who were asked to evaluate and compare the damage on the basis of the number and magnitude of contrast-medium extravasations in the flap. Vascular damage to the perforating vessels was seen even after infiltration alone, although it was very limited. A variable amount of damage (ranging from little to extensive) was observed in the CL and UAL groups. Statistical analysis of the judgments of the observers could not show that either technique was less damaging than the other. UAL is, therefore, probably more beneficial to the surgeon than to the patient. The financial investment in the device is justified for surgeons with large liposuction practices, mainly, and probably solely, because of the reduced physical strain for the surgeon.

Abdominal Wall↗

Liposuction and ischemic optic neuropathy. Case report and review of literature.

Ischemic optic neuropathy occurred in a patient following liposuction. Perioperative anemia and hypotension may be the cause of this complication. Correction of anemia with transfusion improved the hemoglobin and hematocrit but the right eye remained blind. Liposuction should be added to the list of the surgical procedures that may produce ischemic optic neuropathy as an isolated complication.

Arterial Occlusive Diseases↗

Persistence of autologous free fat transplant in bladder submucosa of rats.

The endoscopic correction of vesicoureteral reflux is a well accepted procedure. However, the search for the ideal injectable substance continues. We compared the persistence of autologous free fat transplants from the perivesical fat pad and the abdominal wall to the bladder submucosa in an animal model. Perivesical fat consistently showed greater persistence than abdominal wall fat over time. Perivesical fat may be an ideal substance for endoscopic injection when treating vesicoureteral reflux.

Abdominal Muscles↗

Complication of penile injection of autologous fat.

A new penile enlargement procedure using injection of autologous fat obtained by liposuction has been publicized by the media. We report on a 36-year-old man who suffered 2 painful inflammatory nodules requiring surgical excision 3 months after undergoing this new penile enlargement procedure.

Adipose Tissue↗

Refinements in abdominoplasty.

When performing traditional abdominoplasty, three fundamental defects of the abdominal wall must always be addressed by the plastic surgeon. They include redundant skin, excess fat, and musculofascial laxity. Plastic surgeons have found that this procedure consists of dermolipectomy and rectus plication, extremely effective in restoring the abdomen to its youthful shape in the vast majority of patients. This article will review the recent advancements in body contouring surgery while focusing on the recent technical refinements in abdominoplasty.

Abdomen↗

Transconjunctival lower eyelid blepharoplasty. Technique and complications.

The transconjunctival lower eyelid blepharoplasty is extremely effective at reducing lower lid fullness due to prominent orbital fat. The authors performed 122 consecutive transconjunctival blepharoplasties over a 24-month period. Four patients had skin excision via the pinch technique in conjunction with the transconjunctival fat excision. The main complication was under excision of fat which occurred in nine patients (7.4%). Moderate postoperative wound hemorrhage without hematoma formation occurred in one patient (0.8%). There were no cases of lid retraction, ectropion, entropion, inferior oblique palsy, or over excision of fat. The main advantage of this technique is that it avoids the most common complication of transcutaneous lower eyelid blepharoplasty, namely lower eyelid retraction.

Adipose Tissue↗

[Orbital decompression for dysthyroid orbitopathy: a review of techniques and indications].

Orbital bony decompression has a definite place in the management of severe manifestations of dysthyroid orbitopathy such as optic neuropathy, exposure keratitis, and exophthalmos. This surgical procedure can be undertaken when medication and radiation therapy fail. Esthetic and functional results are globally satisfying and explain the interest taken in this technique. This article will describe the development of this procedure and will outline the surgical techniques and their complications. It emphasizes the multifactor indications for this procedure.

Blepharoplasty↗

[Orbital fat decompression techniques].

Fat removal orbital decompression (FROD) was first described by Olivari in 1988. Through a blepharoplasty approach, fat pads from the five palpebral pockets, as well as intraconal fat, are carefully removed. The main complications are retrobulbar hemorrhage and postoperative diplopia. The best indications are patients with wide orbits without compressive optic neuropathy. FROD is an inescapable procedure in a balanced approach to surgical orbital decompression.

Blepharoplasty↗

The fate of hypodermis after liposuction surgery.

Liposuction surgery can be viewed as a trauma to the hypodermis. With histologic, morphometric, and autoradiographic examination and the use of tritiated thymidine, uridine, and proline, we have studied the fate of adipose tissue at various intervals after liposuction; however, we have never seen a reparative proliferation of the residual lipocytes. Moreover, the metabolic activity of adipocytes apparently is not increased. Inflammatory reaction is minimal in the early weeks, but fibrosis takes place in some lobules of the hypodermis. Our data support the view that liposuction has a long-term effect on the structure of the hypodermis, without any stimulation in the proliferative and biosynthetic activity of residual adipocytes.

Adipose Tissue↗