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Bentaleb M, Abdulrahman M, Ribeiro-Junior MAF. Fat embolism: the hidden murder for trauma patients! Rev Col Bras Cir 2024; 51:e20243690. [PMID: 38716918 PMCID: PMC11185067 DOI: 10.1590/0100-6991e-20243690-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/08/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION fat embolism syndrome (FES) is an acute respiratory disorder that occurs when an inflammatory response causes the embolization of fat and marrow particles into the bloodstream. The exact incidence of FES is not well defined due to the difficulty of diagnosis. FES is mostly associated with isolated long bone trauma, and it is usually misdiagnosed in other trauma cases. The scope of this study was to identify and search the current literature for cases of FES in nonorthopedic trauma patients with the aim of defining the etiology, incidence, and main clinical manifestations. METHODS we perform a literature search via the PubMed journal to find, summarize, and incorporate reports of fat embolisms in patients presenting with non-orthopedic trauma. RESULTS the final literature search yielded 23 papers of patients presenting with fat embolism/FES due to non-orthopedic trauma. The presentation and etiology of these fat embolisms is varied and complex, differing from patient to patient. In this review, we highlight the importance of maintaining a clinical suspicion of FES within the trauma and critical care community. CONCLUSION to help trauma surgeons and clinicians identify FES cases in trauma patients who do not present with long bone fracture, we also present the main clinical signs of FES as well as the possible treatment and prevention options.
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Affiliation(s)
- Malak Bentaleb
- - College of Medicine and Health Sciences, Khalifa University, Department of Surgery - Abu Dhabi - Abu Dhabi - Emirados Árabes Unidos
| | - Mohammed Abdulrahman
- - College of Medicine and Health Sciences, Khalifa University, Department of Surgery - Abu Dhabi - Abu Dhabi - Emirados Árabes Unidos
| | - Marcelo Augusto Fontenelle Ribeiro-Junior
- - College of Medicine and Health Sciences, Khalifa University, Department of Surgery - Abu Dhabi - Abu Dhabi - Emirados Árabes Unidos
- - Sheikh Shakhbout Medical City, Division of Trauma, Critical Care and Acute Care Surgery - Department of Surgery - Abu Dhabi - Abu Dhabi - Emirados Árabes Unidos
- - PUC-Sorocaba, Disciplina de Cirurgia Geral e do Trauma - Sorocaba - SP - Brasil
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Kelishadi SS, Chiemi JA, Chowdhry S, Colorado A, Herring NR, Kinney B, Wilhelmi BJ. Accurate Plane Fat Grafting in Gluteal Augmentation: An Anatomic Study. Aesthet Surg J 2024; 44:311-316. [PMID: 37707558 DOI: 10.1093/asj/sjad298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND The safety of gluteal fat grafting is a global concern in plastic surgery. OBJECTIVE The goal of this study was to test whether fat grafting to the buttocks with Auto Stop Reach (ASR) technology prevents penetration from the subcutaneous space into the fascia and muscle layers of the buttocks. METHODS Fat transfer simulation was performed with blue dye on 8 fresh tissue cadaver buttocks by 3 board-certified plastic surgeons (S.S.K., S.C., B.W.). An open control was utilized to visualize the process in the different anatomic layers, and all of the other procedures were performed blindly, akin to live surgery. After blue dye transfer reached maximum capacity (ranging from 400-800 mL per buttock), dissection of the anatomical layers of the buttocks was performed to determine the plane(s) of injection. RESULTS Blue dye fat transfer injection to the buttocks did not penetrate the gluteal fascia or muscle layers from the subcutaneous space while using ASR. CONCLUSIONS Auto Stop Reach technology supports the safety of gluteal fat transfer in the subcutaneous space by board-certified plastic surgeons. LEVEL OF EVIDENCE: 4
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3
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Ghavami A, Halani SH, Amirlak B. The Hybrid Technique for Autologous Gluteal Augmentation. Aesthet Surg J Open Forum 2023; 5:ojad042. [PMID: 37700791 PMCID: PMC10494780 DOI: 10.1093/asjof/ojad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
This article accompanying these videos will describe the technique created and innovated by the senior author for gluteal augmentation with autologous fat transfer. While the principles of gluteal fat grafting originated with Pitanguy, Regnault, Gonazalez, and Spina, the nuances vary greatly from surgeon to surgeon. Although there is much controversy regarding gluteal fat grafting, the major principle of avoiding intramuscular injection is the central pillar of safe and effective augmentation today. The senior author fine-tuned his method to optimize patient outcomes over the past 14 years and demonstrated lasting, aesthetic results while maximizing patient safety with his technique. More recently, the senior surgeon has developed the Hybrid Technique, involving manual injection of fat through a syringe and a power-assisted cannula to maximize aesthetic outcomes while adhering to safety principles. This method follows the deep and moderate depth subcutaneous injection principle while respecting the muscular, neurovascular, and ligamentous anatomy of the buttock. Level of Evidence 4
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Affiliation(s)
| | | | - Bardia Amirlak
- Corresponding Author: Dr Bardia Amirlak, UT Southwestern Department of Plastic Surgery, Dallas, TX 75390, USA. E-mail: ; Instagram: @dramirlak
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Kao YM, Chen KT, Lee KC, Hsu CC, Chien YC. Pulmonary Fat Embolism Following Liposuction and Fat Grafting: A Review of Published Cases. Healthcare (Basel) 2023; 11:healthcare11101391. [PMID: 37239677 DOI: 10.3390/healthcare11101391] [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: 03/06/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND One of the most severe complications of liposuction and fat grafting is pulmonary fat embolism (PFE). However, most healthcare workers are not familiar with PFE. We performed a systematic review to describe the details of PFE. METHODS PubMed, EMBASE, and Google Scholar were searched up to October 2022. Further analysis focused on clinical, diagnostic, and outcome parameters. RESULTS A total of 40 patients from 19 countries were included. Chest computed tomography (CT) yielded 100% accuracy in the diagnosis of PFE. More than 90% of the deceased died within 5 days after surgery, and in 69% of patients, onset of symptoms occurred within 24 h after surgery. The proportions of patients who required mechanical ventilation, had a cardiac arrest event, or died among all patients and among those whose onset of symptoms occurred within 24 h after surgery were 76%, 38%, and 34% versus 86%, 56%, and 54%, respectively. CONCLUSIONS The earlier the onset of symptoms was, the more severe the clinical course was. Once a patient presents with PFE-related symptoms, surgery should be halted, supportive care initiated, and chest CT used to diagnose PFE. According to our review results, if a patient with PFE survives the initial episode without permanent sequelae, a complete recovery can be anticipated.
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Affiliation(s)
- Yu-Ming Kao
- Division of General Surgery, Department of Surgery, Chi-Mei Medical Center, Tainan 71004, Taiwan
| | - Kuo-Tai Chen
- Emergency Department, Chi-Mei Medical Center, Tainan 71004, Taiwan
| | - Kuo-Chang Lee
- Emergency Department, Chi-Mei Medical Center Chiali Branch, Tainan 71004, Taiwan
| | - Chien-Chin Hsu
- Emergency Department, Chi-Mei Medical Center, Tainan 71004, Taiwan
- Department of Biotechnology, Southern Tainan University of Technology, Tainan 71005, Taiwan
| | - Yeh-Cheng Chien
- Emergency Department, Chi-Mei Medical Center, Tainan 71004, Taiwan
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5
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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: 8] [Impact Index Per Article: 8.0] [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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Sirbu O, Sorodoc V, Floria M, Statescu C, Sascau R, Lionte C, Petris OR, Haliga RE, Morariu PC, Tirnoveanu A, Burduloi VM, Ursulescu C, Sorodoc L. Nontrombotic Pulmonary Embolism: Different Etiology, Same Significant Consequences. J Pers Med 2023; 13:jpm13020202. [PMID: 36836436 PMCID: PMC9963227 DOI: 10.3390/jpm13020202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
Nontrombotic pulmonary embolism represents the embolization of different types of materials (cells, organisms, gas, foreign material) into pulmonary circulation. The disease is uncommon, and clinical presentation together with laboratory findings are nonspecific. Its pathology is usually misdiagnosed based on imaging findings as pulmonary thromboembolism, but the correct diagnosis is essential because different therapeutic approaches are required. In this context, knowledge of the risk factors associated with nontrombotic pulmonary embolism and specific clinical symptoms is fundamental. Our objective was to discuss the specific features of the most common etiologies of nontrombotic pulmonary embolism, gas, fat, amniotic fluid, sepsis and tumors, to provide assistance for a rapid and correct diagnosis. Because the most common etiologies are iatrogenic, knowledge of the risk factors could be an important tool for prevention or rapid treatment if the disease develops during different procedures. The diagnosis of nontrombotic pulmonary embolisms represent a laborious challenge, and endeavors should be made to prevent development and increase awareness of this disease.
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Affiliation(s)
- Oana Sirbu
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Victorita Sorodoc
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
- Correspondence: (V.S.); (C.S.)
| | - Mariana Floria
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Cristian Statescu
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
- Department of Cardiology, Institute of Cardiovascular Diseases “Dr. George I.M. Georgescu”, 700503 Iasi, Romania
- Correspondence: (V.S.); (C.S.)
| | - Radu Sascau
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
- Department of Cardiology, Institute of Cardiovascular Diseases “Dr. George I.M. Georgescu”, 700503 Iasi, Romania
| | - Catalina Lionte
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Ovidiu Rusalim Petris
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Raluca Ecaterina Haliga
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Paula Cristina Morariu
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Andreea Tirnoveanu
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Vladut Mirel Burduloi
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Corina Ursulescu
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
- Department of Radiology, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
| | - Laurentiu Sorodoc
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
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Frojo G, Halani SH, Pessa JE, Pazmiño P, Wall S, Kenkel JM, Del Vecchio DA. Deep Subcutaneous Gluteal Fat Compartments: Anatomy and Clinical Implications. Aesthet Surg J 2023; 43:76-83. [PMID: 35977084 DOI: 10.1093/asj/sjac230] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Advances in gluteal fat grafting have resulted in diminished risks through improved understanding of regional anatomy and technical nuances. No anatomic studies identifying the presence or absence of buttock fat compartments have yet been reported. OBJECTIVES The aim of this cadaveric study was to identify and characterize the deep subcutaneous gluteal fat compartments to further understand the nuanced differences between deep and superficial subcutaneous fat layers. METHODS A cadaveric study was performed to identify the fat compartments. Latex injection into the iliac artery and vein was used to prepare 4 fresh (N = 8 hemibuttocks) hydrated cadavers for dissection. Preliminary work identified the likely position of deep gluteal fat compartments. The cannula was positioned under ultrasound guidance in between the superficial and deep gluteal layers. Cadaveric buttocks were infiltrated by the static technique with dyed human fat, dyed applesauce, and dyed saline in an attempt to identify the gluteal deep subcutaneous fat compartments. RESULTS Dissection identified and characterized 7 discrete deep gluteal fat compartments. These comprise 3 medial fat compartments (superior, middle, and inferior); a central fat compartment; and 3 lateral (superior, middle, and inferior) deep fat compartments. CONCLUSIONS Seven deep gluteal fat compartments have been identified that have distinct boundaries and maintain injected contents separate from each other above the gluteal muscle fascia. These compartments can be selectively expanded for buttock augmentation. Knowledge of these compartments enables surgeons to perform gluteal augmentation by static infiltration, injecting autologous fat under ultrasound guidance in the deep subcutaneous fat layer, while optimizing aesthetic considerations. RESUMEN
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8
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Qi M, Zhou H, Yi Q, Wang M, Tang Y. Pulmonary CT imaging findings in fat embolism syndrome: case series and literature review. Clin Med (Lond) 2023; 23:88-93. [PMID: 36697017 PMCID: PMC11046538 DOI: 10.7861/clinmed.2022-0428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Fat embolism syndrome (FES) is a rare life-threatening complication, which commonly affects the lung. Currently, the most widely accepted criteria for the diagnosis of FES are the Gurd and Wilson Criteria established nearly 40 years ago, but without pulmonary images involved. Our study aims to analyse the pulmonary computed tomography (CT) findings seen in FES. CASE PRESENTATION This report enrolled four cases of FES with lung involvement. The mainly symptoms and signs included dyspnea, disturbance of consciousness, anemia, thrombocytopenia and, most notably, ground-glass opacities, septal thickening, ill-defined centrilobular nodules, and patchy consolidation were demonstrated on bilateral lungs. Combining the clinical manifestations and laboratory tests, the diagnosis of FES was confirmed. With the treatment of steroids, anti-coagulation and supportive treatment, the four patients' symptoms were relieved, abnormalities in chest CT were absorbed significantly and the patients were finally discharged. CONCLUSIONS There are several common manifestations of FES in pulmonary CT images, and the lung parenchymal features give more information for the diagnosis of FES than the pulmonary vessel findings. Given the absence of a gold standard diagnostic test for FES, further investigation to explore new diagnostic criteria of FES involving pulmonary radiological features is needed in the future.
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Affiliation(s)
- Min Qi
- West China Hospital, Sichuan University, Chengdu, China
| | - Haixia Zhou
- West China Hospital, Sichuan University, Chengdu, China
| | - Qun Yi
- West China Hospital, Sichuan University, Chengdu, China
| | - Maoyun Wang
- West China Hospital, Sichuan University, Chengdu, China
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9
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Hsu PY, Wu EB. Anesthetic management for intraoperative acute pulmonary embolism during inferior vena cava tumor thrombus surgery: A case report. World J Clin Cases 2022; 10:5111-5118. [PMID: 35801013 PMCID: PMC9198887 DOI: 10.12998/wjcc.v10.i15.5111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/01/2022] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute pulmonary embolism (APE) is a rare and potentially life-threatening condition, even with early detection and prompt management. Intraoperative APE required specific ways for detecting since classic symptoms of APE in the awake patient could not be observed or self-reported by the patient under general anesthesia.
CASE SUMMARY A 44-year-old man with a history of hepatic cell carcinoma was admitted for radical nephrectomy and tumor thrombectomy due to a newly found kidney tumor with inferior vena cava (IVC) tumor thrombus. APE that occurred during tumor thrombectomy with hypercapnia and desaturation. The capnography combined with the transesophageal echocardiography (TEE) provided a crucial differential diagnosis during the operation. The patient was continuously managed with aggressive intravenous fluid resuscitation and blood transfusion under continuous cardiac output monitoring to maintain hemodynamic stability. He completed the surgery under stable hemodynamics and was extubated after percutaneous mechanical thrombectomy by a certified cardiologist. There were no significant symptoms and signs or obvious discomfort in the patient’s self-report during visits to the general ward.
CONCLUSION Under general anesthesia for IVC tumor thrombus surgery, a sudden decrease in end-tidal carbon dioxide is the initial indicator of APE, which occurs before hemodynamic changes. When intraoperative APE is suspected, TEE is useful in the diagnosis and monitoring before computer tomography pulmonary angiogram. Timely clinical impression and supportive treatment and intervention should be conducted to obtain a better prognosis.
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Affiliation(s)
- Pei-Yu Hsu
- Department of Anesthesiology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan
| | - En-Bo Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
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10
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Abstract
On January 31, 2018, The Multi-Society Task Force for Safety in Gluteal Fat Grafting released a Practice Advisory regarding gluteal fat grafting. The Task Force was assembled in the wake of several highly publicized patient deaths involving Brazilian Butt Lift ("BBL") and produced a second practice advisory in August 2019. In 2021 the ASAPS President commissioned a Working Group on BBL Patient Safety, charging the Group to address new guidelines affecting safety and welfare of BBL patients. The "Practice Advisory on Gluteal Fat Grafting" is the first advisory developed since the Working Group was formed. In addition to surgical technique as a major cause of fatal complications of BBL, the Working Group focused on micro-economic trends of operative time and regional BBL pricing and considered fatigue and distraction in formulating the current guidelines. In Florida the majority of BBL deaths occur at the end of the week. Such a non-normalized distribution most likely represents the result of fatigue and/or distraction, which has been linked to surgical mortality in multiple published communications. In addition, mortality is likely due to uncertainty or lack of documentation as to the correct plane of fat injection. Therefore, the newest and most compelling recommendations from these guidelines include the use of ultrasound-guided documentation of cannula placement prior to and during fat injection, and the limitation of 3 BBL cases as a maximum amount of total operative cases per day. The authors thank members of the Task Force for the insights they brought to this process.
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Affiliation(s)
| | - Jeffrey M Kenkel
- Betty and Warren Woodward Chair, Department of Plastic Surgery, University of Texas Southwestern Medical Center , Dallas, TX , USA
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11
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Wolfe EM, Weber LE, Wo LM, Samaha MJ, Mathew P, Garcia O, Singh D. Two Cases Surviving Macro Fat Emboli Complications Following Gluteal Fat Grafting. Aesthet Surg J 2022; 42:902-906. [PMID: 35311886 DOI: 10.1093/asj/sjac063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Media attention has in recent years created an increased patient demand for gluteal contouring and augmentation. Gluteal augmentation and contouring with autologous fat transfer, colloquially referred to as the “Brazilian butt lift” (BBL), can be performed safely and effectively, with an overall complication rate ranging from 1.5% to 6.8%. However, there have been an alarming number of lethal events from intravenous passage of injected fat and fatal pulmonary embolism due to macro-fat emboli (MAFE). MAFE (fat emboli >1 cm in diameter), distinct from micro-fat emboli, can quickly result in catastrophic cardiopulmonary compromise and death. Accurate mortality estimates are limited by difficulties in determining accurate values for the total number of BBL procedures performed because most of these cases are performed at budget clinics. Accurate morbidity estimates are limited by a lack of published outcomes and a low level of evidence in published studies. The first case of survival of MAFE secondary to BBL was reported in 2019 by Peña et al. Few highly morbid complications secondary to MAFE have been reported because such events are almost universally lethal. We present 2 recent cases of survival after MAFE in the setting of gluteal fat transfer following expedient transfer to a tertiary care setting, allowing for timely and successful intervention. We illustrate examples of how MAFE is a highly lethal complication of gluteal fat grafting. Early recognition and immediate aggressive vital support to stabilize the patient are key for survival.
Level of Evidence: 5
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Affiliation(s)
- Erin M Wolfe
- Dewitt Daughtry Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine , Miami, FL , USA
| | - Lee E Weber
- Dewitt Daughtry Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine , Miami, FL , USA
| | - Luccie M Wo
- Dewitt Daughtry Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine , Miami, FL , USA
| | - Mario J Samaha
- Dewitt Daughtry Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine , Miami, FL , USA
| | - Prakash Mathew
- Dewitt Daughtry Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine , Miami, FL , USA
| | - Onelio Garcia
- Dewitt Daughtry Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine , Miami, FL , USA
| | - Devinder Singh
- Dewitt Daughtry Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine , Miami, FL , USA
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Cheng Q, Zhu Y, Deng K, Qin Z, Zhang J, Zhang J, Huang P, Wan C. Label-Free Diagnosis of Pulmonary Fat Embolism Using Fourier Transform Infrared (FT-IR) Spectroscopic Imaging. APPLIED SPECTROSCOPY 2022; 76:352-360. [PMID: 35020546 DOI: 10.1177/00037028211061430] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The diagnosis of pulmonary fat embolism (PFE) is of great significance in the field of forensic medicine because it can be considered a major cause of death or a vital reaction. Conventional histological analysis of lung tissue specimens is a widely used method for PFE diagnosis. However, variable and labor-intensive tissue staining procedures impede the validity and informativeness of histological image analysis. To obtain complete information from tissues, a method based on infrared imaging of unlabeled tissue sections was developed to identify pulmonary fat emboli in the present study. We selected 15 PFE-positive lung samples and 15 PFE-negative samples from real cases. Oil red O (ORO) staining and infrared spectral imaging collection were both performed on all lung tissue samples. And the fatty tissue of the abdominal wall and the embolized lipid droplets in the lungs were taken for comparison. The results of the blind, evaluation by pathologists, showed good agreement between the infrared spectral imaging of the lung tissue and the standard histological stained images. Fourier transform infrared (FT-IR) spectroscopic imaging significantly simplifies the typical painstakingly laborious histological staining procedure. And we found a difference between lipid droplets embolized in abdominal wall fat and lung tissue.
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Affiliation(s)
- Qi Cheng
- Department of Forensic Medicine, 74628Guizhou Medical University, Guizhou, China
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, China
| | - Yongzheng Zhu
- School of Forensic Medicine, 74648Shanxi Medical University, Taiyuan, China
| | - Kaifei Deng
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, China
| | - Zhiqiang Qin
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, China
| | - Jianhua Zhang
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, China
| | - Ji Zhang
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, China
| | - Ping Huang
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, China
| | - Changwu Wan
- Department of Forensic Medicine, 74628Guizhou Medical University, Guizhou, China
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Che DH, Xiao ZB. Gluteal Augmentation with Fat Grafting: Literature Review. Aesthetic Plast Surg 2021; 45:1633-1641. [PMID: 33216176 DOI: 10.1007/s00266-020-02038-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/01/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The buttock is the second sex feature of the human body, and the graceful buttock curve gives people confidence. Although the safety of gluteal augmentation with autologous fat grafting is still controversial, the proportion of operations is increasing year by year. PURPOSE To provid a comprehensive and detailed review of the literature on gluteal augmentation with fat grafting. METHODS A comprehensive review of the published literature through September of 2020 was performed in PubMed database, with the search terms "gluteal augmentation," "buttock augmentation," "Brazilian buttock lift," "fat grafting," "fat transfer," "gluteal AND aesthetic," "gluteal AND anatomy." RESULTS A total of 64 articles were included. On the basis of the information obtained, surgical recommendations are proposed to achieve buttocks as close as possible to aesthetic standard and improve surgical safety. CONCLUSION With a good grasp of the anatomical structure of the buttocks, complications can be reduced. At the same time, based on the theoretical basis of buttock aesthetics, better postoperative results can be obtained. LEVEL OF EVIDENCE III 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)
- De-Hui Che
- Department of Plastic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
| | - Zhi-Bo Xiao
- Department of Plastic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China.
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14
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Venditto C, Gallagher M, Hettinger P, Havlik R, Zarb R, Argenta A, Doren E, Sanger J, Klement K, Dzwierzynski W, LoGiudice J, Jensen J. Complications of Cosmetic Surgery Tourism: Case Series and Cost Analysis. Aesthet Surg J 2021; 41:627-634. [PMID: 32291444 DOI: 10.1093/asj/sjaa092] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Cosmetic surgery tourism is increasing exponentially. Patients seek cosmetic procedures within the United States and abroad, lured by lower cost procedures, shorter waiting lists, and affordable airfare and hotel accommodations. Unfortunately, operations are often performed by non-board-certified plastic surgeons, sometimes not even by plastic surgeons. Preoperative counseling, frequently limited to a video-chat with an office secretary, provides inadequate discussion regarding potential complications. Postoperative care is careless and rarely involves the operating surgeon. Complications are frequent, with management falling into the hands of plastic surgeons unfamiliar with the patient's care. Furthermore, the physician, rather than the patient or hospital, faces the largest cost burden. OBJECTIVES The authors sought to explore their institution's experience treating complications of cosmetic tourism and investigate associated costs. METHODS The retrospective review of 16 patients treated for complications related to cosmetic surgery tourism plus cost analysis revealed a substantial discrepancy between money saved by undergoing surgery abroad and massive costs accrued to treat surgical complications. RESULTS The most common complication was infection, often requiring surgery or IV antibiotics on discharge. Mean cost per patient was $26,657.19, ranging from $392 (single outpatient visit) to $154,700.79 (prolonged admission and surgery). Overall, the hospital retained 63% of billed charges, while physicians retained only 9%. The greatest amount paid by any single patient was $2635.00 by a patient with private insurance. CONCLUSIONS Cosmetic tourism has severe medical repercussions for patients and complications that burden hospitals, physicians, and the US medical system. Physicians treating the complications suffer the greatest financial loss. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Chelsea Venditto
- Department of Plastic Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Margaret Gallagher
- Department of Plastic Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Patrick Hettinger
- Department of Plastic Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Robert Havlik
- Department of Plastic Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rakel Zarb
- Department of Plastic Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anne Argenta
- Department of Plastic Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Erin Doren
- Department of Plastic Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - James Sanger
- Department of Plastic Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kristen Klement
- Department of Plastic Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - William Dzwierzynski
- Department of Plastic Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - John LoGiudice
- Department of Plastic Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - John Jensen
- Department of Plastic Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA
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15
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Lari A, Abdulshakoor A, Zogheib E, Assaf N, Mojallal A, Lari AR, Bauer C, Sinna R. How to Save a Life From Macroscopic Fat Embolism: A Narrative Review of Treatment Options. Aesthet Surg J 2020; 40:1098-1107. [PMID: 31606739 DOI: 10.1093/asj/sjz277] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Macroscopic fat embolism (MAFE) has grabbed the attention of the plastic surgery community in recent years because of its high mortality rate. Many articles on preventing MAFE during gluteal fat grafting are available in the literature. However, total prevention is difficult: a number of factors, both technical and human, mean that MAFE remains a potential complication. This review was written with the main goal of providing a treatment plan. MAFE shares many similar pathophysiologic and hemodynamic features with massive thrombotic pulmonary embolism (PE), especially the associated cardiopulmonary decompensation. Lessons learned from PE management were used to devise a management algorithm for MAFE. The use of extracorporeal membrane oxygenation and its potential application as a main modality of treatment for MAFE was explored. The lack of evidence in the literature for the treatment of MAFE, and its high mortality, lent urgency to the need to write an article on the management aspect in the form of a narrative review, to ensure that every plastic surgeon practicing gluteal fat grafting is knowledgeable about the treatment aspect of this deadly complication.
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Affiliation(s)
- Aqeel Lari
- University Hospital of Amiens and University Hospital of Lyon, Lyon, France
- plastic and reconstructive surgeon in private practice in Hawally, Kuwait
| | - Abeer Abdulshakoor
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University Hospital of Amiens, Amiens, France
| | | | - Nizar Assaf
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University Hospital of Amiens, Amiens, France
| | | | - Abdul-Reda Lari
- plastic and reconstructive surgeon in private practice in Hawally, Kuwait
| | - Christian Bauer
- Croix Rousse Hospital, University Hospital of Lyon, Lyon, France
| | - Raphael Sinna
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University Hospital of Amiens, Amiens, France
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16
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Singer R. Commentary on: Improvement in Brazilian Butt Lift (BBL) Safety With the Current Recommendations From ASERF, ASAPS, and ISAPS. Aesthet Surg J 2020; 40:871-873. [PMID: 32556181 DOI: 10.1093/asj/sjaa090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Robert Singer
- The University of California, San Diego (UCSD), La Jolla, CA
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17
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Turin SY, Fracol M, Keller E, Markl M, Collins J, Krochmal D, Kim JYS. Gluteal Vein Anatomy: Location, Caliber, Impact of Patient Positioning, and Implications for Fat Grafting. Aesthet Surg J 2020; 40:642-649. [PMID: 31574144 DOI: 10.1093/asj/sjz260] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Deaths in gluteal autografting occur due to gluteal vein injuries, but data are lacking on the precise location and caliber of these veins. OBJECTIVES The authors sought to present the first in vivo study of gluteal vein anatomy utilizing magnetic resonance imaging. METHODS Magnetic resonance imaging venography of 16 volunteer hemi-sections was conducted in the supine, prone, prone with a bump (jack-knife), and left and right decubitus positions in 1 session after a single contrast administration. Caliber and course of the superior and inferior gluteal veins (SGV/IGV) were analyzed vs bony landmarks and position changes. RESULTS The SGV has a very short submuscular course before splitting into 2 smaller branches superolaterally. The IGV runs immediately deep to the gluteus maximus in the center of the buttock as a single large trunk, on average 56 mm deep (mean 27 mm of muscle belly and 30 mm subcutaneous fat). No intramuscular or subcutaneous branches greater than 2 mm were found. In the prone position, the IGV and SGV have an average caliber of 5.96 mm and 5.63 mm. Vessel caliber decreased by 21% and 27%, respectively, in the jack-knife position and by 14% and 15% in lateral decubitus. CONCLUSIONS The SGV and IGV are immediately deep to gluteus maximus approximately 6 cm deep with a caliber on the order of 6 mm in the prone position. The distribution of these vessels suggests there is no "safe zone" in the intramuscular or submuscular planes. The jackknife or lateral decubitus positions can decrease vein caliber by up to 27%, possibly reducing the risk of injury due to either traction or direct cannula impact.
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Affiliation(s)
- Sergey Y Turin
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Megan Fracol
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Eric Keller
- Department of Radiology, Stanford University, Stanford, CA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | - John Y S Kim
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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18
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O'Neill RC, Abu-Ghname A, Davis MJ, Chamata E, Rammos CK, Winocour SJ. The Role of Fat Grafting in Buttock Augmentation. Semin Plast Surg 2020; 34:38-46. [PMID: 32071578 PMCID: PMC7023974 DOI: 10.1055/s-0039-3401038] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Autologous fat grafting is now considered the gold standard for buttock augmentation. Although a variety of techniques are currently being used by surgeons around the world, methods of fat grafting to the buttocks remain unsystematized, poorly understood, and controversial in terms of their safety and efficacy. Nonetheless, buttock augmentation by fat grafting has a satisfaction rate of 97.1%, and its mean complication rate has been estimated to be around 7 to 10%, with serious complications occurring in less than 1% of cases. Fat emboli are one such serious complication, with several reports in the literature discussing morbidity and mortality, specifically with intramuscular injection. With the increasing popularity of fat grafting for buttock augmentation, it is more important than ever to continue researching and learning to safeguard the satisfaction and safety of our patients.
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Affiliation(s)
- Rebecca C. O'Neill
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Amjed Abu-Ghname
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Matthew J. Davis
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Edward Chamata
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Charalambos K. Rammos
- Division of Plastic Surgery, Department of Surgery, University of Illinois College of Medicine, Peoria, Illinois
| | - Sebastian J. Winocour
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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19
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Singer R. Commentary on: Macro Fat Embolism After Gluteal Augmentation With Fat: First Survival Case Report. Aesthet Surg J 2019; 39:NP384-NP386. [PMID: 31264679 DOI: 10.1093/asj/sjz171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Robert Singer
- Dr Singer is a (Voluntary) Professor of Plastic Surgery, The University of California, San Diego (UCSD), La Jolla, CA
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