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Kim EJ, Kim H, Park Y. Enhancing Safety in Tumescent Liposuction: Managing Sedation-Related Respiratory Issues and Serious Complications Under Deep Sedation with the Propofol-Ketamine Protocol. Aesthetic Plast Surg 2024; 48:1964-1976. [PMID: 38536431 DOI: 10.1007/s00266-024-03963-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/16/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Over the past 4 years, aesthetic surgery, notably liposuction, has substantially increased. Tumescent liposuction, a popular technique, has two variants-true tumescent liposuction (TTL) and semi-tumescent liposuction. While TTL reduces risks, it has limitations. There is no literature reported on semi-tumescent liposuction under deep sedation using the propofol-ketamine protocol, which is proposed as a potentially safe alternative. METHODS The retrospective analysis covered 8 years and included 3094 patients performed for tumescent liposuction under deep sedation, utilizing the propofol-ketamine protocol. The evaluation of patient safety involved an examination of potential adverse events with a specific focus on respiratory issues related to sedation, including instances of mask ventilation. RESULTS Among the 3094 cases, no fatalities were recorded. Noteworthy events included 43 mask ventilation instances, primarily occurring in the initial 10 min. Twelve cases experienced surgery cancellation due to various factors, including respiratory issues. Three patients were transferred to upper-level hospitals, while another three required blood transfusions. Vigilant management prevented significant complications, and other adverse events like venous thromboembolism (VTE), fat embolism, severe lidocaine toxicity, and so on were not observed. CONCLUSIONS The analysis of 3094 tumescent liposuction cases highlighted the overall safety profile of the propofol-ketamine protocol under deep sedation. The scarcity of severe complications underscores its viability. The study emphasizes the significance of thorough preoperative assessments, careful patient selection, and awareness of potential complications. Prompt interventions, particularly in addressing sedation-related respiratory issues, further contribute to positive outcomes for patients. LEVEL OF EVIDENCE IV 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 .
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Affiliation(s)
- Eun Ju Kim
- Department of Chemistry Education, Daegu University, Gyeongsan-si, Gyeongbuk, 38453, South Korea
| | - Hyunju Kim
- Liposuction Center, 365mc Hospital, Busanjin-gu, Busan, 47286, South Korea.
| | - Younchan Park
- Liposuction Center, 365mc Hospital, Busanjin-gu, Busan, 47286, South Korea
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2
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Pazmiño P, Garcia O. Brazilian Butt Lift-Associated Mortality: The South Florida Experience. Aesthet Surg J 2023; 43:162-178. [PMID: 35959568 PMCID: PMC9896146 DOI: 10.1093/asj/sjac224] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Brazilian butt lift (BBL) surgery has been the fastest growing aesthetic surgical procedure over the past decade. By 2017, the risk of death from pulmonary fat (PFE) was identified, earning the BBL the highest mortality rate of any aesthetic surgical procedure. South Florida carries the highest BBL mortality by far in the nation. OBJECTIVES The purpose of this study was to explore the factors involved in making South Florida an outlier in terms of BBL mortality. METHODS The anatomic findings of the gluteal dissections from 11 post-BBL surgery autopsies (22 hemibuttocks) were assessed for commonalities. The public records of patients who died from BBL-related fat emboli were examined to determine commonalities. RESULTS All BBL PFE cases had fat grafts injected into the gluteal musculature in multiple different levels. Another commonality involved the location where the surgery took place, with the great majority of patients (92%) undergoing surgery at high-volume, budget clinics located in South Florida. Short surgical times of approximately 90 minutes appeared to be the norm for these cases. CONCLUSIONS South Florida has experienced 25 BBL-related fat emboli deaths between 2010 and 2022; however, 14 of these occurred after publication of the Aesthetic Surgery Education and Research Foundation's 2018 guidelines and the 2019 Florida Board of Medicine's BBL "subcutaneous-only" rule. The working environment at the clinics, and the short surgical times for these cases, may be the most important contributors to the BBL mortality in South Florida.
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Affiliation(s)
- Pat Pazmiño
- Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Onelio Garcia
- Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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3
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Foula AS, Ahmed MA, Foula MS, Nassar MW. Sudden Cardiac Arrest During a Prolonged Liposuction and Lipofilling Procedure: A Case Report. Cureus 2022; 14:e25985. [PMID: 35855235 PMCID: PMC9286308 DOI: 10.7759/cureus.25985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 11/05/2022] Open
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4
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Abstract
Fat embolism is an uncommon but life-threatening postoperative complication. The nonspecific symptoms associated with fat embolism could delay the diagnosis and result in a poor patient outcome. We report the case of a healthy 37-year-old woman who underwent a 6-hr breast and abdominal surgery with liposuction. Postoperatively, she displayed mild dyspnea, decreased oxygen saturation level, chest tightness, and fatigue. On Postoperative Day 3, pulmonary multislice computer tomography showed a fat embolus in her right pulmonary artery. She was treated with an anticoagulant to which she responded well and was discharged on Postoperative Day 7. This case demonstrates the need for surgeons, nurses, and anesthesia professionals to identify potential risk factors, recognize signs and symptoms, and implement effective treatment of pulmonary embolism to ameliorate the prognosis, improve the success of the surgery, and save the life of the patient.
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Affiliation(s)
- Minh Quang Pham
- Minh Quang Pham, MD, PhD , is a surgeon, anesthesiologist, and lecturer at Department of Anesthesia and Critical Care, Hanoi Medical University, Hanoi, Vietnam
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A Case of Systemic Inflammatory Response Syndrome after Liposuction-assisted Abdominoplasty. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3580. [PMID: 34881148 PMCID: PMC8647865 DOI: 10.1097/gox.0000000000003580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/23/2021] [Indexed: 11/25/2022]
Abstract
A 51-year-old woman underwent liposuction-abdominoplasty. After surgery, she developed hypotension and bradycardia, attributed to iatrogenic opioid-intoxication. After discontinuing opioids, the patient had several episodes of hypotension and tachycardia, responding well to fluid resuscitation. The initial differential diagnosis of postoperative bleeding was ruled out with a CT-scan. Other potential causes of hemodynamic instability, such as pulmonary embolism and fat embolism, were considered unlikely in absence of corresponding symptoms. Based on leukocytosis and tachycardia, the patient was diagnosed with systemic inflammatory response syndrome, a disproportional inflammatory reaction to surgery. The patient was managed expectantly with intravenous fluid administration and recovered without further treatment or complications.
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6
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Kim HI, In SK, Yi HS, Kim HY, Kim YS. Experimentally induced fat embolism syndrome: shift from obstruction to toxic effects. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2021. [DOI: 10.14730/aaps.2020.02355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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7
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Zamora-Mostacero VE, Vargas-Ferrer JE, Paredes-Julca AA, Vásquez-Montoya AT. Skeletal muscle and fatty tissue in mixed pulmonary embolism associated with liposuction: An incidental autopsy finding. Forensic Sci Med Pathol 2021; 17:312-316. [PMID: 33564975 DOI: 10.1007/s12024-020-00353-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 11/24/2022]
Abstract
Nonthrombotic pulmonary embolism is an uncommon life-threatening complication following liposuction. We report a rare incidental autopsy finding associated with this procedure. A 43-year-old female who underwent liposuction presented with hypotension, respiratory distress, loss of consciousness and cardiorespiratory arrest during the intraoperative period. The patient died 2 h after admission to the emergency department. Autopsy reported a massive hemoperitoneum (2.2 L) secondary to liver perforation associated with liposuction as the cause of death. Pelvic, umbilical and lumbar peritoneal perforations were also observed. The histological study showed segments of the pulmonary arteries occluded by mixed emboli of skeletal muscle fibers coexisting with fatty tissue. We discuss the origin, pathophysiology and clinical manifestations of this new kind of mixed pulmonary embolism.
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Affiliation(s)
| | | | - Alex A Paredes-Julca
- School of Medicine, Universidad Nacional de Trujillo, Trujillo, Peru.,Department of Thanatology, Unidad Médico Legal II, La Libertad, Peru
| | - Angélica T Vásquez-Montoya
- School of Medicine, Universidad Nacional de Trujillo, Trujillo, Peru.,Department of Pathology, Unidad Médico Legal II, La Libertad, Peru
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Montrief T, Bornstein K, Ramzy M, Koyfman A, Long BJ. Plastic Surgery Complications: A Review for Emergency Clinicians. West J Emerg Med 2020; 21:179-189. [PMID: 33207164 PMCID: PMC7673892 DOI: 10.5811/westjem.2020.6.46415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/11/2020] [Indexed: 12/04/2022] Open
Abstract
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.
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Affiliation(s)
- Tim Montrief
- University of Miami Miller School of Medicine, Department of Emergency Medicine, Miami, Florida
| | - Kasha Bornstein
- University of Miami Miller School of Medicine, Miami, Florida
| | - Mark Ramzy
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, Dallas, Texas
| | - Brit J Long
- Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
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Plastome Phylogenomic and Biogeographical Study on Thuja (Cupressaceae). BIOMED RESEARCH INTERNATIONAL 2020; 2020:8426287. [PMID: 32685531 PMCID: PMC7335403 DOI: 10.1155/2020/8426287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/29/2020] [Indexed: 11/29/2022]
Abstract
Investigating the biogeographical disjunction of East Asian and North American flora is key to understanding the formation and dynamics of biodiversity in the Northern Hemisphere. The small Cupressaceae genus Thuja, comprising five species, exhibits a typical disjunct distribution in East Asia and North America. Owing to obscure relationships, the biogeographical history of the genus remains controversial. Here, complete plastomes were employed to investigate the plastome evolution, phylogenetic relationships, and biogeographic history of Thuja. All plastomes of Thuja share the same gene content arranged in the same order. The loss of an IR was evident in all Thuja plastomes, and the B-arrangement as previously recognized was detected. Phylogenomic analyses resolved two sister pairs, T. standishii-T. koraiensis and T. occidentalis-T. sutchuenensis, with T. plicata sister to T. occidentalis-T. sutchuenensis. Molecular dating and biogeographic results suggest the diversification of Thuja occurred in the Middle Miocene, and the ancestral area of extant species was located in northern East Asia. Incorporating the fossil record, we inferred that Thuja likely originated from the high-latitude areas of North America in the Paleocene with a second diversification center in northern East Asia. The current geographical distribution of Thuja was likely shaped by dispersal events attributed to the Bering Land Bridge in the Miocene and subsequent vicariance events accompanying climate cooling. The potential effect of extinction may have profound influence on the biogeographical history of Thuja.
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10
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Chong K, Sun CK, Miao Y, Hu ZQ. Overcoming the Achilles' heel of orthostatic hypotension during interactive standing liposculpture. J Cosmet Dermatol 2020; 19:3000-3006. [PMID: 32159282 DOI: 10.1111/jocd.13336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 02/03/2020] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Kinman Chong
- Department of Plastic and Anesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, China.,City Idol Aesthetic Clinic, Kaohsiung City, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yong Miao
- Department of Plastic and Anesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, China
| | - Zhi-Qi Hu
- Department of Plastic and Anesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, China
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11
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Garcia O. Commentary on: The Potential Role of Corticosteroid Prophylaxis for the Prevention of Microscopic Fat Embolism Syndrome in Gluteal Augmentations. Aesthet Surg J 2020; 40:90-92. [PMID: 31400760 DOI: 10.1093/asj/sjz196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Onelio Garcia
- Division of Plastic Surgery, University of Miami, Miller School of Medicine, Miami, FL
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12
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Safran T, Abi-Rafeh J, Alhalabi B, Davison PG. The Potential Role of Corticosteroid Prophylaxis for the Prevention of Microscopic Fat Embolism Syndrome in Gluteal Augmentations. Aesthet Surg J 2020; 40:78-89. [PMID: 31152663 DOI: 10.1093/asj/sjz166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Microscopic fat embolism syndrome (micro-FES) has been recently identified as a potentially fatal complication following gluteal augmentation utilizing autologous fat grafts; safety recommendations advocating for subcutaneous lipo-injections may be insufficient for its prevention. OBJECTIVES The authors of this systematic review evaluated the potential role of corticosteroid prophylaxis for the prevention of micro-FES in gluteal augmentation procedures. METHODS The authors performed a systematic search employing the National Library of Medicine (PubMed), Medline, and Embase databases. Search terms were those pertaining to studies reporting the efficacy of prophylactic corticosteroid administration on micro-FES incidence in a high-risk surrogate population. RESULTS Thirteen articles met the inclusion criteria for review, comprising 2 studies reporting on the efficacy of a single intravenous (IV) corticosteroid dose for the prophylaxis of micro-FES, 9 studies reporting on multiple prophylactic IV doses, and 2 additional studies reporting on the efficacy of inhaled corticosteroids in this context. All studies were identified from the orthopedic literature given that none were available directly from within plastic surgery. The prophylactic efficacy of multiple IV doses of methylprednisolone, or a single larger dose, was established, whereas the efficacy of inhaled corticosteroids remains elusive. CONCLUSIONS A single perioperative IV dose of methylprednisolone may be most appropriate for utilization by plastic surgeons; the safety and implication of this therapy on wound healing and fat graft survival are discussed. Further studies directly evaluating the efficacy of corticosteroid prophylaxis in the gluteal augmentation population are indicated. Finally, recommendations pertaining to the prevention, timely recognition, and effective management of micro-FES are discussed.
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Affiliation(s)
- Tyler Safran
- Department of Surgery, Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | | | - Becher Alhalabi
- Department of Surgery, Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Peter G Davison
- Department of Surgery, Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada
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13
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Liposuction fat emboli resulting in myocardial infarction: a case report and review of the literature. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-019-01514-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Understanding Fatal Fat Embolism in Gluteal Lipoinjection: A Review of the Medical Records and Autopsy Reports of 16 Patients. Plast Reconstr Surg 2019; 142:1198-1208. [PMID: 30102664 DOI: 10.1097/prs.0000000000004904] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Deaths secondary to gluteal lipoinjection are relatively recent events of major importance. However, little is known in relation to their behavior and clinical evolution. Therefore, an analysis was performed of case records from clinical cases that encountered this problem, correlating the results with the findings during autopsies. METHODS An analysis was performed of records from patients who died secondary to gluteal lipoinjection. Patient-specific data, surgical procedure, clinical picture, evolution, and outcome were analyzed. The findings of the autopsies and the involvement of other organs were also analyzed and correlated. RESULTS From 2000 to 2009, 16 files were obtained that fulfilled the indicated requirements. There were no statistically significant differences in the general characteristics of the patients, such as age, body mass index, or volume lipoinjected or liposuctioned. The clinical pictures were similar in all cases, and the autopsy findings showed the presence of microembolism in all cases and macroembolism in the most severe cases. CONCLUSIONS The most significant parameter of severity in patients who undergo gluteal lipoinjection is the presence of fat in macroscopic form in the circulation. The volumes of liposuctioned or lipoinjected fat have little influence. Hypoxemia, hypotension, and bradycardia are the characteristic clinical features. Although there is no specific treatment, immediate aggressive vital support to attempt to stabilize the patient is crucial. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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15
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Wollina U, Heinig B. Treatment of lipedema by low‐volume micro‐cannular liposuction in tumescent anesthesia: Results in 111 patients. Dermatol Ther 2019; 32:e12820. [DOI: 10.1111/dth.12820] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 11/24/2018] [Accepted: 01/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Uwe Wollina
- Department of Dermatology and AllergologyStädtisches Klinikum Dresden Dresden Germany
| | - Birgit Heinig
- Center of Physical and Rehabilitative MedicineStädtisches Klinikum Dresden Dresden Germany
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Abstract
BACKGROUND The frequency of fat embolism mortality after liposuction has increased. As the only dependable evidence for this problem is that available in the medical literature, a study of clinical case reports is warranted. METHODS The authors reviewed the medical literature by searching for case reports of fat embolism after liposuction in humans who manifested either of the variants of the condition: microscopic fat embolism or macroscopic fat embolism. The authors performed a literature search of the PubMed and PubMed Central databases from the first case of fat embolism syndrome associated with liposuction reported until March of 2017; keywords Fat Embolism (Fat Embolism Syndrome), Liposuction, and Case (((fat embolism) AND liposuction) AND case) were used. A detailed analysis of the data contained in the clinical case reports was conducted. RESULTS In total, 39 and 98 articles were found in PubMed and PubMed Central, respectively, using the keywords (((Fat + Embolism) + AND + Liposuction) + AND + Case). After analysis, only 15 reports corresponded to cases of macroscopic or microscopic fat embolism after liposuction, and the basic statistics of the two proposed variants were examined. CONCLUSIONS This work provides relevant information regarding very important characteristics of microscopic and macroscopic fat embolism. Despite the diagnostic difficulty, clinical diagnosis remains the gold standard for identifying microscopic and macroscopic fat embolism. The establishment of a rapid and timely diagnosis is of great help for appropriate treatment.
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Alvarez-Alvarez FA, González-Gutiérrez HO, Ploneda-Valencia CF. Safe Gluteal Fat Graft Avoiding a Vascular or Nervous Injury: An Anatomical Study in Cadavers. Aesthet Surg J 2019; 39:174-184. [PMID: 30247585 DOI: 10.1093/asj/sjy237] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Fat grafting for gluteal augmentation is one of the most popular aesthetic surgery procedures. It has an associated mortality to fat embolism of 0.2%. Objectives The authors of this study sought to describe which technique for synthetic graft application was least likely to cause a fat embolism. Methods Ten fresh bodies were obtained and 4 groups arranged with 5 buttocks each randomly assigned. Group 1 was infiltrated through the upper medial intergluteal sulcus (upper medial intergluteal sulcus) with an angulation of -30°, -10°, and 0°. Group 2 was infiltrated through the middle lower gluteal sulcus with an angulation of -30°, 0°, and +15°. Group 3 was infiltrated through a peritrochanteric (PT) access at the level of the femur head at 0° and +10° and in the middle of the buttock at the level of the posterior superior iliac crest at -30° toward the trochanter (lateral direction). Group 4 was infiltrated in the same manner as group 1 without -30°. A complication occurred when the graft was in contact with the vascular or nervous bundle, within the gluteus medius muscle, or both. Results Group 1 had 3 buttocks with a complication (UMIGS -30°). Group 2 had complications in all the injection techniques. Group 3 had 5 buttocks with a complication (PT at 0°). Group 4 had no complications. Conclusions The injection of the fat graft through the UMIGS at 0° and 10° angles, and through the middle of the buttock at the level of posterior superior iliac crest a -30° angle, reaches the surface needed for gluteal augmentation. The group 2 techniques should be avoided because they have a high risk of complication.
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18
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Thamwiwat A, Sudhakar D, Paniagua D, Denktas AE. Suspected coronary fat embolism after liposuction. Catheter Cardiovasc Interv 2018; 92:E449-E452. [PMID: 29602277 DOI: 10.1002/ccd.27598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/06/2018] [Accepted: 02/23/2018] [Indexed: 11/10/2022]
Abstract
A 38-year-old female presented with chest pain and ST elevation on electrocardiogram after an outpatient liposuction procedure. Emergent coronary angiography revealed complete occlusion of multiple coronary arteries, with fat embolism as the suspected etiology. Attempts to restore distal coronary flow with balloon dilatation, aspiration with Pronto catheter, and distal adenosine administration resulted in minimal improvement in flow. The material aspirated was consistent with fat. With supportive therapy, including Impella CP support, the patient's clinical condition improved. To our knowledge, this is the first reported case of multiple coronary occlusion after liposuction.
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Affiliation(s)
- Alisa Thamwiwat
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Deepthi Sudhakar
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - David Paniagua
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas.,Department of Cardiology, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Ali E Denktas
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas.,Department of Cardiology, Michael E. DeBakey VA Medical Center, Houston, Texas
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Xiong L, Sun L, Liu S, Zhu X, Teng Z, Yan J. The Protective Roles of Urinary Trypsin Inhibitor in Brain Injury Following Fat Embolism Syndrome in a Rat Model. Cell Transplant 2018; 28:704-712. [PMID: 30449147 PMCID: PMC6686433 DOI: 10.1177/0963689718814766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Fat embolism syndrome (FES) is a common complication following long bone fracture; fat droplets are released into the blood circulation and form embolisms, mainly in lung and brain. However, the potential mechanisms involved remain to be clarified. In this study, the mechanism of brain injury following FES and the protective effects of urinary trypsin inhibitor (UTI)—a serine protease inhibitor—were investigated. Sixty male Sprague-Dawley rats were divided randomly into sham, FES and FES+UTI treatment groups. The FES model was established using tail vein injection of glycerol trioleate, and UTI was administered by intraperitoneal injection immediately following FES. Brain/lung water content evaluation, Evans blue content and magnetic resonance imaging examination were used to assess the effects of UTI. Furthermore, immunohistochemistry and western blot were also applied to explore the protective mechanism of UTI following FES. The results of oil red O staining indicated that the FES model was successfully established. UTI could significantly attenuate blood-brain-barrier (BBB) disruption, as seen through brain edema evaluation and Evans blue content examination. Immunofluorescence staining results indicated that the TLR4-JNK pathway was involved in brain injury after FES; this effect could be quenched by UTI treatment. Furthermore, UTI could decrease the levels of downstream target proteins of the TLR4-JNK pathway, phosphorylated-NF- κB (p65) and p53 in brain. Our results showed that UTI could alleviate BBB injury after FES through blocking activity of the TLR4-JNK pathway.
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Affiliation(s)
- Lili Xiong
- 1 West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China
| | - Linlin Sun
- 2 Department of Anatomy and Histology, School of Basic Medical Sciences, Peking University, Beijing, China.,3 Beijing Key Lab of Magnetic Resonance Imaging Technology, Beijing, China
| | - Shanshan Liu
- 2 Department of Anatomy and Histology, School of Basic Medical Sciences, Peking University, Beijing, China.,3 Beijing Key Lab of Magnetic Resonance Imaging Technology, Beijing, China
| | - Xingyun Zhu
- 2 Department of Anatomy and Histology, School of Basic Medical Sciences, Peking University, Beijing, China.,3 Beijing Key Lab of Magnetic Resonance Imaging Technology, Beijing, China
| | - Ze Teng
- 3 Beijing Key Lab of Magnetic Resonance Imaging Technology, Beijing, China
| | - Junhao Yan
- 2 Department of Anatomy and Histology, School of Basic Medical Sciences, Peking University, Beijing, China.,3 Beijing Key Lab of Magnetic Resonance Imaging Technology, Beijing, China
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Critical Differences between Microscopic (MIFE) and Macroscopic (MAFE) Fat Embolism during Liposuction and Gluteal Lipoinjection. Plast Reconstr Surg 2018; 141:880-890. [PMID: 29257003 DOI: 10.1097/prs.0000000000004219] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Liposuction and gluteal lipoinjection are two of the most frequent surgical procedures in body contouring surgery, and two of the most important complications are microscopic (MIFE) and macroscopic (MAFE) fat embolism. Despite a high index of morbidity and mortality, few reports exist about these complications, and although they have the same causal agent, their etiopathogenesis, clinical evolution, treatment, prognosis, and prevention are totally different. Therefore, the authors performed a comprehensive review of the literature to exhaustively analyze both pathologic conditions and present the differences between them. METHODS A detailed search was carried out in PubMed of studies on humans from 1946 to March of 2017 in any language and including the keywords microscopic fat embolism and macroscopic fat embolism with either liposuction or gluteal lipoinjection. The articles found were selected according to the search criteria and were analyzed to provide the final data and recommendations. RESULTS Of the 1245 and 26 articles that were found on complications related to liposuction and gluteal lipoinjection, respectively, only 41 on liposuction and microscopic fat embolism and seven on gluteal lipoinjection and microscopic fat embolism met the specific criteria for inclusion in the analysis. Only two articles on liposuction and two on gluteal lipoinjection referred to macroscopic fat embolism as a complication. CONCLUSION Although microscopic fat embolism and macroscopic fat embolism are pathologic conditions with high morbidity and mortality rates in association with liposuction and gluteal lipoinjection, few reports about them exist; therefore, the authors made recommendations based on this study for their diagnosis, prevention, and treatment.
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Cantu CA, Pavlisko EN. Liposuction-Induced Fat Embolism Syndrome: A Brief Review and Postmortem Diagnostic Approach. Arch Pathol Lab Med 2018; 142:871-875. [DOI: 10.5858/arpa.2017-0117-rs] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lipoplasty, or liposuction, the surgical process of removing excess fat, is an elective procedure with rising frequency in the United States. Fat embolism syndrome is a clinical diagnosis and is defined as fat in the circulation with an identifiable clinical pattern of signs and symptoms (eg, hypoxemia, respiratory insufficiency, neurologic impairment, and petechial rash) that occur in the appropriate clinical context. Fat embolism syndrome following liposuction is a life-threatening complication, although its incidence is low. Currently, there is no specific therapy for fat embolism syndrome, so prevention, early detection, and supportive therapy are critical. Many cases of fat embolism syndrome are undiagnosed or misdiagnosed; however, postmortem examination can provide the means for appropriate diagnosis. Therefore, a pathologist must keep a keen eye, as microscopic fat emboli are difficult to appreciate with routine tissue processing and staining.
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Affiliation(s)
| | - Elizabeth N. Pavlisko
- From the Department of Pathology, Duke University Health System, Durham, North Carolina
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Abstract
Gluteal augmentation is rapidly gaining in popularity and this is driving aesthetic surgeons to gain experience and develop techniques to meet patient expectations. Currently, the 2 main techniques - gluteal fat grafting and gluteal implant for augmentation have significant limitations. Autologous fat grafting seems to have a mortality rate significantly higher than other aesthetic procedures. Implant based gluteal augmentation is equally difficult. This is a broad review of all the complications associated with both types and autologous gluteal augmentation. Society and individual surgeons are developing guidelines for the procedure based on theoretic etiologies. Gluteal implant augmentation is also fraught with problems.
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Affiliation(s)
- Bivik Shah
- Private Practice, Columbus Institute of Plastic Surgery, Columbus, OH 43213, USA; Department of Plastic Surgery, Ohio State University, Columbus, OH 43215, USA.
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Correlation between the time elapsed after liposuction and the risk of fat embolism: An animal model. Arch Plast Surg 2017; 45:14-22. [PMID: 29076330 PMCID: PMC5784386 DOI: 10.5999/aps.2017.01347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/12/2017] [Accepted: 10/18/2017] [Indexed: 11/30/2022] Open
Abstract
Background Liposuction has become one of the most frequently performed procedures in the field of aesthetic surgery. Fat embolism syndrome after liposuction can easily be overlooked or underestimated; however, occasionally, fulminating fat embolism syndrome can develop and lead to a critical situation within 2–3 days after lipoplasty. Changes over time in the amount of circulating fat particles and the histology of major organs have not yet been studied. Methods This study was conducted using 18 male Sprague-Dawley rats aged 12 weeks and weighing 500–628 g (average, 562 g). Fifteen rats were used as the experimental group and 3 as the control group. Under general anesthesia, tumescent-technique liposuction was performed at the lateral flank areas and abdomen for 1 hour. Blood, lung, and brain tissue specimens were obtained at 1 hour, 1 day, and 2 days after the liposuction procedure. Results The average number of fat particles in the blood samples was 25,960/dL at 1 hour, 111,100/dL at 24 hours, and 21,780/dL at 48 hours. The differences between study groups were statistically significant. Both intravascular and extravascular fat particles with inflammation were seen in all 15 rats, as were inflammatory cell infiltration, hemorrhage, and consolidation with shrinkage of the lung alveoli. Conclusions These results imply that there is a strong possibility of fat embolism syndrome after liposuction in real clinical practice, and the first 24–48 hours after the operation were found to be the most important period for preventing pulmonary embolism and progression to fulminating fat embolism syndrome.
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Cárdenas-Camarena L, Andrés Gerardo LP, Durán H, Bayter-Marin JE. Strategies for Reducing Fatal Complications in Liposuction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1539. [PMID: 29184746 PMCID: PMC5682182 DOI: 10.1097/gox.0000000000001539] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 08/29/2017] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Lázaro Cárdenas-Camarena
- From the INNOVARE, Specialized Plastic Surgery, Division of Plastic Surgery at the Jalisco Institute of Reconstructive Surgery “Dr. José Guerrerosantos,” Zapopan, Jalisco, México; Private Practice, Monterrey, México; Private Practice, Mérida, Yuc, México; and Private Practice, Medical Director of Clínica “EL Pinar” in Bucaramanga, Colombia
| | - Lozano-Peña Andrés Gerardo
- From the INNOVARE, Specialized Plastic Surgery, Division of Plastic Surgery at the Jalisco Institute of Reconstructive Surgery “Dr. José Guerrerosantos,” Zapopan, Jalisco, México; Private Practice, Monterrey, México; Private Practice, Mérida, Yuc, México; and Private Practice, Medical Director of Clínica “EL Pinar” in Bucaramanga, Colombia
| | - Héctor Durán
- From the INNOVARE, Specialized Plastic Surgery, Division of Plastic Surgery at the Jalisco Institute of Reconstructive Surgery “Dr. José Guerrerosantos,” Zapopan, Jalisco, México; Private Practice, Monterrey, México; Private Practice, Mérida, Yuc, México; and Private Practice, Medical Director of Clínica “EL Pinar” in Bucaramanga, Colombia
| | - Jorge Enrique Bayter-Marin
- From the INNOVARE, Specialized Plastic Surgery, Division of Plastic Surgery at the Jalisco Institute of Reconstructive Surgery “Dr. José Guerrerosantos,” Zapopan, Jalisco, México; Private Practice, Monterrey, México; Private Practice, Mérida, Yuc, México; and Private Practice, Medical Director of Clínica “EL Pinar” in Bucaramanga, Colombia
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Ali A, Theobald G, Arshad MA. Fat attacks!: a case of fat embolisation syndrome postliposuction. BMJ Case Rep 2017; 2017:bcr-2017-220789. [PMID: 28947428 DOI: 10.1136/bcr-2017-220789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Liposuction is a procedure commonly performed in the UK usually with a low incidence of serious sequelae; however with larger patients and increased volumes of lipoaspirate, complications have been reported more frequently. One of the rare but very serious complications postliposuction is fat embolism syndrome (FES), a life-threatening condition difficult to diagnose and limited in treatment.The authors present the case of a 45-year-old woman who was admitted to the intensive care unit postelective liposuction for bilateral leg lipoedema. She presented with the triad of respiratory failure, cerebral dysfunction and petechial rash requiring a brief period of organ support. This case highlights that with the recent increase in liposuction procedures worldwide, FES is a differential to always consider. Although still a rare condition this article emphasises the importance of thinking outside the box and how to identify and manage such a life-threatening complication.
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Affiliation(s)
- Adam Ali
- Sandwell and West Birmingham Hospitals NHS Trust, Intensive Care Unit, Birmingham, UK
| | - George Theobald
- Sandwell and West Birmingham Hospitals NHS Trust, Intensive Care Unit, Birmingham, UK
| | - Mohammed Asif Arshad
- Sandwell and West Birmingham Hospitals NHS Trust, Intensive Care Unit, Birmingham, UK
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Zilg B, Råsten-Almqvist P. Fatal Fat Embolism After Penis Enlargement by Autologous Fat Transfer: A Case Report and Review of the Literature. J Forensic Sci 2017; 62:1383-1385. [DOI: 10.1111/1556-4029.13403] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/08/2016] [Accepted: 11/09/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Brita Zilg
- Swedish National Board of Forensic Medicine; Retzius väg 5 SE-171 65 Stockholm Sweden
| | - Petra Råsten-Almqvist
- Swedish National Board of Forensic Medicine; Retzius väg 5 SE-171 65 Stockholm Sweden
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Mofid MM, Teitelbaum S, Suissa D, Ramirez-Montañana A, Astarita DC, Mendieta C, Singer R. Report on Mortality from Gluteal Fat Grafting: Recommendations from the ASERF Task Force. Aesthet Surg J 2017; 37:796-806. [PMID: 28369293 PMCID: PMC5846701 DOI: 10.1093/asj/sjx004] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Gluteal fat grafting is among the fastest growing aesthetic procedures in the United States and around the world. Given numerous anecdotal and published reports of fatal and nonfatal pulmonary fat embolism resulting from this procedure, the Aesthetic Surgery Education and Research Foundation (ASERF) formed a Task Force to study this complication. Objectives To determine the incidence of fatal and nonfatal pulmonary fat embolism associated with gluteal fat grafting and provide recommendations to decrease the risks of the procedure. Methods An anonymous web-based survey was sent to 4843 plastic surgeons worldwide. Additional data on morbidity and mortality was collected through confidential interviews with plastic surgeons and medical examiners, public records requests for autopsy reports in the United States, and through the American Association for the Accreditation of Ambulatory Surgical Facilities (AAAASF). Results Six hundred and ninety-two (692) surgeons responding to the survey reported 198,857 cases of gluteal fat grafting. Over their careers, surgeons reported 32 fatalities from pulmonary fat emboli as well as 103 nonfatal pulmonary fat emboli. Three percent (3%) of respondents experienced a patient fatality and 7% of respondents reported at least one pulmonary fat embolism in a patient over their careers. Surgeons reporting the practice of injecting into the deep muscle experienced a significantly increased incidence rate of fatal and nonfatal pulmonary fat emboli. Twenty-five fatalities were confirmed in the United States over the last 5 years through of autopsy reports and interviews with surgeons and medical examiners. Four deaths were reported from 2014 to 2015 from pulmonary fat emboli in AAAASF facilities. Conclusions Despite the growing popularity of gluteal fat grafting, significantly higher mortality rates appear to be associated with gluteal fat grafting than with any other aesthetic surgical procedure. Based on this survey, fat injections into the deep muscle, using cannulae smaller than 4 mm, and pointing the injection cannula downwards should be avoided. More research is necessary to increase the safety of this procedure.
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Affiliation(s)
- M Mark Mofid
- Dr Mofid is an Associate Clinical Professor of Plastic Surgery (Voluntary), University of California, San Diego (UCSD), San Diego, CA; and is Chairman of the ASERF Gluteal Fat Grafting Task Force. Dr Teitelbaum is an Associate Clinical Professor (Voluntary), David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA; and is President of ASERF. Dr Suissa is a plastic surgeon in private practice in Los Angeles, CA. Dr Ramirez-Montañana is a plastic surgeon in private practice in Monterey, Mexico. Dr Astarita is a Surgical Consultant, Department of Medical Examiner-Coroner, County of Los Angeles, CA. Dr Mendieta is a plastic surgeon in private practice in Miami, FL. Dr Singer is a Clinical Professor of Plastic Surgery (Voluntary), UCSD, San Diego, CA; and is a Past President of ASERF
- Corresponding Author: Dr M. Mark Mofid, University of California San Diego, Department of Surgery, 4150 Regents Park Row Suite 300, La Jolla, CA 92037, USA. E-mail:
| | - Steven Teitelbaum
- Dr Mofid is an Associate Clinical Professor of Plastic Surgery (Voluntary), University of California, San Diego (UCSD), San Diego, CA; and is Chairman of the ASERF Gluteal Fat Grafting Task Force. Dr Teitelbaum is an Associate Clinical Professor (Voluntary), David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA; and is President of ASERF. Dr Suissa is a plastic surgeon in private practice in Los Angeles, CA. Dr Ramirez-Montañana is a plastic surgeon in private practice in Monterey, Mexico. Dr Astarita is a Surgical Consultant, Department of Medical Examiner-Coroner, County of Los Angeles, CA. Dr Mendieta is a plastic surgeon in private practice in Miami, FL. Dr Singer is a Clinical Professor of Plastic Surgery (Voluntary), UCSD, San Diego, CA; and is a Past President of ASERF
| | - Daniel Suissa
- Dr Mofid is an Associate Clinical Professor of Plastic Surgery (Voluntary), University of California, San Diego (UCSD), San Diego, CA; and is Chairman of the ASERF Gluteal Fat Grafting Task Force. Dr Teitelbaum is an Associate Clinical Professor (Voluntary), David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA; and is President of ASERF. Dr Suissa is a plastic surgeon in private practice in Los Angeles, CA. Dr Ramirez-Montañana is a plastic surgeon in private practice in Monterey, Mexico. Dr Astarita is a Surgical Consultant, Department of Medical Examiner-Coroner, County of Los Angeles, CA. Dr Mendieta is a plastic surgeon in private practice in Miami, FL. Dr Singer is a Clinical Professor of Plastic Surgery (Voluntary), UCSD, San Diego, CA; and is a Past President of ASERF
| | - Arturo Ramirez-Montañana
- Dr Mofid is an Associate Clinical Professor of Plastic Surgery (Voluntary), University of California, San Diego (UCSD), San Diego, CA; and is Chairman of the ASERF Gluteal Fat Grafting Task Force. Dr Teitelbaum is an Associate Clinical Professor (Voluntary), David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA; and is President of ASERF. Dr Suissa is a plastic surgeon in private practice in Los Angeles, CA. Dr Ramirez-Montañana is a plastic surgeon in private practice in Monterey, Mexico. Dr Astarita is a Surgical Consultant, Department of Medical Examiner-Coroner, County of Los Angeles, CA. Dr Mendieta is a plastic surgeon in private practice in Miami, FL. Dr Singer is a Clinical Professor of Plastic Surgery (Voluntary), UCSD, San Diego, CA; and is a Past President of ASERF
| | - Denis C Astarita
- Dr Mofid is an Associate Clinical Professor of Plastic Surgery (Voluntary), University of California, San Diego (UCSD), San Diego, CA; and is Chairman of the ASERF Gluteal Fat Grafting Task Force. Dr Teitelbaum is an Associate Clinical Professor (Voluntary), David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA; and is President of ASERF. Dr Suissa is a plastic surgeon in private practice in Los Angeles, CA. Dr Ramirez-Montañana is a plastic surgeon in private practice in Monterey, Mexico. Dr Astarita is a Surgical Consultant, Department of Medical Examiner-Coroner, County of Los Angeles, CA. Dr Mendieta is a plastic surgeon in private practice in Miami, FL. Dr Singer is a Clinical Professor of Plastic Surgery (Voluntary), UCSD, San Diego, CA; and is a Past President of ASERF
| | - Constantino Mendieta
- Dr Mofid is an Associate Clinical Professor of Plastic Surgery (Voluntary), University of California, San Diego (UCSD), San Diego, CA; and is Chairman of the ASERF Gluteal Fat Grafting Task Force. Dr Teitelbaum is an Associate Clinical Professor (Voluntary), David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA; and is President of ASERF. Dr Suissa is a plastic surgeon in private practice in Los Angeles, CA. Dr Ramirez-Montañana is a plastic surgeon in private practice in Monterey, Mexico. Dr Astarita is a Surgical Consultant, Department of Medical Examiner-Coroner, County of Los Angeles, CA. Dr Mendieta is a plastic surgeon in private practice in Miami, FL. Dr Singer is a Clinical Professor of Plastic Surgery (Voluntary), UCSD, San Diego, CA; and is a Past President of ASERF
| | - Robert Singer
- Dr Mofid is an Associate Clinical Professor of Plastic Surgery (Voluntary), University of California, San Diego (UCSD), San Diego, CA; and is Chairman of the ASERF Gluteal Fat Grafting Task Force. Dr Teitelbaum is an Associate Clinical Professor (Voluntary), David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA; and is President of ASERF. Dr Suissa is a plastic surgeon in private practice in Los Angeles, CA. Dr Ramirez-Montañana is a plastic surgeon in private practice in Monterey, Mexico. Dr Astarita is a Surgical Consultant, Department of Medical Examiner-Coroner, County of Los Angeles, CA. Dr Mendieta is a plastic surgeon in private practice in Miami, FL. Dr Singer is a Clinical Professor of Plastic Surgery (Voluntary), UCSD, San Diego, CA; and is a Past President of ASERF
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Ramos-Gallardo G, Orozco-Rentería D, Medina-Zamora P, Mota-Fonseca E, García-Benavides L, Cuenca-Pardo J, Contreras-Bulnes L, Ambriz-Plasencia AR, Curiel-Beltran JA. Prevention of Fat Embolism in Fat Injection for Gluteal Augmentation, Anatomic Study in Fresh Cadavers. J INVEST SURG 2017; 31:292-297. [PMID: 28485991 DOI: 10.1080/08941939.2017.1321703] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Liposuction is a popular surgical procedure. As in any surgery, there are risks and complications, especially when combined with fat injection. Case reports of fat embolism have described a possible explanation as the puncture and tear of gluteal vessels during the procedure, especially when a deep injection is planned. METHODS A total of 10 dissections were performed in five fresh cadavers. Each buttocks was divided into four quadrants. We focused on the location where the gluteal vessels enter the muscle and the diameter of the vessels. Colorant at two different angles was injected (30° and 45°). We evaluated the relation of the colorant with the main vessels. RESULTS We found two perforators per quadrant. The thickness of the gluteal muscle was 2.84 ± 1.54 cm. The area under the muscle where the superior gluteal vessels traverse the muscle was located 6.4 ± 1.54 cm from the intergluteal crease and 5.8 ± 1.13 cm from the superior border of the muscle. The inferior gluteal vessels were located 8.3 ± 1.39 cm from the intergluteal crease and 10 ± 2.24 cm from the superior border of the muscle. When we compared the fat injected at a 30° angle, the colorant stayed in the muscle. Using a 45° angle, the colorant was in contact with the superior gluteal artery and the sciatic nerve. No puncture or tear was observed in the vessels or the nerve. CONCLUSIONS The location where the vessels come in contact with the muscle, which can be considered for fat injection, were located in quadrants 1 and 3. A 30° angle allows for an injection into the muscle without passing into deeper structures, unlike a 45° injection angle.
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Affiliation(s)
- Guillermo Ramos-Gallardo
- a University of Guadalajara, Centro Universitario de la Costa , Puerto Vallarta , Jalisco , México
| | - David Orozco-Rentería
- b Antiguo Hospital Civil de Guadalajara, Fray Antonio Alcalde , Puerto Vallarta , Jalisco , México
| | - Pablo Medina-Zamora
- b Antiguo Hospital Civil de Guadalajara, Fray Antonio Alcalde , Puerto Vallarta , Jalisco , México
| | - Eduardo Mota-Fonseca
- c Instituto Jalisciense de Ciencias Forenses , Puerto Vallarta , Jalisco , México
| | - Leonel García-Benavides
- b Antiguo Hospital Civil de Guadalajara, Fray Antonio Alcalde , Puerto Vallarta , Jalisco , México
| | - Jesus Cuenca-Pardo
- d Asociación Mexicana de Cirugía, Plástica, Estética y Reconstructiva , Puerto Vallarta , Jalisco , México
| | - Livia Contreras-Bulnes
- d Asociación Mexicana de Cirugía, Plástica, Estética y Reconstructiva , Puerto Vallarta , Jalisco , México
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Stump B, Weinhouse G. Fat Embolism Syndrome: Fact or Myth? CURRENT TRAUMA REPORTS 2016. [DOI: 10.1007/s40719-016-0042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sato HK, Kowacs PA, Dalmau J, Santos PSF. Fat embolism showing restriction on diffusion sequence in brain magnetic resonance imaging. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:597-8. [PMID: 27224310 DOI: 10.1590/0004-282x20160052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 03/01/2016] [Indexed: 11/22/2022]
Affiliation(s)
- Henry Koiti Sato
- Instituto de Neurologia de Curitiba, Departamento de Neurologia, Curitiba PR, Brasil
| | - Pedro André Kowacs
- Instituto de Neurologia de Curitiba, Departamento de Neurologia, Curitiba PR, Brasil
| | - Josep Dalmau
- Universitat de Barcelona, Institut D'Investigacions Biomédiques August Pi I Sunyer, Hospital Clínic, Barcelona, Spain
| | - Paulo Sergio Faro Santos
- Universitat de Barcelona, Institut D'Investigacions Biomédiques August Pi I Sunyer, Hospital Clínic, Barcelona, Spain
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Abstract
Background: Liposuction is the commonest aesthetic procedure performed by Indian plastic surgeons. However, there exists substantial disparity amongst Indian surgeons about guidelines concerning liposuction. To address this disparity, a nationwide email survey (Association of Plastic Surgeons of India [APSI] database) was started in December 2013 and continued for 5 months. Material and Methods: The survey was developed with software from www.fluidsurveys.com. The study was designed to cover most aspects of patient selection, perioperative management, technical considerations, postoperative management and complications. This is the first survey to be conducted in India for an extremely popular procedure. It is also one of the most exhaustive surveys that have been conducted in terms of the topics covered. Results and Conclusions: One hundred and eighteen surgeons (including a majority of the cosmetic surgery stalwarts in the country) completed the survey. As expected, the results show a disparity in most parameters but also consolidation on some issues. Liposuction is considered extremely safe (86.1%). The majority of surgeons (70.3%) aspirated >5 L at onetime. The majority (80.2%) felt that the limits for liposuction should be relative and not absolute. The survey highlights lack of standardization with respect to infiltration solutions. The commonest complications observed were contour irregularities, followed by seroma and inadequate skin redrape. The amount of aspirate is the only factor, which achieves statistical significance with respect to major complications. A review of the current evidence and recommendations has been incorporated, along with an in depth analysis of the survey.
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Affiliation(s)
- Bijoy Methil
- Department of Plastic Surgery Jaslok Hospital, Saifee Hospitals, Sir HN Hospitals Mumbai, Maharashtra, India
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Abstract
Fat embolism syndrome (FES) is a rare but potentially fatal postoperative complication from liposuction. We present the case of a 24-year-old woman with Klippel-Trenaunay syndrome who developed FES as a complication of lower extremity liposuction. There may be an increased risk of FES in patients with vascular malformations undergoing liposuction.
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Abstract
BACKGROUND Intramuscular gluteal lipoinjection has become one of the most commonly used surgical procedures for achieving improvement in the gluteal contour; however, there are few studies that report and analyze the causes of secondary death from this surgical procedure. METHODS An analysis of secondary deaths from gluteal lipoinjection procedures was performed in Mexico and Colombia over periods of 10 and 15 years, respectively. In Mexico, the study was performed through a survey of all members of the Mexican Association of Reconstructive, Plastic and Aesthetic Surgery. In Colombia, the study was performed through an analysis of deaths and autopsies documented by the National Institute of Legal Medicine and Forensic Sciences Regional Bogotá. RESULTS A total of 413 Mexican plastic surgeons reported 64 deaths related to liposuction, with 13 deaths caused by gluteal lipoinjection. In Colombia, nine deaths were documented. Of the 13 deaths in Mexico, eight (61.6 percent) occurred during lipoinjection, whereas the remaining five (38.4 percent) occurred within the first 24 hours. In Colombia, six deaths (77.7 percent) occurred during surgery and three occurred (22.2 percent) immediately after surgery. In the Colombian autopsy results, seven cases of macroscopic fat embolism and two cases with a microscopic embolism were reported, with abundant fatty tissue in the infiltrated gluteal muscles. CONCLUSIONS In this study, the authors found that intramuscular gluteal lipoinjection is associated with mortality caused by gluteal blood vessel damage allowing macroscopic and microscopic fat embolism; therefore, buttocks lipoinjection should be performed very carefully, avoiding injections into deep muscle planes. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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Inflammatory responses to neutral fat and fatty acids in multiple organs in a rat model of fat embolism syndrome. Forensic Sci Int 2015. [PMID: 26218407 DOI: 10.1016/j.forsciint.2015.07.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fat embolism syndrome (FES) is a common complication of long bone fractures. FES is rare but with significant morbidity and occasional fatalities. Studies of animal models of FES are numerous; however, few studies compare inflammatory reactions in multiple organs. The present study investigated the effect of neutral fat and fatty acids, which cause changes in multiple organs and induce FES. Using rats we evaluated the ratio of lung-to-body weight and conducted histological analyses and quantitative analysis of inflammatory cytokine mRNAs in the lungs following intravenous administration of neutral fat or fatty acids. Neutral fat increased the ratio of lung-to-body weight, and neutral fat formed emboli in lung capillaries. The levels of interleukin-1 beta (IL-1β), IL-6 and tumor necrosis factor-alpha (TNF-α) in the lungs increased after injection of neutral fat and oleic acid. Analysis of the histologic changes revealed that the highest numbers of fat droplets, occluding the capillaries of the lungs, kidney, heart, and brain formed 12h after the injection of neutral fat and fat droplets gradually diminished 48h later. Fat droplets were not detected in any organs after the injection of oleic acid. IL-1β and TNF-α levels in the lungs were elevated 9-24h after the injection of neutral fat, although IL-6 levels peaked at 6h. After injection of oleic acid, peak levels of IL-1β, IL-6, and TNF-α were detected at 6h, and IL-6 again increased in all organs and plasma at 15h. Neutral fat, but not fatty acids, formed emboli in the capillaries of multiple organs. These findings suggest that neutral fat increased inflammatory cytokine levels by forming emboli in organ capillaries, particularly in the lungs, while oleic acid augmented inflammatory cytokine levels by stimulating endothelial cells of multiple organs.
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Moravvej H, Akbari Z, Mohammadian S, Razzaghi Z. Focused Ultrasound Lipolysis in the Treatment of Abdominal Cellulite: An Open-Label Study. J Lasers Med Sci 2015; 6:102-5. [PMID: 26464776 DOI: 10.15171/jlms.2015.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Despite a growing popularity of noninvasive ultrasonic lipolysis procedure, there is a lack of evidence about the efficacy of this method. This study was performed to evaluate the efficacy of focused ultrasonic lipolysis on abdominal cellulite treatment. METHODS Twenty-eight consecutive subjects (age: 37.8 ± 8 years) underwent weekly transdermal focused ultrasonic lipolysis (Med Contour, General Project Ltd., Florence, Italy) and vacuum drainage for a maximum of eight sessions. Largest abdominal girth and 2 lines at 4 cm to 7 cm distance above and under it were located as fixed points of measurements. The mean value of the three fixed lines was considered as the abdominal circumference. Subjects were evaluated using measurements of circumference, immediately after and 3 weeks after the final treatment and compared using paired t test. RESULTS One hundred ninety-four ultrasonic lipolysis procedures were performed on 28 subjects. A statistically significant (P < .001) average of 1.89 cm (95% CI: 1.63-2.02 cm) decrease of circumference value was observed in each session of ultrasonic lipolysis. The mean pretreatment to posttreatment circumference reduction was 8.21 cm (95% CI: 6.38-10.04, P < .001) that declined to 7 cm (95% CI: 3.2-10.8, P < .001) at the 3-month follow-up visit. CONCLUSION Focused ultrasonic lipolysis appears to be an effective method for reduction of abdominal cellulite, although some amount of circumference reduction reversal may be observed in long term follow-up visit.
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Affiliation(s)
- Hamideh Moravvej
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran ; Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Akbari
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahrzad Mohammadian
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Razzaghi
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Perforation of viscera, a dramatic complication of liposuction: a review of 19 cases evaluated by experts in France between 2000 and 2012. Plast Reconstr Surg 2015; 135:743-750. [PMID: 25719693 DOI: 10.1097/prs.0000000000001030] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Perforation of one or several intraperitoneal organs during a liposuction procedure is an exceptional but underestimated complication. Knowledge of this complication is essential because of frequent delay in diagnosis and possible dramatic consequences. METHODS Nineteen cases were evaluated by experts and are presented in a retrospective analysis. Sixteen women and three men, aged 24 to 72 years, were operated on in France between July of 2001 and January of 2012. Abdominal liposuction (200 to 2400 ml) was performed in combination or not with an abdominoplasty. RESULTS Uncommon pain and an intestinal obstruction were present in all of the patients. The peritonitis was never frank, replaced frequently by infraclinic peritonitis with septic and/or hypovolemic shock. Diagnosis, performed by abdominal scan between days 1 and 7, revealed intraperitoneal gas or liquid. Perforation, unique or multiple, because of the intraperitoneal passage of the cannula, often in the umbilical region and promoted by the presence of a hernia, involved the following organs: ileum (14 cases), jejunum (two cases), spleen (two cases), transverse colon (one case), cecum (one case), and sigmoid (one case). Death occurred in three cases, between days 2 and 11. Eleven patients had temporary ileostomy or colostomy. Associated complications were abdominal wall cellulitis, necrotizing fasciitis, thrombophlebitis, lung collection, and late subobstructive syndrome. CONCLUSIONS Visceral perforation during liposuction, a severe and sometimes fatal complication with late and difficult diagnosis, is not often reported. Careful technique, particularly if an umbilical approach is used, should avoid this dramatic complication. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Vongpaisarnsin K, Tansrisawad N, Hoonwijit U, Jongsakul T. Pseudomonas aeruginosa septicemia causes death following liposuction with allogenic fat transfer and gluteal augmentation. Int J Legal Med 2014; 129:815-8. [PMID: 25107297 DOI: 10.1007/s00414-014-1056-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 07/30/2014] [Indexed: 11/26/2022]
Abstract
Cosmetic surgery to improve aesthetic and body conditions is becoming increasingly popular worldwide. In 2013, the American Society of Plastic Surgeons (ASPS) reported that one of the top five cosmetic procedures in the US is liposuction with over 200,000 procedures per year. This type of surgery is regarded as a minimal risk operation. Since surgical complications are not often reported, liposuction is usually performed in outpatient clinics. Fatality after cosmetic liposuction surgery is also relatively rare. This case report presents a death following cosmetic liposuction with allogenic fat transfer and gluteal augmentation. The medico-legal autopsy, pathology, and postmortem microbiology examinations reveal that septicemia by Pseudomonas aeruginosa was the definite cause of death. Surgical risk assessment and pathogenesis of the organism was reviewed.
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What are the limits of the surgeon's responsibility in the operating theater? Aesthetic Plast Surg 2014; 38:830-1. [PMID: 24879041 DOI: 10.1007/s00266-014-0331-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 04/19/2014] [Indexed: 10/25/2022]
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Transposition of intravascular lipid in experimentally induced fat embolism: a preliminary study. Arch Plast Surg 2014; 41:325-9. [PMID: 25075352 PMCID: PMC4113689 DOI: 10.5999/aps.2014.41.4.325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Liposuction is a procedure to reduce the volume of subcutaneous fat by physical force. Intracellular storage fat is composed of triglyceride, whereas circulating fat particles exist as cholesterol or triglycerol bound to carrier proteins. It is unavoidable that the storage form of fat particles enters the circulation system after these particles are physiologically destroyed. To date, however, no studies have clarified the fatal characteristics of fat embolism that occurs after the subclinical phase of free fat particles. METHODS A mixture of human lipoaspirate and normal saline (1:100, 0.2 mL) was injected into the external jugular vein of rats, weighing 200 g on average. Biopsy specimens of the lung and kidney were examined at 12-hour intervals until postoperative 72 hours. The deposit location and transport of the injected free fat particles were confirmed histologically by an Oil Red O stain. RESULTS Inconsistent with previous reports, free fat particles were transported from the intravascular space to the parenchyma. At 24 hours after infusion, free fat particles deposited in the vascular lumen were confirmed on the Oil Red O stain. At 72 hours after infusion, free fat particles were accumulated compactly within the parenchymal space near the perivascular area. CONCLUSIONS Many surgeons are aware of the fatal results and undiscovered pathophysiologic mechanisms of free fat particles. Our results indicate that free fat particles, the storage form of fat that has been degraded through a physiological process, might be removed through a direct transport mechanism and phagocytotic uptake.
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Abstract
Liposuction is one of the most popular cosmetic surgery procedures currently performed by plastic surgeons around the world. It must be clear at the outset that liposuction is not primarily a modality for weight loss, it is meant to be a body contouring procedure and therefore the inherent limitations and safety issues related to this must always be respected if complications and unfavourable results are to be avoided as far as possible.
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Affiliation(s)
- Varun V Dixit
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hinduja Healthcare Surgical and Dr. LH Hiranandani Hospital, Mumbai, Maharashtra, India
| | - Milind S Wagh
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hinduja Healthcare Surgical and Dr. LH Hiranandani Hospital, Mumbai, Maharashtra, India
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Ely SF. The Forensic Implications of Liposuction: A Review. Acad Forensic Pathol 2013. [DOI: 10.23907/2013.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Liposuction continues to be one of the most popular cosmetic procedures in developed cultures worldwide. Since a 1999 report describing five liposuction-related deaths in New York City, three of which were incompletely explained, abundant analysis and literature has emerged. This paper aims to present the history of liposuction, review recent clinical safety/guidelines and forensic fatality literature, describe current and emerging trends and techniques, and offer an approach to the forensic investigation of these deaths.
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Affiliation(s)
- Susan F. Ely
- Office of Chief Medical Examiner of the City of New York New York University School of Medicine
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Felzemburgh VA, Barbosa RCDN, Nunes VLC, Campos JHO. Fat embolism in liposuction and intramuscular grafts in rabbits. Acta Cir Bras 2012; 27:289-93. [PMID: 22666740 DOI: 10.1590/s0102-86502012000500002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 03/19/2012] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the effects of fat embolism in organs such as lung and liver. METHODS Twenty rabbits underwent autologous intramuscular fat grafting in the right thigh after liposuction. The groups were determined according to the postoperative day that occurred in euthanasia: 60, 90 and 120 day. Then, lung and liver were excised and sent to the histopathology laboratory for analysis in search of late injury secondary to a prior event of fat embolism in the tissues. RESULTS The results showed a change in the macroscopic sample with discoloration of the liver tissue heterogeneously. There were no changes consistent with embolic effect under the microscope. CONCLUSION The option of performing a technique of fat grafting with a less traumatic surgical procedure can be considered protective against embolic events, with no impact to late embolic events on the tissues.
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Byard RW. The complex spectrum of forensic issues arising from obesity. Forensic Sci Med Pathol 2012; 8:402-13. [DOI: 10.1007/s12024-012-9322-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2012] [Indexed: 12/28/2022]
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Abstract
Liposuction is one of the most commonly performed procedures in aesthetic surgery. The primary aim is body contouring and not weight reduction. The vast amount of available methods for suctioning subcutaneous fat allows an optimal individual treatment plan, keeping in mind the correct indications. Although liposuction is often offered as a minor and harmless surgery, it is a complex procedure. A thorough training of the surgeon and in-depth knowledge about possible complications is essential. In addition to aesthetic indications liposuction is also a valuable tool in reconstructive surgery. For optimal patient selection the skin elasticity has to be considered during the preoperative assessment. Besides pure volume reduction through liposuction, the regenerative possibilities of adipose tissue are of great interest for basic research and clinical applications. Lipofilling or autologous fat transfer is used for a wide variety of aesthetic and reconstructive procedures. Of special interest is the regenerative and reconstructive potential of adipose-derived stem cells (ADSC).
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Affiliation(s)
- N Pallua
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Universitätsklinikum der RWTH Aachen, Deutschland.
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Abstract
Liposuction is considered to be one of the most frequently performed plastic surgery procedures in the United States, yet despite the popularity of liposuction, there is relatively little scientific evidence available on patient safety issues. This practice advisory provides an overview of various techniques, practices, and management strategies that pertain to individuals undergoing liposuction, and recommendations are offered for each issue to ensure and enhance patient safety.
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Coronado-Malagón M, Visoso-Palacios P, Arce-Salinas CA. Fat embolism syndrome secondary to injection of large amounts of soft tissue filler in the gluteal area. Aesthet Surg J 2010; 30:448-50. [PMID: 20601576 DOI: 10.1177/1090820x10373381] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
There are no reports in the literature of an association between soft tissue filler (STF) injection and fat embolism syndrome (FES). The authors present the case of a 26-year-old woman who was injected in the gluteal area with approximately 200 cc of STF on each side for aesthetic purposes. After this procedure, she presented with the triad of hypoxemia, neurological impairment, and petechiae consistent with the diagnosis of FES. After advanced support measures, she recovered completely. This article reviews the presence of FES after a cosmetic procedure with STF.
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Affiliation(s)
- Martín Coronado-Malagón
- Division of Internal Medicine, Hospital Central Sur de Alta Especialidad (HCSAE) de PEMEX, Andador Analco #17, Colonia Isidro Fabela, Mexico City, Mexico.
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McIff TE, Poisner AM, Herndon B, Lankachandra K, Schutt S, Haileselassie B, Patel S, Quinn T, Adler F, Molteni A. Fat embolism: evolution of histopathological changes in the rat lung. J Orthop Res 2010; 28:191-7. [PMID: 19688870 DOI: 10.1002/jor.20963] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The pathophysiology of Fat Embolism Syndrome (FES) is poorly understood and subject to some controversy. Evaluation of the evolution of histological changes in the lungs of patients with FES is impractical. The current theories of FES were established through acute clinical observations and acute animal experiments, but sequential changes in the histology of lungs over a prolonged period have not been made. The progressive effects of fat embolization of the lungs were examined in a rat model over a period of 11 days. Triolein, a major bone marrow fat, was administered to conscious Sprague-Dawley rats via the caudal vein. Rats were euthanized at 24, 48, 96 h, and 11 days, but some died within a few hours. Histomorphometric evaluations of lung tissue were made, including stains for fat, collagen, and smooth muscle actin. Arterial and arteriolar patency decreased progressively up to 96 h, but returned toward normal after 11 days. A striking finding was the very early presence of inflammation and fibrosis after only several hours, persisting up to 11 days. The results of this study provide evidence of both very early and prolonged changes due to fat embolization.
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Affiliation(s)
- Terence E McIff
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas 66160, USA.
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