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Tyle MR, Olafson A, Hiro ME, Payne WG. Clearing the Smoke: The Evidence behind Risk of Electrocautery Smoke and Mitigation Strategies. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6039. [PMID: 39139844 PMCID: PMC11321753 DOI: 10.1097/gox.0000000000006039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/10/2024] [Indexed: 08/15/2024]
Abstract
Background Electrocautery has been a useful, fundamental instrument utilized for surgical procedures since its implementation in the 1920s. However, concerns exist regarding the health hazards of the by-product smoke associated with the use of electrocautery. Methods A comprehensive review of articles on the composition, mitigation, and effects of smoke was conducted using the PubMed search engine and excluding articles that did not meet the predetermined inclusion criteria. From January 1963 to December 2021, a total of 264 articles resulted, and a total of 69 articles were included in this narrative review. Results Surgical smoke contains volatile organic compounds, polycyclic aromatic compounds, viral particles, and ultrafine particles. There has been some evidence of mutagenicity to bacterial cells during animal in vivo studies, and one human survey study has shown similar mutagenic effects. We also discuss additional hemostatic techniques that can be used, including the use of hemostatic and antithrombolytic agents, epinephrine infiltration, and the use of tourniquet when appropriate. Conclusions Further studies should be conducted regarding human effects, but until the data are available, we recommend precautionary measures and actions to protect operating room staff from cautery smoke exposure.
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Affiliation(s)
- Madison Rose Tyle
- From the Department of Plastic Surgery, University of South Florida College of Medicine, Tampa, Fla
| | - Amra Olafson
- From the Department of Plastic Surgery, University of South Florida College of Medicine, Tampa, Fla
| | - Matthew E. Hiro
- From the Department of Plastic Surgery, University of South Florida College of Medicine, Tampa, Fla
- Department of Plastic Surgery, Bay Pines VA Healthcare System, Plastic Surgery Section, Bay Pines, Fla
| | - Wyatt G. Payne
- From the Department of Plastic Surgery, University of South Florida College of Medicine, Tampa, Fla
- Department of Plastic Surgery, Bay Pines VA Healthcare System, Plastic Surgery Section, Bay Pines, Fla
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Tejada VFDS, Zhang L, Zogbi L. Efficacy and safety of topical application of tranexamic acid in patients undergoing reconstructive plastic surgery after excision of facial skin cancers: a randomised clinical trial. Rev Col Bras Cir 2024; 51:e20243761. [PMID: 39045920 DOI: 10.1590/0100-6991e-20243761-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/10/2024] [Indexed: 07/25/2024] Open
Abstract
INTRODUCTION Tranexamic acid (TA) has attracted increased attention among surgical specialties, but its use in plastic surgery is limited. The aim of this study was to assess the efficacy and safety of topical administration of 3% TA solution in reconstructive surgery of the face and scalp after excision of skin cancers. METHODS a randomized, double-blind, parallel-group clinical trial was conducted in patients aged 18 years or older with malignant skin neoplasms in the face or scalp region (ICD-10 C44.9). The primary outcome was volume of blood loss in the intraoperative and immediate postoperative period. Secondary outcomes included difficult-to-control intraoperative haemorrhage, hematoma, ecchymosis, and other adverse events. RESULTS of the 54 included patients, 26 were randomised to TA group and 28 to placebo group. The mean blood loss was 11.42ml (SD 6.40, range 8.83-14.01) in the TA group, and 17.6ml (SD 6.22, range 15.19-20.01) in the placebo group, representing a mean decrease of 6.18ml (35.11%) (p=0.001). TA significantly reduced the risk of ecchymosis (RR = 0.046; 95% CI: 0.007-0.323). Only two patients in the placebo group experienced ischemia in the flaps, and one patient in the placebo group experienced tissue necrosis requiring surgical reintervention. There were no surgical wound infections, thromboembolic phenomena, or other adverse events related to TA. CONCLUSIONS topical TA may reduce intraoperative and immediate postoperative bleeding, with a significantly decreased risk of ecchymosis. There is no evidence of ischemic damage of flaps, systemic thromboembolic complications, or other adverse events.
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Affiliation(s)
| | - Linjie Zhang
- - Universidade Federal do Rio Grande - Rio Grande - RS - Brasil
| | - Luciano Zogbi
- - Universidade Federal do Rio Grande - Rio Grande - RS - Brasil
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Reinhardt ME, Mutyala S, Gerald M, Zhao H, Nova V, Araya Cambronero S, Patel S, Baltodano PA. The Critical Blood-Sparing Effect of Tranexamic Acid (TXA) in Liposuction: A Systematic Review and Meta-Analysis. JPRAS Open 2024; 40:48-58. [PMID: 38425698 PMCID: PMC10904189 DOI: 10.1016/j.jpra.2023.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/18/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Tranexamic acid (TXA) has been used to improve bleeding outcomes in many surgical procedures. However, its blood-sparing effect in liposuction is not well established. Methods A systematic literature search was performed using PubMed, Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central, ClinicalTrials.gov, and WorldWideScience.org databases from their inception to October 8, 2021, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The authors focused on 3 main topics: 1) TXA, 2) liposuction, and 3) complications. We included articles evaluating the potential blood-sparing effects of TXA in liposuction. Studies were excluded if they were systematic review articles or protocol papers, animal studies, conference abstracts, survey studies, or non-English publications. Results A total of 711 articles were identified, with 1 retrospective and 4 prospective (3 randomized) studies meeting our inclusion criteria. TXA was used in various forms: administered intravenously either on induction or after the procedure, mixed into the tumescent solution, or infiltrated into the liposuction sites after lipoaspiration. A significantly smaller reduction in hematocrit was noted in the TXA group compared with that in the non-TXA group (p<0.001) despite a significantly greater amount of lipoaspirate removed in the TXA group (p<0.001). Patients in non-TXA cohorts experienced adverse effects (such as seroma and need for transfusion) that were not seen in TXA cohorts. Conclusion TXA use in patients undergoing liposuction seems to be associated with a beneficial blood-sparing effect, which may enhance safety in this population. Future studies should aim to determine the optimal route and dosing for TXA in liposuction. Evidence Based Medicine Level IV.
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Affiliation(s)
| | | | | | - Huaqing Zhao
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Vitalina Nova
- Temple University, Charles Library, Philadelphia, PA, USA
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Benito-Ruiz J, Fontbona M. Recommendations on How to Reduce Blood Loss in Plastic Surgery and Blood Transfusions. Aesthetic Plast Surg 2024; 48:2221-2223. [PMID: 38727845 DOI: 10.1007/s00266-024-04036-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Affiliation(s)
- Jesus Benito-Ruiz
- Patient Safety Committee, International Society of Aesthetic Plastic Surgery (ISAPS), Mount Royal, NJ, USA.
- Antiaging Group Barcelona, Barcelona, Spain.
| | - Montserrat Fontbona
- Patient Safety Committee, International Society of Aesthetic Plastic Surgery (ISAPS), Mount Royal, NJ, USA
- Hospital Militar de Santiago, Santiago, Chile
- Clinica Aurea, Santiago, Chile
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Meretsky CR, Polychronis A, Schiuma AT. Use of Intravenous Tranexamic Acid in Patients Undergoing Plastic Surgery: Implications and Recommendations per a Systematic Review and Meta-Analysis. Cureus 2024; 16:e62482. [PMID: 39015854 PMCID: PMC11251670 DOI: 10.7759/cureus.62482] [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] [Accepted: 06/16/2024] [Indexed: 07/18/2024] Open
Abstract
With increasing interest in aesthetic plastic procedures, the event of blood loss has compromised patients' safety and satisfaction. Tranexamic acid (TXA) is a drug used for the reduction of blood loss during surgical procedures. This systematic review aims to evaluate the clinical efficacy and safety of TXA in aesthetic plastic surgery for the reduction of bleeding and related complications. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Electronic databases PubMed, EMBASE, Cochrane Library, and Google Scholar were searched. The medical subject headings (MeSH) keywords used for data extraction were ("TXA," OR "tranexamic acid,") AND ("plastic surgery," OR "aesthetic surgery," OR "rhinoplasty," OR "blepharoplasty,") AND ("blood loss" OR "bleeding" OR "TBL") AND ("Edema" OR "ecchymosis"). A combination of these MeSH terms was used in the literature search. The timeline of research was set from 2015 to January 2024. A total of 7380 research articles were identified from the above-mentioned databases, and only 13 research articles met the inclusion criteria. There was a significant difference in total blood loss (TBL) among patients who had undergone plastic surgery procedures while on TXA as compared to a placebo (mean difference = -6.02; Cl: -1.07 to -0.16; p > 0.00001), and heterogeneity was found (degrees of freedom (df) = 9; I2 = 97%). Only two studies reported the average ecchymosis scores after TXA among interventions in comparison to the placebo group. This review provides evidence that TXA lowers TBL, ecchymosis, edema, and anemia during cosmetic surgery without significantly increasing thromboembolic consequences.
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Kandulu H. Evaluation of Blood Loss in Third-Generation Internal Ultrasound-Assisted Liposuction. Aesthetic Plast Surg 2024; 48:152-156. [PMID: 37758855 DOI: 10.1007/s00266-023-03633-3] [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: 06/19/2023] [Accepted: 08/20/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND In large-volume liposuction procedures, one of the most important limitations of total lipoaspirate volume is blood loss. In this study, we aimed to determine the amount of blood loss in individuals who underwent a third-generation internal ultrasound-assisted liposuction (UAL). METHODS Eleven female and eleven male participants with a mean age of 35.31 (range 20-47) were included in this prospective study. The third-generation internal UAL was performed on multiple anatomical regions using the VASER® Internal Ultrasound Device (Sound Surgical Technologies; Louisville, CO). The demographic characteristics of the participants, the amount of aspirate collected, and hemoglobin (Hgb) and hematocrit (Htc) values before and after the third-generation internal UAL were evaluated. RESULTS The mean third-generation internal UAL time was 74.81 ± 17.95 minutes, and the mean aspiration amount was 5,122.27 ± 1,597.43 ml. The aspirated amount was 6.64% ± 2.20 of body weight. The mean Hgb value was 13.87 ± 1.99 before the third-generation internal UAL and 11.26 ± 2.16 (g/dL) after the third-generation internal UAL (z = 4.108, p < 0.001). The mean reduction in Hgb levels with the third-generation internal UAL was 2.61 ± 1.73 and 0.53 ± 0.36 per liter of aspirate taken. The mean Htc value after the third-generation internal UAL was 33.91 ± 6.03 and was significantly lower than the mean Htc value before the third-generation internal UAL, 41.39 ± 5.13 (z = -3.946, p < 0.001). The mean reduction in Htc with the third-generation internal UAL was 7.48 ± 5.42, and the Htc value decreased by 1.50 ± 1.13 per liter of aspirate ingested. The amount of aspirated supernatant was responsible for 44.4% of the change in Hgb and 30.9% of the change in Htc after the third-generation internal UAL. CONCLUSION Knowing the reduction rates in Hgb and Htc with the third-generation internal UAL is useful to plan the amount of aspirate to be taken, the amount of blood loss that may occur with the third-generation internal UAL, and the postoperative care of the 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)
- Hüseyin Kandulu
- Huseyin Kandulu Clinic for Plastic Surgery, Terrace Fulya Teşvikiye Mah. Hakkı Yeten Cad.No.13 Center 1 Kat 11 D.59, Teşvikiye, Istanbul, Turkey.
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Wo LM, Garcia O. Ultrasound-Assisted Lipoplasty. Clin Plast Surg 2024; 51:13-28. [PMID: 37945069 DOI: 10.1016/j.cps.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
- Luccie M Wo
- Division of Plastic Surgery, University of Miami, Miller School of Medicine, 7190 SW 87th Avenue, Suite 407, Miami, FL 33173, USA
| | - Onelio Garcia
- Division of Plastic Surgery, University of Miami, Miller School of Medicine, 7190 SW 87th Avenue, Suite 407, Miami, FL 33173, USA.
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De La Cruz E. Lipoplasty in the Overweight Patient. Clin Plast Surg 2024; 51:29-43. [PMID: 37945074 DOI: 10.1016/j.cps.2023.06.010] [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: 11/12/2023]
Abstract
The practice of large volume liposuction, when executed by board-certified plastic surgeons using a variety of energy-assisted liposuction devices, has been substantiated as a secure procedure, yielding enhanced aesthetic results and minimal complications. Techniques including the superwet technique and ultrasonic-assisted liposuction are utilized to diminish blood loss, while also maintaining a keen awareness of the maximum volume of infiltration fluid permissible for safe infusion. Adherence to evidence-based protocols is of paramount importance to reduce the risk of postoperative complications. These protocols encompass hypothermia prevention, deep vein thrombosis (DVT) prophylaxis, and perioperative antibiotic prophylaxis. To ensure the highest quality of care, it is recommended that large volume liposuction procedures be performed in accredited hospitals or certified ambulatory surgery centers. Postoperative procedures should include overnight admission of patients to facilitate proper hemodynamic monitoring. While the employment of multiple devices such as VASERLipo and Renuvion has been noted to augment skin and soft tissue contraction, it is worth noting that there may be a heightened risk of seroma formation (at 2.27%) and subcutaneous emphysema (at 1.47%). Consequently, prudent use of these advanced medical devices is essential to avoid any potential adverse events.
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Lonie S, Abesamis GM, Law J, Mohaghegh MH, Vickery K, Deva A, Tavakoli K. Topical Tranexamic Acid in Primary Breast Augmentation Surgery: Short- and Long-term Outcomes. Aesthet Surg J 2023; 44:NP23-NP27. [PMID: 37427875 DOI: 10.1093/asj/sjad219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/03/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Breast augmentation mammaplasty (BAM) remains the most popular cosmetic procedure done worldwide. Bleeding in this procedure increases the chance of capsular contracture. Tranexamic acid (TXA), an antifibrinolytic, has been widely used by other surgical specialties to reduce bleeding. OBJECTIVES We aimed to evaluate the use of TXA in BAM surgery. METHODS This was a single-surgeon case series of all patients who underwent primary BAM from March 2017 to March 2018 and received topical TXA spray to the implant pocket before implant insertion. Early postoperative complications and long-term outcomes, such as capsular contracture and revisional surgery, were recorded and described. RESULTS Two hundred and eighty-eight patients were included in the study with an overall complication rate of 2.8% over 5 years. No patients had postoperative bleeding or hematoma formation. One patient had a seroma, managed with ultrasound drainage. Complications requiring reoperation included rippling (3, 1.0%), pocket revision (2, 0.7%), capsule contracture (1, 0.3%) and rupture (1, 0.3%). CONCLUSIONS This study highlights the safety and potential benefits of the use of topical TXA in breast augmentation, with low bleeding and capsular contracture rates. LEVEL OF EVIDENCE: 4
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Wolf Y, Skorochod R, Kwartin S, Shapira L. Tranexamic Acid Irrigation in Liposuction: A Double-Blind, Half-Body, Randomized, Placebo-Controlled Trial. Aesthetic Plast Surg 2023; 47:2525-2532. [PMID: 37488309 DOI: 10.1007/s00266-023-03499-5] [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: 05/06/2023] [Accepted: 06/30/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Hematomas are common complications following plastic and esthetic surgeries. Large and complex hematomas might result in prolonged hospitalization, further interventions, additional expenses, and poor esthetic outcome. Tranexamic acid (TXA), an antifibrinolytic agent, has long been used to reduce blood loss. Its use in the field of plastic surgery has gained popularity recently. Several studies have presented the ability of TXA to reduce blood loss, hematomas, and ecchymoses after liposuctions. However, the proper dose and the route of administration remained controversial. OBJECTIVE The objective of the study was to quantify the effect of a low dose of TXA in an irrigation method in reducing hematomas and ecchymoses following liposuction. METHODS A prospective randomized controlled trial was conducted. Following liposuction, 400 mg of TXA were administered in an irrigation protocol to one side of the body in each patient, while the other side was administered with saline. The patients were photographed on 1, 2, 4, and 11 post-operative days. Ecchymosis and hematoma were measured and rated. RESULTS No statistical difference was observed between the intervention and control groups in terms of RBC in liposuction area (p = 0.11), RBC in lipoaspirate (p = 0.79), bruising size on days 1, 2, 4, and 11 (p = 0.68, 0.21, 0.42, and 0.75), and average ecchymosis score on the same days (p = 0.34, 0.72, 0.09, and 1) CONCLUSIONS: The use of a low-dose TXA irrigation solution did not demonstrate a statistically significant difference in post-operative hematoma formations rates and subsequent ecchymosis size and scale. LEVEL OF EVIDENCE II 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)
- Yoram Wolf
- Plastic Surgery Unit, Hillel Yaffe Medical Center, P.O.B 169, 38100, Hadera, Israel.
| | - Ron Skorochod
- Plastic Surgery Unit, Hillel Yaffe Medical Center, P.O.B 169, 38100, Hadera, Israel
| | - Shmuel Kwartin
- Plastic Surgery Unit, Hillel Yaffe Medical Center, P.O.B 169, 38100, Hadera, Israel
| | - Liran Shapira
- Plastic Surgery Unit, Hillel Yaffe Medical Center, P.O.B 169, 38100, Hadera, Israel
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Wolf Y, Skorochod R, Shapira L. Letter to the Editor: "Tranexamic Acid Irrigation in Liposuction: A Double-Blind, Half-Body, Randomized, Placebo-Controlled Trial". Aesthetic Plast Surg 2023:10.1007/s00266-023-03720-5. [PMID: 37985506 DOI: 10.1007/s00266-023-03720-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 10/14/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Yoram Wolf
- Unit of plastic and reconstructive surgery, Hillel Yaffe Medical Center, Hadera, Israel.
| | - Ron Skorochod
- Unit of plastic and reconstructive surgery, Hillel Yaffe Medical Center, Hadera, Israel
| | - Liran Shapira
- Unit of plastic and reconstructive surgery, Hillel Yaffe Medical Center, Hadera, Israel
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Bayter-Marín JE, Hoyos A, Cárdenas-Camarena L, Peña-Pinzón W, Bayter-Torres AF, Díaz-Díaz CA, McCormick-Méndez M, Plata-Rueda EL, Niño-Carreño CS. Effectiveness of Tranexamic Acid in the Postoperative Period in Body Contour Surgery: Randomized Clinical Trial. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5403. [PMID: 38025645 PMCID: PMC10653580 DOI: 10.1097/gox.0000000000005403] [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: 08/10/2023] [Accepted: 09/26/2023] [Indexed: 12/01/2023]
Abstract
Background Tranexamic acid (TXA) is used to reduce bleeding in body contouring procedures; however, there are no studies that show the effectiveness of TXA when it is also used in the immediate postoperative period. Methods A controlled, randomized, parallel, and open-label clinical trial was carried out in adult patients undergoing liposculpture and/or abdominoplasty. A control group administering presurgical TXA and a study group with presurgical and postsurgical TXA were formed. The decrease in hemoglobin and the incidence of blood transfusions between both groups were compared as well as the possible adverse effects of TXA. Results Four hundred twenty-seven subjects were included, 208 (48.7%) in the control group and 219 (51.3%) in the study group. The median age was 34 years (interquartile range 28-42). Median postoperative hemoglobin levels at 24 hours were similar in both groups (study 11.3 g/dL versus control 11.1 g/dL, P = 0.07); however, at 72 hours, postoperative hemoglobin was higher in the study group versus control (10.8 versus 10.0 g/dL, P ≤ 0.001). The incidence of transfusions at 72 hours was 1.8% in the study group and 8.6% in the control group, for a risk ratio of 0.21 (95% confidence interval 0.07-0.61). There were no adverse or thromboembolic events. Conclusion TXA proved to be more effective in reducing intra- and postsurgical bleeding and the need for transfusions, when used preoperatively and continued for 48 hours after surgery, than when used only preoperatively, without reporting adverse or thromboembolic effects.
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Affiliation(s)
- Jorge Enrique Bayter-Marín
- From the Universidad Industrial de Santander
- Department of Reanimation Critical and Intensive Care, Universidad La Sabana, Bucaramanga, Colombia
- Clínica “EL Pinar” Bucaramanga, Colombia
| | | | | | - William Peña-Pinzón
- Department of Anesthesiology and Perioperative Medicine, Fundación Universitaria Sanitas, Bucaramanga, Colombia
| | | | | | | | - Erika Liliana Plata-Rueda
- Department of Anesthesiology and Perioperative Medicine, Universidad Industrial de Santander, Fundación Universitaria Sanitas, Bucaramanga, Colombia
| | - Claudia Stella Niño-Carreño
- Department of Anesthesiology and Perioperative Medicine, Fundación Universitaria Sanitas, Bucaramanga, Colombia
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Golpanian S, Rahal GA, Rahal WJ. Outpatient-Based High-Volume Liposuction: A Retrospective Review of 310 Consecutive Patients. Aesthet Surg J 2023; 43:1310-1324. [PMID: 37227017 DOI: 10.1093/asj/sjad164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Currently, the definition of large-volume liposuction is the removal of 5 L or more of total aspirate. Higher volumes of lipoaspirate come into consideration with higher BMIs, because more than 5 L is often required to achieve a satisfactory aesthetic result. The boundaries of what lipoaspirate volume is considered safe are based on historical opinion and are constantly in question. OBJECTIVES Because to date there have been no scientific data available to support a specific safe maximum volume of lipoaspirate, the authors discuss necessary conditions for safe high-volume lipoaspirate extraction. METHODS This retrospective study included 310 patients who had liposuction of ≥5 L over a 30-month period. All patients had 360° liposuction alone or in combination with other procedures. RESULTS Patient ages ranged from 20 to 66 with a mean age of 38.5 (SD = 9.3). Average operative time was 202 minutes (SD = 83.1). Mean total aspirate was 7.5 L (SD = 1.9). An average of 1.84 L (SD = 0.69) of intravenous fluids and 8.99 L (SD = 1.47) of tumescent fluid were administered. Urine output was maintained above 0.5 mL/kg/hr. There were no major cardiopulmonary complications or cases requiring blood transfusion. CONCLUSIONS High-volume liposuction is safe if proper preoperative, intraoperative, and postoperative protocols and techniques are employed. The authors believe that this bias should be modified and that sharing their experience with high-volume liposuction may help guide other surgeons to incorporate this practice with confidence and safety for better patient outcomes. LEVEL OF EVIDENCE: 3
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Isaev R, Frey E, Motamedi M, Allert S. [Role of Tranexamic Acid in Plastic Surgery: a Systematic Review]. HANDCHIR MIKROCHIR P 2023; 55:304-314. [PMID: 37473772 DOI: 10.1055/a-2082-1813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Bleeding events in surgery are a problem and can lead to revision surgery and bleeding anaemia, which sometimes must be treated by blood transfusion. Tranexamic acid is an antifibrinolytic agent and is already known for its role in the prevention and treatment of perioperative bleeding in the fields of orthopaedics, cardiovascular surgery and gynaecology. In plastic surgery, the use of tranexamic acid is increasing in popularity and has already been described in individual studies. METHODS A literature search was performed using the database MEDLINE from the United States National Library of Medicine (NLM). The keywords "tranexamic acid in plastic surgery", "intravenous tranexamic acid in plastic surgery", "topical tranexamic acid in plastic surgery" and "subcutaneous tranexamic acid in plastic surgery" were used. The search was limited to the period from 2010 to 2023. The studies were analysed according to the level of evidence, validity and availability and divided into three groups for the topical, intravenous or subcutaneous application of tranexamic acid. Randomised controlled trials and non-randomised prospective and retrospective cohort studies were included in the systematic review. Studies from other disciplines, review articles, technical notes, experimental studies, letters to the editor, comments and case reports were excluded. RESULTS The literature search resulted in a total of 135 papers. Of these, 56 papers were assessed as relevant to plastic surgery. After further analysis, 41 papers were excluded using the exclusion criteria described above. Fifteen studies were finally included in the present work and recommendations for possible applications such as intravenous, topical and subcutaneous application of tranexamic acid, including the indications, contraindications and dosage formulas were developed. DISCUSSION Although the current study situation on the use of tranexamic acid is limited, the results show more advantages than disadvantages for perioperative use. Establishing the use of tranexamic acid in plastic surgery could facilitate the reduction of perioperative bleeding and lead to more precision in surgery, and it could enable a rapid removal of drains. However, following the analysis of benefit and risk factors, further randomised controlled trials are required for use in plastic surgery.
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Affiliation(s)
- Raya Isaev
- Klinik für Plastische und Ästhetische Chirurgie, Handchirurgie, Sana Klinikum Hameln-Pyrmont, Hameln, Germany
| | - Elena Frey
- Klinik für Plastische und Ästhetische Chirurgie, Handchirurgie, Sana Klinikum Hameln-Pyrmont, Hameln, Germany
| | - Melodi Motamedi
- Klinik für Plastische und Ästhetische Chirurgie, Handchirurgie, Sana Klinikum Hameln-Pyrmont, Hameln, Germany
| | - Sixtus Allert
- Klinik für Plastische und Ästhetische Chirurgie, Handchirurgie, Sana Klinikum Hameln-Pyrmont, Hameln, Germany
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Tawa P, Boeken T, Cetrulo CL, Lellouch AG. Treatment with selective transcatheter arterial embolization of a ruptured profunda artery perforator after internal thigh liposuction: a case report. J Med Case Rep 2023; 17:321. [PMID: 37491356 PMCID: PMC10369928 DOI: 10.1186/s13256-023-04067-w] [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: 03/28/2023] [Accepted: 07/04/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Hemorrhage is an uncommon complication of liposuction that may be trauma-induced by the cannula on the subcutaneous perforators. It usually resolves spontaneously with external compression and results in mild to moderate ecchymosis on the liposuction site. However, in sporadic cases, active bleeding may persist and require urgent intervention for hemostasis. CASE PRESENTATION We report the case of a 60-year-old White female who developed a massive hematoma in the hour following liposuction of the right internal thigh, with active bleeding in the subcutaneous plane reported on contrast-enhanced computed tomography. The initial angiogram was conducted in the right common femoral artery and showed active bleeding from a profunda artery perforator. After careful selective catheterization of the feeding artery using a 2.0-French microcatheter, 0.3 mL of Onyx 34 was injected. Control angiography showed no immediate complication and confirmed the exclusion of the pseudoaneurysm. No postoperative event occurred. Blood pressure and hemoglobin levels remained stable throughout the episode. CONCLUSIONS Although liposuction is a very common procedure in plastic surgery, hemorrhagic complications may occur and require urgent hemostasis. This case suggests a vital place for interventional radiology in the management of hemorrhagic complications after liposuction.
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Affiliation(s)
- Pierre Tawa
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University of Paris, Hôpital Européen Georges Pompidou, Paris, France.
| | - Tom Boeken
- Vascular and Oncological Interventional Radiology, University of Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Curtis L Cetrulo
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexandre G Lellouch
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University of Paris, Hôpital Européen Georges Pompidou, Paris, France
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16
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Om A, Marxen T, Kebede S, Losken A. The Usage of Intravenous Tranexamic Acid in Reduction Mammaplasty Safely Reduces Hematoma Rates. Ann Plast Surg 2023; 90:S371-S374. [PMID: 36729851 PMCID: PMC10578999 DOI: 10.1097/sap.0000000000003296] [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] [Indexed: 02/03/2023]
Abstract
BACKGROUND Bleeding complications are not uncommon after breast reduction surgery, and recently, tranexamic acid (TXA) as an antifibrinolytic agent has been used in various surgical specialties as a way to minimizes such adverse outcomes. We elected to evaluate the effectiveness of intravenous (IV) intraoperative TXA in reduction mammoplasty patients. METHODS This is a retrospective chart review of clinical charts of all patients who received reduction mammoplasty by a single surgeon at Emory University Hospital or its affiliated Aesthetic Center from January 1, 2020, to March 1, 2022. Seventy-four consecutive breast reduction patients received 1-g IV TXA intraoperatively compared with 117 consecutive controls. The outcome of interest included 30-day postoperative bleeding complications. RESULTS There was no significant difference in age ( P = 0.92), body mass index ( P = 0.98), percentage of smokers ( P = 0.56), operating time ( P = 0.87), estimated blood loss ( P = 0.90), or weight removed ( P = 0.98) between patients in each arm. There were 19 bleeding events (16.2%) in the non-TXA arm compared with 1 bleeding event (1.4%) in the TXA arm ( P = 0.0143). Of the 19, 6 (5.1%) were major events, and 13 were minor events (11.1%); the only bleeding event in the TXA arm was minor. Number needed to treat all bleeding events with use of TXA was 7, and the number needed to treat minor hematomas was 11. There was no significant difference in the rate of seroma, wound healing complications, infection, or nipple necrosis between the 2 arms ( P > 0.05). CONCLUSIONS The use of IV TXA is a safe and effective way to reduce hematoma rates in patients receiving reduction mammoplasty.
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Affiliation(s)
- Anjali Om
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Emory University, Atlanta, GA
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17
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El Minawi HM, Kadry HM, El-Essawy NM, El Saadany ZA, Nouh OM. The effect of tranexamic acid on blood loss in liposuction: a randomized controlled study. EUROPEAN JOURNAL OF PLASTIC SURGERY 2023; 46:227-237. [PMID: 36311870 PMCID: PMC9589853 DOI: 10.1007/s00238-022-01995-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/26/2022] [Indexed: 11/26/2022]
Abstract
Background Liposuction is one of the most common procedures in the practice of plastic surgery. Since it evolved, continuous modifications have been to decrease blood loss so that patients are hemodynamically stable intra- and postoperatively. Tranexamic acid (TXA) has long been used for its antifibrinolytic properties that were beneficial in reducing blood loss, rate of transfusion, and hemoglobin drop in major trauma and surgeries. Its use in plastic surgery, however, is still limited. In this study, we aim to illustrate the effect of intravenous (IV) and local infiltration of TXA on blood loss in liposuction surgery. Methods Between April 2019 and April 2021, 90 patients who requested liposuction for various body parts were randomly allocated into 3 equal groups: control group, IV TXA, and local infiltration of TXA. A sample was taken from infranatant and sent for hematocrit calculation. Volume of blood in lipoaspirate was then calculated. Patients were assessed for blood loss and postoperative bruising. Results Volume of blood loss in lipoaspirate was considerably lower in the TXA groups, with 60% decrease in blood loss for the local TXA group in comparison with the control group. TXA has also been shown to markedly decrease bruising tendency in postoperative liposuction patients. Conclusions TXA can be used to decrease blood loss in large-volume liposuction, modify the need for blood transfusion intra- and postoperative, and improve the results of liposuction procedure without the need for multiple sessions. Level of evidence Level II, Risk/Prognostic Study.
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Affiliation(s)
- Hisham M El Minawi
- Plastic and Reconstructive Surgery, Faculty of Medicine, Cairo University, 1 salah Aldin Street, from Ring Road, Alhadaba Alwosta, Mokattam, Cairo, Egypt
| | - Hamed M Kadry
- Plastic and Reconstructive Surgery, Faculty of Medicine, Cairo University, 1 salah Aldin Street, from Ring Road, Alhadaba Alwosta, Mokattam, Cairo, Egypt
| | | | | | - Omar M Nouh
- Plastic and Reconstructive Surgery, Faculty of Medicine, Cairo University, 1 salah Aldin Street, from Ring Road, Alhadaba Alwosta, Mokattam, Cairo, Egypt
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18
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A 7-Step Guide to High-Definition Liposuction. Aesthetic Plast Surg 2022; 46:2863-2879. [PMID: 35729373 DOI: 10.1007/s00266-022-02965-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/19/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND High-Definition (HD) Liposuction refers to the most advanced body contouring technique, offering an athletic and healthy body appearance. The latest available devices, the criteria of proper selection, and an expert surgeon's tips are highlighted in a 7-step guide approach. METHODS A retrospective study of prospectively maintained database was conducted from 2015 to 2020. Demographic information, personal history, outcomes, complications were collected and analyzed from 568 patients who underwent the same surgical procedure. RESULTS 568 patients (247 male and 321 female) were included in the study with a mean BMI of 25.6 (range 21-29 kg/m2) and follow up time ranging from 1 to 48 months. The first 50 procedures represented the initial learning curve, during which most complications had occurred (14 patients/50 patients). Using the 7-step guide, we managed to minimize the overall complications to a rate of 3%. CONCLUSION The outlined steps have been simplified in a 7-step guide for plastic surgeons to understand, practice and refine HD liposuction in a contemporaneous, efficient, and reproducible manner. 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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19
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Coombs DM, Kwiecien GJ, Sinclair NR, Jin A, Zins JE. Local Infiltration of Tranexamic Acid During Facelift Improves Operating Room Efficiency: A Matched Patient Study. Aesthet Surg J 2022; 42:971-977. [PMID: 35350068 DOI: 10.1093/asj/sjac067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Tranexamic acid (TXA) has rapidly gained popularity in aesthetic surgery. Previous reports have suggested that TXA provides a dry surgical field and significantly reduces operating time during facelift surgery. OBJECTIVES The aim of this study was to build upon earlier findings by providing a large cohort matched alongside historic controls and more clearly document time saved when performing facelift surgery. METHODS A retrospective, single-surgeon case-control study was undertaken between July 2016 and October 2021. All patients underwent facelift surgery alone or in combination with fat transfer and perioral chemical peel. All patients received subcutaneous infiltration of 0.5% lidocaine/1:200,000 epinephrine with or without 1 or 2 mg/mL TXA. Patient demographics, TXA dose, surgical time, and minor and major complications were examined. RESULTS In total 145 consecutive patients were identified: 73 in Group 1 (no-TXA) and 72 in Group 2 (TXA). No differences in terms of gender distribution (P = 0.75), age (P = 0.54), BMI (P = 0.18), frequency of secondary rhytidectomy (P = 0.08), rate of ancillary lipografting (P = 0.44), TXA dose (P = 0.238), and minor complication rate (P = 0.56) were observed. However, mean surgical time in the no-TXA group was 21 minutes longer than in the TXA group (P = 0.016). Six patients (8%) in the no-TXA group experienced minor complications vs 8 patients (11%) in the TXA group. No patients experienced major complications. CONCLUSIONS Although previous studies have highlighted the potential benefits of TXA in aesthetic surgery, most of the data remain subjective and non-validated. This report adds to the objective body of evidence supporting TXA in facial aesthetic surgery by documenting time saved in the operating room without additional surgical morbidity. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | | | | | - Alison Jin
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - James E Zins
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
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20
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Weissler JM, Kuruoglu D, Antezana L, Curiel D, Kerivan L, Alsayed A, Banuelos J, Harless CA, Sharaf BA, Vijayasekaran A, Martinez-Jorge J, Tran NV, Nguyen MDT. Efficacy of Tranexamic Acid in Reducing Seroma and Hematoma Formation Following Reduction Mammaplasty. Aesthet Surg J 2022; 42:616-625. [PMID: 35029651 DOI: 10.1093/asj/sjab399] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Tranexamic acid (TXA) has gained increasing recognition as a valuable pharmacologic agent within plastic surgery. OBJECTIVES The aim of this study was to investigate the value and safety profile of both intravenous and topically administered TXA in the setting of bilateral reduction mammaplasty. METHODS A retrospective review was performed to identify consecutive patients who underwent bilateral reduction mammaplasty for symptomatic macromastia (January 2016-July 2021). Pertinent preoperative, intraoperative, and postoperative details were collected/reviewed. Primary outcome measures included hematoma requiring surgical evacuation and clinically significant/symptomatic seroma formation mandating percutaneous aspiration. Patients taking anticoagulation/antiplatelet medication or those with a history of thromboembolic diseases were excluded. Patients who had received TXA were compared to a historical control group who did not receive TXA within the same consecutive cohort. RESULTS A total of 385 consecutive patients (770 breasts) were included. TXA was used in 514 (66.8%) cases (topical, 318 [61.9%]; intravenous, 170 [33.1%]; intravenous and topical, 26 [5.1%]). Neither seroma nor hematoma were impacted/reduced with TXA (P > 0.05). Increased age (hazards ratio, 1.06 per 1-year increase; 95% CI, 1.004-1.118) significantly increased the risk of hematoma (P = 0.032). The use of drains significantly decreased the risk of seroma (P < 0.0001). Increased BMI increased the risk of seroma (hazards ratio, 1.16 per 1-kg/m2 increase; 95% CI, 1.06-1.26; P = 0.0013). The use of TXA did not impact drain duration. CONCLUSIONS This study, the largest to date on the use of IV and topical TXA, did not find any reduction in risk when using TXA in breast reduction surgery. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Jason M Weissler
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Doga Kuruoglu
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Luis Antezana
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Daniel Curiel
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Lauren Kerivan
- Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Ahmed Alsayed
- Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Joseph Banuelos
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Christin A Harless
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Basel A Sharaf
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Aparna Vijayasekaran
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Jorys Martinez-Jorge
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Nho V Tran
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Minh-Doan T Nguyen
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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21
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Chen L, Chang K, Chen Y, Xu Z, Shen W. Does Autologous Transfusion Decrease Allogeneic Transfusion in Liposuction Surgery of Lymphedema Patients? Front Med (Lausanne) 2022; 9:778230. [PMID: 35479938 PMCID: PMC9037081 DOI: 10.3389/fmed.2022.778230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Objective Liposuction is an effective treatment for fat disposition in lymphedema. Blood transfusion has been seldom investigated in lymphedema liposuction surgery. The purpose of the study was to analyze clinical factors associated with blood transfusion in liposuction surgery of lymphedema patients and compare the autologous and allogeneic transfusion patterns. Methods A total of 1,187 cases of liposuction due to lymphedema were recruited. Demographic, laboratory tests and operation information were collected. Patients were divided into a transfusion and a non-transfusion group. Different transfusion patterns were compared and analyzed. Results Between the two groups, there is a significant difference in postoperative hemoglobin levels, and as well as gender, age, surgery duration, body weight change, intraoperative transfusion volume and blood loss, hospital length of stay, and surgical site distribution. There is a significant difference in the comparison of hospital stay length, autologous transfusion volume, combined allogeneic volume, operative blood loss, intraoperative transfusion volume, and change in hemoglobin levels between predonation and acute normovolemic hemodilution (ANH) transfusion. In comparison with the allogeneic transfusion-only patients, the mean allogeneic transfusion volume in either ANH group, predonated transfusion group, or mixed group is statistically lower. Allogeneic transfusion volume in the predonated-only group is significantly lower than that of either the ANH-only group or the mixing ANH with predonation group. Ordinary least squares regression analysis suggests that autologous transfusion in the ANH-only mode is statistically associated with allogeneic transfusion. Conclusions This study described the blood transfusion in lymphedema liposuction surgery and compared autologous and allogeneic transfusion patterns in these patients. Autologous transfusion can reduce the transfusion volume of allogeneic blood and might be a beneficial mode of transfusion in these patients.
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Affiliation(s)
- Linfeng Chen
- Department of Blood Transfusion, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Kun Chang
- Department of Lymph Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yan Chen
- Department of Blood Transfusion, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zhenhua Xu
- HealSci Technology Co. Ltd., Beijing, China
| | - Wenbin Shen
- Department of Lymph Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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22
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Laikhter E, Comer CD, Shiah E, Manstein SM, Bain PA, Lin SJ. A Systematic Review and Meta-Analysis Evaluating the Impact of Tranexamic Acid Administration in Aesthetic Plastic Surgery. Aesthet Surg J 2022; 42:548-558. [PMID: 34486647 DOI: 10.1093/asj/sjab333] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Recent evidence suggests tranexamic acid (TXA) may improve outcomes in aesthetic surgery patients. OBJECTIVES This systematic review aimed to investigate the impact of TXA use in aesthetic plastic surgery on bleeding and aesthetic outcomes. METHODS A systematic literature search was conducted to identify studies evaluating TXA use in aesthetic plastic surgery. The primary outcome of interest was perioperative bleeding, reported as total blood loss (TBL), ecchymosis, and hematoma formation. Meta-analyses analyzing TBL and postoperative hematoma were performed. RESULTS Of 287 identified articles, 14 studies evaluating TXA use in rhinoplasty (6), rhytidectomy (3), liposuction (3), reduction mammaplasty (1), and blepharoplasty (1) were included for analysis. Of 820 total patients, 446 (54.4%) received TXA. Meta-analysis demonstrated TXA is associated with 26.3 mL average blood loss reduction (95% CI, -40.0 to -12.7 mL; P < 0.001) and suggested a trend toward decreased odds of postoperative hematoma with TXA use (odds ratio, 0.280; 95% CI, 0.076-1.029; P = 0.055). Heterogeneity among reporting of other outcomes precluded meta-analysis; however, 5 of 7 studies found significantly decreased postoperative ecchymosis levels within 7 days of surgery, 3 studies found statistically significant reductions in postoperative drain output, and 1 study reported significantly improved surgical site quality for patients who received TXA (P = 0.001). CONCLUSIONS TXA is associated with decreased blood loss and a trend toward decreased hematoma formation in aesthetic plastic surgery. Its use has the potential to increase patient satisfaction with postoperative recovery and decrease costs associated with complications, including hematoma evacuation. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Elizabeth Laikhter
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA , USA
| | - Carly D Comer
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA , USA
| | - Eric Shiah
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA , USA
| | - Samuel M Manstein
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA , USA
| | - Paul A Bain
- Countway Library, Harvard Medical School , Boston, MA , USA
| | - Samuel J Lin
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA , USA
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23
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Zins JE, Dutton JW. Commentary on: A Systematic Review and Meta-Analysis Evaluating the Impact of Tranexamic Acid Administration in Aesthetic Plastic Surgery. Aesthet Surg J 2022; 42:559-561. [PMID: 34922333 DOI: 10.1093/asj/sjab420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- James E Zins
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
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24
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Rodríguez-García FA, Sánchez-Peña MA, de Andrea GT, Villarreal-Salgado JL, Álvarez-Trejo HJ, Medina-Quintana VM, García-Valenzuela SE, Morfin-Meza KE, Fierro-Rodríguez DA, Dorado-Hernández E, Bonilla-Catalán PV, Ramos-Maciel J, Romero-Algara E, Jiménez-Pavón KE, Torres-Salazar QL. Efficacy and Safety of Tranexamic Acid for the Control of Surgical Bleeding in Patients Under Liposuction. Aesthetic Plast Surg 2022; 46:258-264. [PMID: 34351508 DOI: 10.1007/s00266-021-02486-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/18/2021] [Indexed: 11/27/2022]
Abstract
Liposuction remains one of the most frequently performed cosmetic surgical procedures and its popularity is increasing every year. However, since its inception, justified concerns regarding patient safety have placed limits on the volume of fat that can be aspirated, influenced by hemodynamic fluctuations and blood loss during liposuction. Tranexamic acid (TXA) is an antifibrinolytic agent that competitively inhibits the conversion of plasminogen to plasmin, thus preventing the binding and degradation of fibrin. Despite the existence of evidence of the effectiveness of TXA in orthopedic and cardiac surgeries, there is little evidence of its use in liposuction. The objective of this study was to evaluate the efficacy and safety of tranexamic acid in the control of surgical bleeding in patients undergoing liposuction, through a prospective, open, randomized and controlled clinical trial. Two groups of 25 participants each were formed to whom the application of TXA in a tumescent solution prior to liposuction or liposuction with the traditional technique was randomly assigned. The results showed a decrease in blood loss reflected by the differences in the final hematocrit values, as well as decrease in the same per aspirated volume (p = 0.003). No adverse events were found related with the TXA application and no blood transfusions were required in this group, in contrast to the control group where the need for blood transfusion was present in 20% of the intervened participants. LEVEL OF EVIDENCE II: 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)
- F A Rodríguez-García
- Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Hospital Regional "Dr. Valentín Gómez Farias", Av. Soledad Orozco 203, El Capullo, 45100, Zapopan, Guadalajara, Jalisco, México
| | - M A Sánchez-Peña
- Hospital INNOVARE, Av. Verona 7412, Villa Verona, Zapopan, Jalisco, México
| | | | - J L Villarreal-Salgado
- Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Hospital Regional "Dr. Valentín Gómez Farias", Av. Soledad Orozco 203, El Capullo, 45100, Zapopan, Guadalajara, Jalisco, México
| | - H J Álvarez-Trejo
- Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Hospital Regional "Dr. Valentín Gómez Farias", Av. Soledad Orozco 203, El Capullo, 45100, Zapopan, Guadalajara, Jalisco, México
| | - V M Medina-Quintana
- Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Hospital Regional "Dr. Valentín Gómez Farias", Av. Soledad Orozco 203, El Capullo, 45100, Zapopan, Guadalajara, Jalisco, México
| | - S E García-Valenzuela
- Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Hospital Regional "Dr. Valentín Gómez Farias", Av. Soledad Orozco 203, El Capullo, 45100, Zapopan, Guadalajara, Jalisco, México
| | - K E Morfin-Meza
- Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Hospital Regional "Dr. Valentín Gómez Farias", Av. Soledad Orozco 203, El Capullo, 45100, Zapopan, Guadalajara, Jalisco, México
| | - D A Fierro-Rodríguez
- Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Hospital Regional "Dr. Valentín Gómez Farias", Av. Soledad Orozco 203, El Capullo, 45100, Zapopan, Guadalajara, Jalisco, México
| | - E Dorado-Hernández
- Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Hospital Regional "Dr. Valentín Gómez Farias", Av. Soledad Orozco 203, El Capullo, 45100, Zapopan, Guadalajara, Jalisco, México
| | - P V Bonilla-Catalán
- Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Hospital Regional "Dr. Valentín Gómez Farias", Av. Soledad Orozco 203, El Capullo, 45100, Zapopan, Guadalajara, Jalisco, México
| | - J Ramos-Maciel
- Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Hospital Regional "Dr. Valentín Gómez Farias", Av. Soledad Orozco 203, El Capullo, 45100, Zapopan, Guadalajara, Jalisco, México
| | - E Romero-Algara
- Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Hospital Regional "Dr. Valentín Gómez Farias", Av. Soledad Orozco 203, El Capullo, 45100, Zapopan, Guadalajara, Jalisco, México
| | - K E Jiménez-Pavón
- Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Hospital Regional "Dr. Valentín Gómez Farias", Av. Soledad Orozco 203, El Capullo, 45100, Zapopan, Guadalajara, Jalisco, México
| | - Q L Torres-Salazar
- Universidad Juárez del Estado de Durango, Calle Paloma No.806, Colonia Fátima, 34060, Durango, Durango, México.
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25
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Adipose-Derived Stem Cells for Facial Rejuvenation. J Pers Med 2022; 12:jpm12010117. [PMID: 35055432 PMCID: PMC8781097 DOI: 10.3390/jpm12010117] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/08/2021] [Accepted: 12/30/2021] [Indexed: 01/27/2023] Open
Abstract
The interest in regenerative medicine is increasing, and it is a dynamically developing branch of aesthetic surgery. Biocompatible and autologous-derived products such as platelet-rich plasma or adult mesenchymal stem cells are often used for aesthetic purposes. Their application originates from wound healing and orthopaedics. Adipose-derived stem cells are a powerful agent in skin rejuvenation. They secrete growth factors and anti-inflammatory cytokines, stimulate tissue regeneration by promoting the secretion of extracellular proteins and secrete antioxidants that neutralize free radicals. In an office procedure, without cell incubation and counting, the obtained product is stromal vascular fraction, which consists of not only stem cells but also other numerous active cells such as pericytes, preadipocytes, immune cells, and extra-cellular matrix. Adipose-derived stem cells, when injected into dermis, improved skin density and overall skin appearance, and increased skin hydration and number of capillary vessels. The main limitation of mesenchymal stem cell transfers is the survival of the graft. The final outcomes are dependent on many factors, including the age of the patient, technique of fat tissue harvesting, technique of lipoaspirate preparation, and technique of fat graft injection. It is very difficult to compare available studies because of the differences and multitude of techniques used. Fat harvesting is associated with potentially life-threatening complications, such as massive bleeding, embolism, or clots. However, most of the side effects are mild and transient: primarily hematomas, oedema, and mild pain. Mesenchymal stem cells that do not proliferate when injected into dermis promote neoangiogenesis, that is why respectful caution should be taken in the case of oncologic patients. A longer clinical observation on a higher number of participants should be performed to develop reliable indications and guidelines for transferring ADSCs.
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Weissler JM, Banuelos J, Molinar VE, Tran NV. Local Infiltration of Tranexamic Acid (TXA) in Liposuction: A Single-Surgeon Outcomes Analysis and Considerations for Minimizing Postoperative Donor Site Ecchymosis. Aesthet Surg J 2021; 41:NP820-NP828. [PMID: 33399815 DOI: 10.1093/asj/sjaa437] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Tranexamic acid (TXA) has gained increasing recognition in plastic surgery as a dependable adjunct capable of minimizing blood loss, ecchymosis, and edema. To date, there have been limited data on the utilization of TXA to mitigate liposuction donor site ecchymosis. OBJECTIVES The authors sought to investigate whether infiltration of TXA into liposuction donor sites safely reduces postoperative ecchymosis. METHODS A single-surgeon retrospective cohort study was performed to analyze patients undergoing autologous fat transfer for breast reconstruction between 2016 and 2019. Following lipoaspiration, patients in the intervention group received 75 mL of TXA (3 g in NaCl 0.9%) infiltrated into the liposuction donor sites, whereas the historical controls did not. Patient demographics, degree of ecchymosis, surgical complications, and thromboembolic events were examined. A blinded assessment of postoperative photographs of the donor sites was performed. RESULTS Overall, 120 autologous fat grafting procedures were reviewed. Sixty patients received TXA, whereas 60 patients did not. Patient demographics and comorbidities were similar among the groups. No difference existed between groups regarding donor site locations, tumescent volume, lipoaspirate volume, or time to postoperative photograph. Ten blinded evaluators completed the assessment. The median bruising score of patients who received TXA was significantly lower than that of patients who did not (1.6/10 vs 2.3/10, P = 0.01). Postoperative complications were similar among the groups. Adverse effects of TXA were not observed. CONCLUSIONS Patients who received local infiltration of TXA into the liposuction donor sites were found to have less donor site ecchymosis than patients who did not. Further prospective randomized studies are warranted. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Jason M Weissler
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Joseph Banuelos
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Vanessa E Molinar
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Nho V Tran
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Hunstad J, Alsubaie S. Commentary on: Local Infiltration of Tranexamic Acid (TXA) in Liposuction: A Single-Surgeon Outcomes Analysis and Considerations for Minimizing Postoperative Donor Site Ecchymosis. Aesthet Surg J 2021; 41:NP829-NP830. [PMID: 33821973 DOI: 10.1093/asj/sjaa433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Joseph Hunstad
- University of North Carolina Chapel Hill, Chapel Hill, NC, USA
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Tranexamic acid in plastic surgery: routes of administration and dosage considerations. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01794-5] [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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Abboud M, Geeroms M, El Hajj H, Abboud N. Improving the Female Silhouette and Gluteal Projection: An Anatomy-Based, Safe, and Harmonious Approach Through Liposuction, Suspension Loops, and Moderate Lipofilling. Aesthet Surg J 2021; 41:474-489. [PMID: 32506115 DOI: 10.1093/asj/sjaa157] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Liposuction is the main technique to improve body contour, emphasize appealing curves, and highlight one's muscular definition. The number of procedures in which the harvested fat is utilized for gluteal augmentation has greatly increased. OBJECTIVES The authors aim to demonstrate their technique in order to obtain a sculpted harmonious body through a safe procedure, as well as review their 101 consecutive cases between 2014 and 2018. METHODS Anatomical guidelines and preoperative markings were provided to guide the 3-step procedure: zones of maximal and mild liposuction, barbed wire suspension, and moderate fat grafting. Novel concepts are introduced as the anterior body diagonal, posterior body diagonal as well as other specific axes the pubic unit, and a vertical ratio for the buttock, which are the basic foundations for sculpting the female body into a pleasing hourglass shape with a well projected buttock. Recommendations for location of sacral diamond, sacral dimples, and the maximally projected point of the buttock are given. The authors explain their philosophy through 4 principles: knowledge of anatomy, the relationship between specific body areas and surrounding zones, a balanced gluteal augmentation is not achieved through large volume fat grafting alone, and grafting in the subcutaneous layer. RESULTS A total of 101 patients were treated following the described technique and examples are shown. The complication rate was low. No serious adverse effects were recorded apart from 1 ruptured suspension loop. CONCLUSIONS The described anatomy-based approach, including liposuction, suspension loops, and fat grafting, is a novel and safe technique leading to a desirable, long-lasting outcome. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Marwan Abboud
- Plastic and Reconstructive Surgery Department, Centre Hospitalier Universitaire de Tivoli, La Louvière, Belgium
| | - Maxim Geeroms
- Plastic and Reconstructive Surgery Department, Centre Hospitalier Universitaire de Tivoli, La Louvière, Belgium
| | - Hiba El Hajj
- Plastic and Reconstructive Surgery Department, Centre Hospitalier Universitaire de Tivoli, La Louvière, Belgium
| | - Nicolas Abboud
- Plastic and Reconstructive Surgery Department, Centre Hospitalier Universitaire de Tivoli, La Louvière, Belgium
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Kochuba AL, Coombs DM, Kwiecien GJ, Sinclair NR, Zins JE. Prospective Study Assessing the Effect of Local Infiltration of Tranexamic Acid on Facelift Bleeding. Aesthet Surg J 2021; 41:391-397. [PMID: 32644111 DOI: 10.1093/asj/sjaa198] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Rebound bleeding during facelift surgery is a major cause of facelift hematomas. Subcutaneous infiltration of tranexamic acid (TXA) combined with lidocaine and epinephrine was recently retrospectively shown to decrease rebound bleeding. No study has prospectively examined the effect of subcutaneous TXA on intraoperative and postoperative bleeding during facelift surgery. OBJECTIVES The aim of this study was to prospectively demonstrate that TXA combined with local anesthesia safely reduces the effects of rebound bleeding, reduces operative time, and decreases postoperative drainage. METHODS This was a prospective, single-surgeon, case-control study performed between July 2019 and March 2020. Thirty-nine patients (35 female and 4 male; mean age, 64.9 years; age range, 49-80 years) underwent facelift surgery alone or in combination with facial rejuvenation procedures. All patients were injected subcutaneously with 1 or 2 mg/mL TXA + 0.5% lidocaine/1:200,000 epinephrine. Patient demographics, TXA dose, time to hemostasis, drain output, and minor and major complications were recorded. RESULTS The mean time to hemostasis was 6.4 minutes for the left and right sides each. Average postoperative day (POD) 0 drain outputs were 13.9 mL (left) and 10.1 mL (right). Average POD 1 drain outputs were 15.1 mL (left) and 15.6 mL (right). Drains were removed from all patients on POD 1 or 2. There were 2 minor complications (flap necrosis plus infection, marginal mandibular neuropraxia) and no major complications. CONCLUSIONS TXA safely and effectively decreased bleeding, operating room time, and drain output compared with traditional local anesthetic techniques. Our future goal is to determine if epinephrine can be completely removed from the local anesthetic and replaced with TXA for facelift surgery. LEVEL OF EVIDENCE: 2
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Elena Scarafoni E. A Systematic Review of Tranexamic Acid in Plastic Surgery: What's New? PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3172. [PMID: 33907653 PMCID: PMC8062149 DOI: 10.1097/gox.0000000000003172] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/14/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Blood loss associated with surgical interventions can lead to several complications. Therefore, minimizing perioperative bleeding is critical to improve overall survival. Several interventions have been found to successfully reduce surgical bleeding, including the antifibrinolytic agent. After aprotinin was withdrawn from the market in 2008, TXA remained the most commonly used medication. The safety and efficacy of TXA has been well studied in other specialties. TXA has been rarely used in plastic surgery, except in craniofacial procedures. Since the last review, the number of articles examining the use of TXA has doubled; so the aim of this systematic review is to update the readers on the current knowledge and clinical recommendations regarding the efficacy of TXA in plastic surgical procedures. METHODS A systematic literature search was conducted in Medline, SciELO, Cochrane, and Google Scholar to evaluate all articles that discussed the use of TXA in plastic surgery in the fields of aesthetic surgery, burn care, and reconstructive microsurgery. RESULTS A total of 233 publications were identified using the search criteria defined above. After examination of titles and abstracts, and exclusion of duplicates, a total of 23 articles were selected for analysis. CONCLUSIONS The literature shows a clear benefit of using TXA to decrease blood loss regardless of the administration route, with no risk of thrombosis events. Also, TXA elicits a potent anti-inflammatory response with a decrease in postoperative edema and ecchymosis, which improves recovery time. Further investigations are needed to standardize the optimal administration route and dosage of TXA.
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Affiliation(s)
- Esteban Elena Scarafoni
- From the Department of Plastic and Reconstructive Surgery, Hospital de Quemados, Buenos Aires, Argentina
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Fayman M, Beeton A, Potgieter E, Ndou R, Mazengenya P. Efficacy of Topical Tranexamic Acid (Cyclokapron) in "Wet" Field Infiltration with Dilute Local Anaesthetic Solutions in Plastic Surgery. Aesthetic Plast Surg 2021; 45:332-339. [PMID: 33051719 DOI: 10.1007/s00266-020-02001-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/27/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Surgical bleeding may lead to the need for blood transfusion and minimizing blood loss has been a basic principle followed by surgeons for generations. Antifibrinolytic agents are widely used to reduce perioperative haemorrhage. The present study sought to assess the efficacy of directly infiltrated tranexamic acid in ameliorating bruising in participants undergoing cosmetic plastic surgery (liposuction). MATERIALS AND METHODS The study employed a blinded, prospective, randomized, case control design. Thirty-three patients were studied. Tranexamic acid free infiltration tumescent solution (saline, bupivacaine lignocaine and adrenalin) was infiltrated to one flank of patients undergoing liposuction of flanks. The other flank was infiltrated with the same tumescent solution (saline, bupivacaine lignocaine and adrenalin) mixed with tranexamic acid (0.1%). Bruises were photographed one and seven days after surgery and measured for size. The surface area of the bruises was calculated using ImageJ software. We compared the bruised surface are between the tranexamic acid infiltrated flank and non-tranexamic acid infiltrated flank in the same patient. The model employed involved measuring the bruises on each flank of the same patient, with surgery by a single surgeon using the same infiltration and surgical techniques for both sides. The only variable was the difference in tranexamic acid concentration between study and control flanks. RESULTS We found that use of tranexamic acid consistently resulted in a smaller bruise area on days one and seven after liposuction of flanks. Results were statistically significant. CONCLUSIONS This is the first study examining addition of tranexamic acid to a tumescent infiltration solution-to produce a predictable local concentration of tranexamic acid-in order to maximize surgical site effect and minimize systemic effect. The authors recommend incorporation of tranexamic acid as a routine component along with adrenaline and local anaesthetics in tumescent field infiltration solution 10-15 min before commencement of the cosmetic surgery. LEVEL OF EVIDENCE II 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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Zins JE, Grow JN. Invited Discussion on: Efficacy of Topical Tranexamic Acid (Cyclokapron) in "Wet" Field Infiltration with Dilute Local Anesthetic Solutions in Plastic Surgery. Aesthetic Plast Surg 2021; 45:340-342. [PMID: 33241463 DOI: 10.1007/s00266-020-02042-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/01/2020] [Indexed: 11/27/2022]
Affiliation(s)
- James E Zins
- Department of Plastic Surgery, Cleveland Clinic Desk A60, 9500 Euclid Ave, Cleveland, OH, 44195-5243, USA.
| | - Jacob Nathaniel Grow
- Department of Plastic Surgery, Cleveland Clinic Desk A60, 9500 Euclid Ave, Cleveland, OH, 44195-5243, USA
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Wokes JET, Erdmann MWH, McLean NR. The Role of Tranexamic Acid in Aesthetic Plastic Surgery: A Survey of the British Association of Aesthetic Plastic Surgeons. Aesthet Surg J 2021; 41:244-249. [PMID: 32505129 DOI: 10.1093/asj/sjaa149] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Tranexamic acid (TXA) can reduce intra- and postoperative bleeding as well as minimizing postoperative swelling and ecchymosis. It can be administered both intravenously and topically during surgery with minimal side effects. OBJECTIVES To assess the evidence of TXA use in aesthetic surgery and to complete a survey of current practice of full British Association of Aesthetic Plastic Surgeons members. METHODS The authors performed a literature review and online survey of full British Association of Aesthetic Plastic Surgeons members. RESULTS There is an increased indication of TXA utilization in aesthetic surgery. It provides multiple surgeon and patient benefits. CONCLUSIONS TXA is a useful adjunct in aesthetic surgery.
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Affiliation(s)
- James E T Wokes
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom
| | - Matthias W H Erdmann
- Department of Plastic and Reconstructive Surgery, University Hospital North Durham, Durham, United Kingdom
| | - Neil R McLean
- Department of Plastic and Reconstructive Surgery, Wansbeck District General Hospital, Ashington, United Kingdom
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Abboud NM, Kapila AK, Abboud S, Yaacoub E, Abboud MH. The Combined Effect of Intravenous and Topical Tranexamic Acid in Liposuction: A Randomized Double-Blinded Controlled Trial. Aesthet Surg J Open Forum 2021; 3:ojab002. [PMID: 34212138 PMCID: PMC8240743 DOI: 10.1093/asjof/ojab002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2021] [Indexed: 01/28/2023] Open
Abstract
Background Tranexamic acid (TXA) use in surgical procedures due to its hemostatic effects has been gaining an increased interest. In plastic surgery, the effects of TXA have been studied intravenously (IV), and there have been some reports regarding local use. Objectives A comparative study examining the combined effect of IV and local TXA was conducted. Methods A randomized double-blinded controlled trial was performed for patients undergoing breast reduction treatment with liposuction and resection following the power-assisted liposuction mammaplasty (PALM) technique. All patients received 5 mL IV of 0.5 g/5 mL TXA on induction. Before installation, one researcher prepared two solutions of 1 L normal saline: one with 5 mL of 0.5 g/5 mL TXA associated with epinephrine 1:100,000 and the other with only epinephrine 1:100,000. These were randomly infiltrated in either the left or right breast. Clinical dermal bleeding was assessed for both breasts after deepithelialization. The lipoaspirate from these breasts was then compared with each other. A postoperative evaluation at 24 hours was performed to compare the ecchymosis rate. Results Ratios of decanted volume to total lipoaspirate was measured in bottles and compared between breasts. There was a statistical difference (P = 0.0002) in the ratio of decanted to lipoaspirated volume when comparing the control group (ratio: 0.21) with the treatment group (0.13). Video analysis revealed decreased dermal bleeding in the TXA group and postoperative evaluation less ecchymosis. Conclusions The combined use of IV and local TXA can help reducing blood loss in liposuction as measured by decantation in separate drain bottles and as assessed clinically preoperatively and postoperatively. Level of Evidence 2
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Affiliation(s)
- Nicolas M Abboud
- Plastic and Reconstructive Surgery Department, Centre Hospitalier Universitaire de Tivoli, La Louvière, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Ayush K Kapila
- Department of Plastic and Reconstructive Surgery at the University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | - Sofie Abboud
- Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Elie Yaacoub
- Plastic and Reconstructive Surgery Department, Centre Hospitalier Universitaire de Tivoli, La Louvière, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Marwan H Abboud
- Plastic and Reconstructive Surgery Department, Centre Hospitalier Universitaire de Tivoli, La Louvière, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
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Intravenous Tranexamic Acid in Implant-Based Breast Reconstruction Safely Reduces Hematoma without Thromboembolic Events. Plast Reconstr Surg 2020; 146:238-245. [PMID: 32740567 DOI: 10.1097/prs.0000000000006967] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Antifibrinolytic medications, such as tranexamic acid, have recently garnered increased attention. Despite its ability to mitigate intraoperative blood loss and need for blood transfusion, there remains a paucity of research in breast reconstruction. The authors investigate whether intravenous tranexamic acid safely reduces the risk of hematoma following implant-based breast reconstruction. METHODS A single-center retrospective cohort study was performed to analyze all consecutive patients undergoing immediate two-stage implant-based breast reconstruction following mastectomy between 2015 and 2016. The incidence of postoperative hematomas and thromboembolic events among all patients was reviewed. The patients in the intervention group received 1000 mg of intravenous tranexamic acid before mastectomy incision and 1000 mg at the conclusion of the procedure. Fisher's exact test and the Mann-Whitney-Wilcoxon test were used. Multivariate logistic regression models were performed to study the impact of intravenous tranexamic acid after adjusting for possible confounders. RESULTS A total of 868 consecutive breast reconstructions (499 women) were reviewed. Overall, 116 patients (217 breasts) received intravenous tranexamic acid, whereas 383 patients (651 breasts) did not. Patient characteristics and comorbidities were similar between the two the groups. Patients who received tranexamic acid were less likely to develop hematomas [n = 1 (0.46 percent)] than patients who did not [n = 19 (2.9 percent)] after controlling for age, hypertension, and type of reconstruction (prepectoral and subpectoral) (p = 0.018). Adverse effects of intravenous tranexamic acid, including thromboembolic phenomena were not observed. Multivariate analysis demonstrated that age and hypertension independently increase risk for hematoma. CONCLUSIONS Intravenous tranexamic acid safely reduces risk of hematoma in implant-based breast reconstruction. Further prospective randomized studies are warranted to further corroborate these findings. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Liposuction: Keeping It Safe! PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2783. [PMID: 32440445 PMCID: PMC7209863 DOI: 10.1097/gox.0000000000002783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/26/2022]
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Fernau J. Commentary on: Local Infiltration of Tranexamic Acid With Local Anesthetic Reduces Intraoperative Facelift Bleeding: A Preliminary Report. Aesthet Surg J 2020; 40:594-596. [PMID: 32297914 DOI: 10.1093/asj/sjaa019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- James Fernau
- Dr Fernau is a plastic surgeon in private practice in Pittsburgh, PA; and is Chair of the Patient Safety Committee for The Aesthetic Society
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Couto RA, Charafeddine A, Sinclair NR, Nayak LM, Zins JE. Local Infiltration of Tranexamic Acid With Local Anesthetic Reduces Intraoperative Facelift Bleeding: A Preliminary Report. Aesthet Surg J 2020; 40:587-593. [PMID: 31504134 DOI: 10.1093/asj/sjz232] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Rebound bleeding as a result of loss of epinephrine effect is a common problem encountered during facelift surgery. Tranexamic acid (TXA) is an anti-fibrinolytic agent whose safety and efficacy in reducing bleeding are well documented. We have found that local infiltration of TXA combined with a lidocaine with epinephrine solution during facelift surgery has been effective in decreasing rebound bleeding and the time required to gain hemostasis. OBJECTIVES The authors sought to share their local infiltration protocol of TXA combined with epinephrine solution in facelift. METHODS Patients who underwent facelift received subcutaneous injection of TXA-lidocaine 0.5% solution following the authors' protocol. After completing both sides of the facelift and the submental platysmaplasty, the first and second sides were sequentially closed. The time to gain hemostasis on each side prior to closure was prospectively measured. RESULTS Twenty-seven consecutive patients who underwent facelift surgery received local infiltration of TXA-lidocaine solution. In 23 of the 27 patients, the time required for hemostasis was prospectively recorded. The mean age was 62.1 years (±9.3) and all were females. The average time spent achieving hemostasis on the right, left, and both sides of the face was 6.5 (±2.7), 6.3 (±2.1), and 12.9 (±4.2) minutes, respectively. The total surgical time saving is approximately 25 to 60 minutes. Although primary facelift [13.6 (± 4.3)] exhibited a longer time of hemostasis compared with the secondary group [10.2 (± 2.8)], this was not statistically significant (P = 0.09). CONCLUSIONS Local infiltration of TXA with local anesthetic prior to a facelift appears to decrease bleeding, operative time, and postoperative facelift drainage output. Level of Evidence: 4.
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Affiliation(s)
- Rafael A Couto
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Ali Charafeddine
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | | | | | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH
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Danilla S, Babaitis RA, Jara RP, Quispe DA, Andrades PR, Erazo CA, Albornoz CR, Sepulveda SL. High-Definition Liposculpture: What are the Complications and How to Manage Them? Aesthetic Plast Surg 2020; 44:411-418. [PMID: 31432229 DOI: 10.1007/s00266-019-01475-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/04/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND High-definition liposculpture is a novel surgical technique widely accepted among plastic surgeons. The aim of this article is to describe surgical outcomes with a special emphasis on complications in high-definition liposculpture patients. METHODS An historical cohort of patients who underwent high-definition liposculpture from two senior surgeons was reviewed. Technique, patient selection criteria, preoperative marks and surgical outcomes are described. Postoperative complications are discussed. RESULTS A total of 417 patients underwent high-definition liposculpture between 2015 and 2018. Primary liposuction and secondary liposuction were performed in 308 (74%) and 109 (26%), respectively. Combined surgeries were performed in 121 cases (29%). There were no systemic complications. Local complications included hyperpigmentation (n = 276), seroma (n = 125), nodular fibrosis (n = 83), unsatisfactory definition in superficial liposuction areas (n = 16), unnatural appearance of body contour (n = 17), VASER-related burns (n = 3) and Mondor's syndrome (n = 2). Most patients (94%) were satisfied with the results. CONCLUSION High-definition liposculpture is a body contouring technique that has shown excellent results. Despite non-serious complications were frequent, most complications were local and safely treated without affecting surgical outcome. To know these complications will help to recognize them earlier and to adjust patient expectation about the postoperative period. 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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Abdominal Etching: Surgical Technique and Outcomes. Plast Reconstr Surg 2020; 145:454e. [DOI: 10.1097/prs.0000000000006460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Local Pro- and Anti-Coagulation Therapy in the Plastic Surgical Patient: A Literature Review of the Evidence and Clinical Applications. MEDICINA-LITHUANIA 2019; 55:medicina55050208. [PMID: 31137735 PMCID: PMC6572131 DOI: 10.3390/medicina55050208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/23/2019] [Accepted: 05/22/2019] [Indexed: 11/17/2022]
Abstract
The risks of systemic anti-coagulation or its reversal are well known but accepted as necessary under certain circumstances. However, particularly in the plastic surgical patient, systemic alteration to hemostasis is often unnecessary when local therapy could provide the needed adjustments. The aim of this review was to provide a summarized overview of the clinical applications of topical anti- and pro-coagulant therapy in plastic and reconstructive surgery. While not a robust field as of yet, local tranexamic acid (TXA) has shown promise in achieving hemostasis under various circumstances, hemostats are widely used to halt bleeding, and local anticoagulants such as heparin can improve flap survival. The main challenge to the advancement of local therapy is drug delivery. However, with increasingly promising innovations underway, the field will hopefully expand to the betterment of patient care.
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