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Gonzales Y Tucker RD, Addepalli A. Fever and Rash. Emerg Med Clin North Am 2024; 42:303-334. [PMID: 38641393 DOI: 10.1016/j.emc.2024.01.005] [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: 04/21/2024]
Abstract
Infectious causes of fever and rash pose a diagnostic challenge for the emergency provider. It is often difficult to discern rashes associated with rapidly progressive and life-threatening infections from benign exanthems, which comprise the majority of rashes seen in the emergency department. Physicians must also consider serious noninfectious causes of fever and rash. A correct diagnosis depends on an exhaustive history and head-to-toe skin examination as most emergent causes of fever and rash remain clinical diagnoses. A provisional diagnosis and immediate treatment with antimicrobials and supportive care are usually required prior to the return of confirmatory laboratory testing.
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Affiliation(s)
- Richard Diego Gonzales Y Tucker
- Department of Emergency Medicine, University of California San Francisco, Box 0209, 505 Parnassus Avenue, San Francisco, CA 94143, USA; Department of Emergency Medicine, Alameda Health System - Wilma Chan Highland Hospital, 1411 E 31st Street, Oakland, CA 94602, USA.
| | - Aravind Addepalli
- Department of Emergency Medicine, University of California San Francisco, Box 0209, 505 Parnassus Avenue, San Francisco, CA 94143, USA
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Nagano S, Unuma K, Makino Y, Mori H, Uemura K. Acute upper airway obstruction due to cervical hematoma after cervicofacial liposuction. J Forensic Leg Med 2024; 104:102697. [PMID: 38772270 DOI: 10.1016/j.jflm.2024.102697] [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: 02/07/2024] [Revised: 05/12/2024] [Accepted: 05/15/2024] [Indexed: 05/23/2024]
Abstract
Liposuction is a surgical procedure performed worldwide. Although many fatal complications of liposuction have been reported, to our knowledge, no cases of fatal liposuction complications specifically related to the face region have been reported. Here, we present a case of a woman in her 30s who developed a cervical hematoma and upper airway obstruction following facial liposuction. We present this unique case to highlight the rare occurrence of fatal complications specific to facial liposuction. The patient underwent liposuction during surgery at a cosmetic surgical clinic and awoke from anesthesia after the procedure. Two hours later, she developed a neck swelling and dyspnea. While the anesthesiologist managed her airway, she went into cardiopulmonary arrest. She was then transferred to the emergency room but died on day 7 of hospitalization. The autopsy revealed swelling of the right cheek and mandible, a subcutaneous hematoma in the same area, and laryngeal edema. A damaged facial artery branch was identified, which was consistent with the computed tomography (CT) findings on admission. CT also showed that the hematoma compressed the right internal jugular vein, suggesting that venous outflow impairment caused by the hematoma may have exacerbated the airway obstruction. This case reveals that cervical hematoma caused by facial liposuction can cause fatal upper airway obstruction and the onset of the hematoma may be gradual.
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Affiliation(s)
- Shutaro Nagano
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Kana Unuma
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-0033, Japan
| | - Hiroki Mori
- Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Koichi Uemura
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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Tuan HT, Ngoc NA, Ai LD, Van Luat N. Complicated Surgical Site Infection with Mycobacterium Abscessus After Liposuction and Affections of Corticosteroids in the Treatment Regimen: Three Cases Report and a Systematic Review. Aesthetic Plast Surg 2024; 48:1365-1385. [PMID: 37530819 DOI: 10.1007/s00266-023-03512-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/30/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION Mycobacterium abscessus infection after liposuction/fat grafting is a rare complication that is hard to diagnose and treat. Misdiagnosis could result in treatment failure and prolonged hospital stays. The paradoxical reaction is another complication that rarely occurs in non-HIV patients infected with nontuberculosis mycobacteria. This study reported 3 cases infected with M. abscessus complicated by the paradoxical reaction after liposuction and fat grafting. It highlighted characteristics giving clues of the paradoxical reaction and a successful strategy. Also, a systematic review was conducted to comprehensively provide varied aspects of M. abscessus infection after liposuction and/or fat grafting. METHODS Three cases were retrospectively included reporting data characteristics of patients, cosmetic procedures, and treatment strategy. PubMed, Scopus, Virtual Health Library (VHL), and Global Health Library (GHL) were searched to find and include cases with M. abscessus infection after liposuction and/or fat grafting based on defined selection criteria. Relevant data were extracted and summarized. The risk of bias in included studies was assessed using JBI critical appraisal checklists. RESULTS Twenty-four articles were included in the systematic review. Symptoms often developed approximately 1 month after the cosmetic surgery. Culture, AFB, and PCR were common methods of diagnosis of M. abscessus after liposuction and/or fat grafting. It took about 33 days on average from the presentation to isolate and detect the pathogens. Antibiotics based on susceptibility testing results along with surgical interventions were effective methods of treatment. Our three cases which were complicated by the paradox were addressed by adding methylprednisolone for 2 weeks to the macrolide-based therapy. CONCLUSIONS Awareness of this disease should be widely raised among physicians for early diagnosis and proper treatments. Cultures of specimens and AFB should be repeated many times before excluding the possibility of Mycobacterium spp. A paradoxical reaction should be suspected if the symptoms were worse after the antibiotic therapy based on susceptibility testing results and proper surgical interventions, especially if patients had taken corticosteroids before being admitted. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
| | | | - Luu Dang Ai
- Hoang Tuan Clinic, Hoang Quoc Viet, Hanoi, Vietnam
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Robles MF. Safety and Efficacy Study of the Application of Redensified Cross-Linked Hyaluronic Acid for Filling Gluteal Volume and Cellulite Depressions. Aesthetic Plast Surg 2024; 48:1181-1192. [PMID: 38110737 DOI: 10.1007/s00266-023-03739-8] [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: 08/17/2023] [Accepted: 10/23/2023] [Indexed: 12/20/2023]
Abstract
PURPOSE To test the efficacy and safety of cross-linked hyaluronic acid application for filling buttocks and cellulite depressions and its permanence over time. METHODS For a period of a year, 25 patients were applied redensified cross-linked hyaluronic acid in the gluteal area. These patients were all 23-45-year-old women with little fat to be removed. The product used is composed of hyaluronic acid with high cross-linking and redensification which allows it to maintain shape and durability over time. All patients underwent tumescent anesthesia with neuroleptic sedation in the operating room. The procedure was regarded as minimal (container, sterile gloves, and surgical field). The amount applied for gluteal augmentation varied from 50 to 100 ml per application area and according to the patient's needs. For the filling of cellulite depressions, the application was up to 3 cc per depression and up to a total of 40 ml. The maximum volume used per patient in the buttocks did not exceed 200 ml, and it did not exceed 40 ml in cellulite depressions. RESULTS A group of patients was treated in the upper and middle third of the buttocks in superficial and deep subcutaneous layers and in cellulite depressions. Very good results have been obtained without any major complications. CONCLUSIONS The use of redensified cross-linked hyaluronic acid of non-animal origin is therefore an option for gluteal augmentation and cellulite depressions. Although the product degrades over time, after 12 months, 44% of treated patients rated their results as highly or very much improved, 36% as improved, 16% rated the improvement as poor, and one patient (4%) was dissatisfied. 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)
- Marcelo F Robles
- Plastic Surgery & Laser Department, Clínica Robles, 2530 Virrey del Pino St, C1426EGT, Autonomous City of Buenos Aires, Buenos Aires, Argentina.
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Peng C, Yang F, Yu J, Peng L, Zhang C, Chen C, Lin Z, Li Y, He J, Jin Z. Machine Learning Prediction Algorithm for In-Hospital Mortality following Body Contouring. Plast Reconstr Surg 2023; 152:1103e-1113e. [PMID: 36940163 DOI: 10.1097/prs.0000000000010436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND Body contouring is a common procedure, but it is worth attention because of concern for a variety of complications, and even the potential for death. As a result, the purpose of this study was to determine the key predictors following body contouring and create models for the risk of mortality using diverse machine learning (ML) models. METHODS The National Inpatient Sample database from 2015 to 2017 was queried to identify patients undergoing body contouring. Candidate predictors, such as demographics, comorbidities, personal history, postoperative complications, and operative features, were included. The outcome was in-hospital mortality. Models were compared by area under the curve, accuracy, sensitivity, specificity, positive and negative predictive values, and decision curve analysis. RESULTS Overall, 8214 patients undergoing body contouring were identified, among whom 141 (1.72%) died in the hospital. Variable importance plot demonstrated that sepsis was the variable with greatest importance across all ML algorithms, followed by Elixhauser Comorbidity Index, cardiac arrest, and so forth. The naive Bayes model had a higher predictive performance (area under the curve, 0.898; 95% CI, 0.884 to 0.911) among these eight ML models. Similarly, in the decision curve analysis, the naive Bayes model also demonstrated a higher net benefit (ie, the correct classification of in-hospital deaths considering a tradeoff between false-negatives and false-positives) compared with the other seven models across a range of threshold probability values. CONCLUSION The ML models, as indicated by this study, can be used to predict in-hospital death for patients at risk who undergo body contouring.
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Affiliation(s)
- Chi Peng
- From the Department of Health Statistics, Second Military Medical University
| | - Fan Yang
- Departments of Plastic Surgery and Burns
| | - Jian Yu
- From the Department of Health Statistics, Second Military Medical University
| | - Liwei Peng
- Neurosurgery, Tangdu Hospital, Fourth Military Medical University
| | - Chenxu Zhang
- From the Department of Health Statistics, Second Military Medical University
| | - Chenxin Chen
- From the Department of Health Statistics, Second Military Medical University
| | - Zhen Lin
- From the Department of Health Statistics, Second Military Medical University
| | - Yuejun Li
- Departments of Plastic Surgery and Burns
| | - Jia He
- From the Department of Health Statistics, Second Military Medical University
| | - Zhichao Jin
- From the Department of Health Statistics, Second Military Medical University
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Valentine L, Alvarez AH, Weidman AA, Foppiani J, Hassell NE, Elmer N, Hwang P, Kaul S, Rosenblatt W, Lin SJ. Liposuction Complications in the Outpatient Setting: A National Analysis of 246,119 Cases in Accredited Ambulatory Surgery Facilities. Aesthet Surg J Open Forum 2023; 6:ojad107. [PMID: 38348141 PMCID: PMC10860384 DOI: 10.1093/asjof/ojad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Background Suction lipectomy (liposuction) is a popular cosmetic surgical procedure performed in the United States, but little has been documented regarding perioperative complications due to its outpatient nature. Objectives This cross-sectional study aims to analyze the most common complications that accompany liposuction-related procedures and importantly estimate the total complication rate occurring at ambulatory surgical facilities. Methods Adult patients who experienced liposuction-related complications from 2019 to 2021 were identified in the reporting database of the global surgery accreditation authority, the American Association for Accreditation of Ambulatory Surgery Facilities (QUAD A). Patients were then divided by complication type and procedure location. Demographics and facility-specific variables were analyzed. Descriptive statistics were performed. Results Overall, 984 patients were included, with a mean age of 44 years (interquartile range [IQR] 37-53) and a median BMI of 28.7 kg/m2 (IQR 25.7-32.2). The overall confirmed complication rate was found to be 0.40% (984/246,119). Unplanned emergency department presentation was the most common complication overall (24%). Wound disruption was associated with the longest median procedure length (261 min), and venous thromboembolism was associated with the highest median BMI (30.1 kg/m2). The Southeast had the most complications (431), which accounted for 13/21 deaths (61.9%). Out of all complications, death was associated with the highest average annual case volume (241). Conclusions Procedures that involve liposuction are associated with a variety of medical and surgical complications. Given the high frequency and variability in how liposuction is performed, a thorough assessment of complications is critical to improve the safety of this procedure. Level of Evidence 3
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Samuel J Lin
- Corresponding Author: Dr Samuel J. Lin, 110 Francis Street, Suite 5A, Boston, MA 02215, USA. E-mail: ; Instagram: @drsamuellin
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van la Parra RFD, Deconinck C, Pirson G, Servaes M, Fosseprez P. Lipedema: What we don't know. J Plast Reconstr Aesthet Surg 2023; 84:302-312. [PMID: 37390539 DOI: 10.1016/j.bjps.2023.05.056] [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: 12/21/2022] [Revised: 05/05/2023] [Accepted: 05/14/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Lipedema is a loose connective tissue disease characterized by a disproportionate accumulation of adipose tissue in the limbs of women. Despite its incidence of 10-20%, lipedema is often underdiagnosed and misdiagnosed. OBJECTIVES This review aims to outline current, available evidence regarding this enigmatic syndrome and gives a synopsis of the subjects that are still unknown. MATERIALS AND METHODS PubMed and Embase searches were conducted to identify relevant articles on lipedema pathophysiology, clinical presentation, diagnosis, and treatment. RESULTS Lipedema can be considered a disease of the adipocytes or a circulatory disorder of the lymphatics. The relationship between lymphatics and adipose tissue remains controversial. The clinical distinction between lipedema, lymphedema, phlebolymphedema, and lipolymphedema can be difficult. Diagnoses often coexist, further complicating the diagnosis of lipedema, which is currently made on clinical grounds alone. The value of diagnostic imaging studies is unclear. Liposuction appears to be an effective treatment and significantly improves symptoms. CONCLUSION Diagnosing lipedema remains a challenge due to its heterogeneous presentation, co-existing diseases, and lack of objective diagnostic imaging. Further directions for research include the effect of excess skin resection surgery on lymphatic drainage.
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Affiliation(s)
- R F D van la Parra
- Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU UCL Namur, Université Catholique de Louvain, Belgium.
| | - C Deconinck
- Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU UCL Namur, Université Catholique de Louvain, Belgium
| | - G Pirson
- Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU UCL Namur, Université Catholique de Louvain, Belgium
| | - M Servaes
- Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU UCL Namur, Université Catholique de Louvain, Belgium
| | - Ph Fosseprez
- Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU UCL Namur, Université Catholique de Louvain, Belgium
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Stein MJ, Sasson DC, Harrast J, Alderman A, Matarasso A, Gosain AK. A 16-Year Review of Clinical Practice Patterns in Liposuction Based on Continuous Certification by the American Board of Plastic Surgery. Plast Reconstr Surg 2023; 152:523-531. [PMID: 36735816 DOI: 10.1097/prs.0000000000010254] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The American Board of Plastic Surgery has collected data on cosmetic surgery tracers as part of the Continuous Certification process since 2005. The current study was performed to analyze evolving trends in liposuction from the American Board of Plastic Surgery database. METHODS Tracer data from 2005 through 2021 were reviewed and grouped into an early cohort (EC) (2005-2014) and a recent cohort (RC) (2015-2021). Fisher exact tests and two-sample t tests were used to compare patient demographics, techniques, and complications. RESULTS A total of 2810 suction-assisted liposuction cases were included (1150 EC, 1660 RC). In-office procedures increased (36% EC versus 41% RC). The use of general anesthesia remained the same (63% EC versus 62% RC). The use of power-assisted liposuction increased (24% EC versus 40% RC) and use of ultrasound-assisted liposuction decreased (5% versus 2%). With respect to body areas treated, liposuction of the abdomen (64% EC versus 69% RC), flanks (60% EC versus 64% RC), and back (22% EC versus 34% RC) increased; treatments of thighs (36% EC versus 23% RC), and knees (8% EC versus 5% RC) decreased. Intraoperative position changes are more common (30% EC versus 37% RC), as is liposuction of multiple areas in one case (28% EC versus 36% RC). The volume of lipoaspirate also increased (1150 cc EC versus 1660 cc RC). CONCLUSIONS This study highlights evolving trends in liposuction over 16 years. Liposuction is becoming more common as an outpatient procedure performed concomitantly with other procedures. Despite multiple emerging technologies, the popularity of power-assisted liposuction is increasing. Although adverse events have not significantly increased with these changes, the authors stress careful preoperative evaluation of patients to identify factors that increase the risk of complications.
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Affiliation(s)
- Michael J Stein
- From the Department of Plastic and Reconstructive Surgery, Lenox Hill Hospital
| | - Daniel C Sasson
- Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital
| | | | | | - Alan Matarasso
- From the Department of Plastic and Reconstructive Surgery, Lenox Hill Hospital
| | - Arun K Gosain
- Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital
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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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10
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Mortada H, Alshenaifi SA, Samawi HA, Marzoug MM, Alhumsi T, Alaithan B. The Safety of Large-Amount Liposuction: A Retrospective Analysis of 28 Cases. J Cutan Aesthet Surg 2023; 16:227-231. [PMID: 38189064 PMCID: PMC10768962 DOI: 10.4103/jcas.jcas_59_22] [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] [Indexed: 01/09/2024] Open
Abstract
Aim Our study aims to assess the safety of large amounts of liposuction in a new light. Materials and Methods This is a retrospective review of patients who underwent large-volume liposuction from August 2020 to April 2021. Patient demographics, liposuction areas, the amount of infiltrate and aspirate, the surface area of liposuction areas, anesthesia duration, pain score after surgery, preoperative and 4-h postoperative hemoglobin, and basic metabolic panel (sodium, potassium, creatinine, urea) were measured. Results Out of the 28 patients, 26 (92.85%) were females. The mean age was 37.1 years old. The mean preoperative hemoglobin was 13.73 g/dL. The average anesthesia time was 220.39 min. The average amount of liposuction infiltrated was 7.55 L, and the average amount of liposuction aspirate was 6.83 L. The mean hemoglobin 4 h postoperatively was 13.7 g/dL. Conclusions With proper patient selection and a comprehensive physical exam with preoperative blood workup performed in an accredited facility with a highly experienced plastic surgeon and anesthesiologist, mega liposuction can be safely performed as a day surgery procedure.
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Affiliation(s)
- Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Hussain A Samawi
- Department of Anesthesia, The Clinics Medical Center, Riyadh, Saudi Arabia
| | - Mohanad M Marzoug
- Department of Anesthesia, The Clinics Medical Center, Riyadh, Saudi Arabia
| | - Taghreed Alhumsi
- Plastic Surgery Division, Surgery Department, King Saud University Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia
| | - Bander Alaithan
- Plastic Surgery Division, Surgery Department, King Fahad Medical City, Riyadh, Saudi Arabia
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Fayi KA, Ali HA, Ali NM. The Incident of Multiple Skin Necrosis and Unilateral Vision Loss Post Liposuction: A Case Report. Cureus 2023; 15:e40384. [PMID: 37456502 PMCID: PMC10344639 DOI: 10.7759/cureus.40384] [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: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
For many years, people with excess weight around specific body parts who wanted to improve their shape or establish symmetry to achieve their ideal body image chose liposuction. As with any intervention, there is a chance of complications and unfavorable outcomes with liposuction. As a late result of the procedure, skin necrosis, infection, and hematoma are some of the known complications of such a procedure. Other known complications include damage to surrounding structures like nerves, vasculature, or perforating body viscera. This study aimed to report an eventful and unwanted result of a common and relatively safe cosmetic procedure. A 31-year-old Saudi female presented to the emergency room (ER) with right unilateral vision loss, bruises, and burning pain involving the upper limbs, thighs, abdomen, back, and flanks after having liposuction and rhinoplasty two weeks ago in a private clinic overseas. Multiple investigations were obtained to investigate her blindness, which showed a right upper branch of retinal vein occlusion. She was treated conservatively with daily wound dressings and analgesics. After five days, the patient returned with infected wounds and clinical deterioration, necessitating multiple excisions, debridement, and grafting. She eventually recovered and was discharged in good health. Herein, we report a rare case of unilateral blindness and multiple skin necrosis following liposuction of the abdomen and thigh. Debridement and skin grafting were the ideal treatment strategies.
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Affiliation(s)
- Khalid A Fayi
- Plastic and Reconstructive Surgery Section, Department of Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Hassan A Ali
- Department of Plastic and Reconstructive Surgery, King Abdulaziz Medical City, Riyadh, SAU
| | - Nashwa M Ali
- College of Medicine, Alfaisal University, Riyadh, SAU
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12
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Pulmonary Embolism after Liposuction Totally by Tumescent Local Anesthesia in a Patient with Large Uterine Fibroids. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4876. [PMID: 36923713 PMCID: PMC10010803 DOI: 10.1097/gox.0000000000004876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/31/2023] [Indexed: 03/16/2023]
Abstract
A fatal pulmonary embolism occurred in a 43-year-old black woman after tumescent liposuction totally by local anesthesia. An autopsy revealed large uterine fibroids, peri-uterine vascular thrombi, and a large saddle pulmonary embolism. Large uterine fibroids are a risk factor for postsurgical venous thromboembolism. Fatal outcomes after tumescent liposuction totally by local anesthesia are exceedingly rare.
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13
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Beyond the abdominal and pelvic cavity: abdominal wall and spinal "Aunt Minnies". Abdom Radiol (NY) 2023; 48:1479-1504. [PMID: 36790455 PMCID: PMC9930021 DOI: 10.1007/s00261-023-03830-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 02/16/2023]
Abstract
Abdominal wall and spinal soft tissue findings are frequently encountered on CT or MR imaging of the abdomen and pelvis. Many of these entities have specific imaging findings, for which a definitive diagnosis can be made without the need for further work up. These abdominal wall and spinal findings may be diagnostically challenging for sub-specialized abdominal radiologists who are unfamiliar with their appearance and appropriate management. This review article describes and illustrates pathognomonic or characteristic abdominal wall and spinal pathologies, which reside outside the abdominopelvic cavity. The cases selected all have findings that allow a confident diagnosis without further imaging or intervention. The cases presented include myonecrosis, intramuscular abscess, myositis, iliopsoas bursitis, Morel-Lavallée lesion, hydrocele of canal of Nuck, Klippel Trenaunay Weber syndrome, neurofibroma with target sign, perineural cysts, filum terminale lipoma, calvarial bone flap, transverse rectus abdominis muscle (TRAM) flap, liposuction, and hidradenitis suppurativa, among others. Although not all-encompassing, this paper will help abdominal radiologists to accurately diagnose a variety of abdominal and pelvic extra-cavitary soft tissue pathologies by identifying key radiologic findings.
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Khalaf MH, Sameer M, Khan MB, Ahmed A. Abdominal Visceral Injury, a Devastating Consequence of Abdominal Liposuction: A Case Report and Literature Review. Cureus 2023; 15:e34378. [PMID: 36874694 PMCID: PMC9977203 DOI: 10.7759/cureus.34378] [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: 01/29/2023] [Indexed: 01/31/2023] Open
Abstract
Abdominal liposuction is a commonly performed cosmetic procedure. However, as with any procedure, it can be associated with complications. One of the life-threatening complications of this procedure is visceral injury and bowel perforation. This complication is very rare, nevertheless general, and acute care surgeons must be aware of its possibility, its management, and its possible sequelae. We report a case of a 37-year-old female who underwent abdominal liposuction which was complicated by bowel perforation and was transferred to our facility for further care. She underwent an exploratory laparotomy in which multiple perforations were repaired. The patient then underwent multiple surgeries including stoma creation and had a long postoperative course. A literature review reveals the devastating sequelae of reported similar visceral and bowel injuries. The patient eventually did well and her stoma was reversed. This patient population will require close intensive care unit observation and a low threshold of suspicion for missed injuries during initial exploration. Further down the line, they will need psychosocial support and the mental health implications of this outcome must be cared for. The long-term aesthetic outcome is yet to be addressed.
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Affiliation(s)
| | | | | | - Aryan Ahmed
- Acute Care Surgery, Hamad Medical Corporation, Doha, QAT
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15
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Stahl S, Santos Stahl A, Feng YS, Estler A, Swoboda K, Buiculescu F, Seabra Robalo Gomes Jorge AC. Enhanced Recovery After Aesthetic Breast Surgery Under Sedation, Intercostal Block and Tumescent Anaesthesia: A Prospective Cohort Study of the Early Postoperative Phase. Aesthetic Plast Surg 2022; 47:979-997. [PMID: 36544050 PMCID: PMC9770569 DOI: 10.1007/s00266-022-03214-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: 09/01/2022] [Accepted: 11/26/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Comfort and recovery are major concerns of patients seeking aesthetic surgery. This study aimed to assess postoperative pain and recovery after outpatient breast surgery under sedation, intercostal block, and local anaesthesia. METHODS This prospective cohort study included all consecutive patients who underwent aesthetic breast surgery between April 2021 and August 2022. Epidemiological data, anaesthesia, pain, and patients' satisfaction were systematically assessed with standardized self-assessment questionnaires. RESULTS Altogether, 48 patients [median (IQR) age: 30 (36-25)] were included. The most frequent surgery was mastopexy. 69% of surgeries involved additional procedures. The mean intercostal block and local anaesthesia time was 15 min. Patients received a median (IQR) of 19 (34-2) mg/kg lidocaine and 2.3 (2.5-2.0) mg/kg ropivacaine. The median (IQR) consumption of propofol and alfentanil was, respectively, 4.89 (5.48-4.26) mg/kg/h and 0.27 (0.39-0.19) µg/kg/min. No conversion to general anaesthesia or unplanned hospital admission occurred. Patients were discharged after a median (IQR) of 2:40 (3:43-1:58) hours. Within the first 24 postoperative hours, 17% required once an antiemetic medication and 38% an opioid. Patients were very satisfied with the anaesthesia and 90% of the patients had not wished more analgesia in the first 24 h. CONCLUSIONS Aesthetic breast surgery under sedation, intercostal block, and tumescent anaesthesia can safely be performed as an ambulatory procedure and is associated with minimal intra- and postoperative opioid consumption and high patient satisfaction. These data may be used to inform patients and clinicians and improve the overall quality of care. 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)
- Stéphane Stahl
- CenterPlast Private Practice, Bahnhofstraße 36, 66111, Saarbrücken, Germany
| | | | - You-Shan Feng
- Institute for Clinical Epidemiology and Applied Biometrics, Medical University of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany
| | - Arne Estler
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Kamil Swoboda
- CenterPlast Private Practice, Bahnhofstraße 36, 66111, Saarbrücken, Germany
| | - Florian Buiculescu
- CenterPlast Private Practice, Bahnhofstraße 36, 66111, Saarbrücken, Germany
| | - Ana Cristina Seabra Robalo Gomes Jorge
- Department of General, Visceral, Vascular, and Pediatric Surgery, Saarland University Hospital, Kirrberger Straße 100, 66421, Homburg, Saarland, Germany.
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Muacevic A, Adler JR, Khan MM, Basireddy PR. ECG Changes Occurring During Chest Liposuction for Gynecomastia - Artifacts or a Cause for Concern? Cureus 2022; 14:e32850. [PMID: 36694503 PMCID: PMC9867793 DOI: 10.7759/cureus.32850] [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: 12/21/2022] [Indexed: 12/25/2022] Open
Abstract
Currently, liposuction alone or combined with various methods of gland excision has become the standard of care in the surgical management of gynecomastia. Although liposuction is considered a safe and straightforward method of body contouring, serious complications related to the procedure, including deaths, have been reported in the literature. We report the occurrence of ECG artifacts intra-operatively while performing chest liposuction under general anesthesia. Patients may receive unnecessary and potentially dangerous therapeutic interventions if these ECG artifacts are not identified correctly. A careful and rational evaluation of the patient and the ECG by the clinician can accurately identify these pseudo-abnormalities and avoid unnecessary therapies.
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Di Santis ÉP, Yarak S, Martins MR, Hirata SH. Compulsory notification of injuries in aesthetic procedures. Impact on patient safety. An Bras Dermatol 2022; 97:491-497. [PMID: 35654648 PMCID: PMC9263632 DOI: 10.1016/j.abd.2022.01.002] [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: 11/04/2021] [Revised: 01/04/2022] [Accepted: 01/18/2022] [Indexed: 11/25/2022] Open
Abstract
The disparity between the number of aesthetic procedures performed worldwide, and the complications described in the literature is remarkable. Doubts regarding the underreporting are reasonable and should be considered. The aim of this study is to demonstrate the scarcity of scientific publications on complications in aesthetic procedures compared to the abundance of these procedures performed worldwide. Based on this knowledge, it will be demonstrated to the health authorities the importance of compulsory notification of complications in aesthetic procedures that require medical attention so that the available data will allow their prevention. The limitation of knowledge regarding complications was demonstrated in the data collection for the preparation of the thesis “Deaths Related to Liposuction in Brazil” presented in 2018 and published in Surgical and Cosmetical Dermatology in 2020. The definition of complication in aesthetic procedures needs to be objective to prevent different and subjective interpretations. With the compulsory notification of complications in aesthetic procedures, it is intended to learn about their causes to develop guidelines for their prevention.
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Stein MJ, Matarasso A. High-Definition Liposuction in Men. Clin Plast Surg 2022; 49:307-312. [DOI: 10.1016/j.cps.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Perforation of Abdominal Viscera Following Liposuction: A Systemic Literature Review. Aesthetic Plast Surg 2022; 46:774-785. [PMID: 34462799 DOI: 10.1007/s00266-021-02532-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Liposuction is among the most popular esthetic procedures worldwide. With growing demand and popularity, reports of serious complications accumulate. Despite being a rare complication of the procedure, visceral perforation is associated with morbidity and severe debilitation. METHODS The authors conducted a literature search for reported cases of perforation of abdominal viscera following liposuction procedures in the electronic databases of PubMed, Scopus and Cochrane Library databases. RESULTS The authors found 22 publications; 19 cases case reports and three studies, reporting a total of 49 cases of visceral perforation following abdominal liposuction procedures. Average age of patients was 50 years (range 24-72). Twenty-seven patients (73%) were female, and 10 were male (27%). Forty (81%) patients underwent isolated liposuction, and nine (19%) had multiple procedures carried out in a single surgery. Twenty patients (42%) had undergone previous abdominal surgery, 13 (27%) suffered abdominal wall weakness or deformities, and 7 (14%) suffered from obesity. 25 (52%) ileal perforations occurred, 6 jejunal (12.5%), 5 colic (10%) and 2 (4%) each of splenic and hepatic. Seven patients (14%) died during their hospitalization, 20 (41%) were discharged with no sequelae complications, and 22 (45%) developed complications after discharge. CONCLUSIONS Liposuction is a popular esthetic procedure that underwent numerous changes over the past century since its introduction. Despite its widely accepted reputation of a safe procedure with minimal complications, a growing number of reports on visceral perforation following liposuction have emerged. Scrupulous pre-operative evaluation and high index of suspicion are crucial for avoiding complications and unfavorable outcomes. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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20
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Lee HJ, Lee JH, Bang CH, Jung JY, Park YM. High-intensity Focused Ultrasound Treatment for Excessive Subcutaneous Fat in Abdomen, Upper Arms, and Thigh: a Pilot Study. J Cosmet Dermatol 2022; 21:2009-2014. [PMID: 35080337 DOI: 10.1111/jocd.14801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 01/17/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND High-intensity focused ultrasound (HIFU) has been recently introduced as a non-invasive therapeutic modality for controlling excessive subcutaneous fat. OBJECTIVE The efficacy and safety of the HIFU device for sculpting the abdomen, upper arm, and thigh were evaluated. MATERIALS AND METHODS Ten subjects with more than 10 mm of subcutaneous fat in the abdomen, upper arm, and/or thigh were recruited. We evaluate mean change in the thickness and circumference of subcutaneous fat of each treated area measured using ultrasound 12 weeks after the procedure, the degree of pain, and subject and practitioner satisfaction 12 weeks after the procedure. RESULTS The mean change of subcutaneous fat thickness in the abdomen, upper arm, and thigh measured using ultrasound 12 weeks after the procedure was -4.33 ± 2.42, -1.86 ± 1.35, and -1.86 ± 1.35 mm, respectively. Compared with pretreatment, subcutaneous fat thickness of the abdomen and upper arm was significantly reduced (p = 0.0020 and p = 0.0004, respectively), but not in the thigh (p = 0.0716). Highest patient satisfaction was for the abdomen. Pain was generally tolerable. CONCLUSION The results from the present study indicate HIFU can be an effective and safe therapeutic modality for removing excessive subcutaneous fat in humans.
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Affiliation(s)
- Hyun Ji Lee
- Department of Dermatology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hyun Lee
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul Hwan Bang
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon-Yong Jung
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young Min Park
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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21
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Chinen H, Yoshimura S, Takegawa M, Miyamae N, Sumida Y. Iatrogenic abdominal hematoma and severe anemia due to cosmetic liposuction. Acute Med Surg 2022; 9:e780. [PMID: 36051447 PMCID: PMC9420171 DOI: 10.1002/ams2.780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/07/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Hitomi Chinen
- Department of Dermatology Rakuwakai Otowa Hospital Kyoto‐shi Japan
| | - Satoshi Yoshimura
- Department of Emergency Medicine Rakuwakai Otowa Hospital Kyoto‐shi Japan
| | - Masayasu Takegawa
- Department of Plastic Surgery Rakuwakai Otowa Hospital Kyoto‐shi Japan
| | - Nobuhiro Miyamae
- Department of Emergency Medicine Rakuwakai Otowa Hospital Kyoto‐shi Japan
| | - Yasuyuki Sumida
- Department of Emergency Medicine Rakuwakai Otowa Hospital Kyoto‐shi Japan
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Abstract
Fat embolism is an uncommon but life-threatening postoperative complication. The nonspecific symptoms associated with fat embolism could delay the diagnosis and result in a poor patient outcome. We report the case of a healthy 37-year-old woman who underwent a 6-hr breast and abdominal surgery with liposuction. Postoperatively, she displayed mild dyspnea, decreased oxygen saturation level, chest tightness, and fatigue. On Postoperative Day 3, pulmonary multislice computer tomography showed a fat embolus in her right pulmonary artery. She was treated with an anticoagulant to which she responded well and was discharged on Postoperative Day 7. This case demonstrates the need for surgeons, nurses, and anesthesia professionals to identify potential risk factors, recognize signs and symptoms, and implement effective treatment of pulmonary embolism to ameliorate the prognosis, improve the success of the surgery, and save the life of the patient.
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Affiliation(s)
- Minh Quang Pham
- Minh Quang Pham, MD, PhD , is a surgeon, anesthesiologist, and lecturer at Department of Anesthesia and Critical Care, Hanoi Medical University, Hanoi, Vietnam
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23
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Liu Z, Zhang W, Zhang B, Ma L, Zhou F, Hu Z, Jie X, Gao H, Zhu X. Toxic shock syndrome complicated with symmetrical peripheral gangrene after liposuction and fat transfer: a case report and literature review. BMC Infect Dis 2021; 21:1137. [PMID: 34742247 PMCID: PMC8571909 DOI: 10.1186/s12879-021-06777-2] [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: 05/13/2021] [Accepted: 10/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Liposuction is one of the most commonly performed aesthetic procedures. Toxic shock syndrome(TSS) is a rare, life-threatening complication. The incidence rate of TSS is very low in the plastic surgery field, especially after liposuction and fat transfer. CASE PRESENTATION A 23-year-old female patient was transferred to our emergency department from an aesthetic clinic with sepsis shock features after received liposuction and fat transfer. The patient underwent TSS, disseminated intravascular coagulation(DIC), multiple organ dysfunction syndrome (MODS), symmetrical peripheral gangrene (SPG), and necrotizing soft tissue infection of the buttocks in the next 10 days. Authors used a series of debridement and reconstructive surgery including vacuum sealing drainage (VSD) treatment, artificial dermis grafts,split-thickness skin grafts, amputation surgeries when her vital signs were stable. The patient experienced desquamation of the hand on the 26th day. The skin grafts survived and the function of both fingers and toes recovered. She was discharged 2 months after admission and was in good health. CONCLUSION TSS is extremely rare in the field of liposuction and autologous fat transfer. The mortality rate of TSS is very high. Early diagnosis and operative treatment, as well as correction of systemic abnormalities, are the important keys to save a patient's life.
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Affiliation(s)
- Zhiwan Liu
- Department of Plastic Surgery, Shanghai Changzheng Hospital, No.415 Fengyang Road, Huangpu District, Shanghai, 200003, China
| | - Wenjun Zhang
- Department of Plastic Surgery, Shanghai Changzheng Hospital, No.415 Fengyang Road, Huangpu District, Shanghai, 200003, China
| | - Boyu Zhang
- Department of Emergency, Shanghai Changzheng Hospital, Shanghai, China
| | - Linhao Ma
- Department of Emergency, Shanghai Changzheng Hospital, Shanghai, China
| | - Feng Zhou
- Department of Plastic Surgery, Shanghai Tongji Hospital, Shanghai, China
| | - Zheyuan Hu
- Department of Plastic Surgery, Shanghai Changzheng Hospital, No.415 Fengyang Road, Huangpu District, Shanghai, 200003, China
| | - Xiang Jie
- Department of Plastic Surgery, Shanghai Changzheng Hospital, No.415 Fengyang Road, Huangpu District, Shanghai, 200003, China
| | - Hong Gao
- Department of Plastic Surgery, Shanghai Changzheng Hospital, No.415 Fengyang Road, Huangpu District, Shanghai, 200003, China
| | - Xiaohai Zhu
- Department of Plastic Surgery, Shanghai Changzheng Hospital, No.415 Fengyang Road, Huangpu District, Shanghai, 200003, China.
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Pacifico M, Kanapathy M, Dancey A, MacQuillan A, Ross G, Mosahebi A. Summary document on safety and recommendations for aesthetic liposuction: Joint British Association of Aesthetic Plastic Surgeons (BAAPS)/British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) expert liposuction group. J Plast Reconstr Aesthet Surg 2021; 75:941-947. [PMID: 34776388 DOI: 10.1016/j.bjps.2021.09.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/22/2021] [Accepted: 09/27/2021] [Indexed: 11/27/2022]
Abstract
Liposuction is one of the commonest surgical aesthetic procedures performed worldwide. Despite being perceived to be a technically simple procedure, poor patient selection, sub-optimal technical execution or sub-optimal peri‑operative management could lead to significant harm. This guidance was produced on behalf of the British Association of Aesthetic Plastic Surgeons (BAAPS) and British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) by the expert liposuction group. The guidance is based on the evidence available in the literature along with specialist expert opinion in aesthetic liposuction to provide plastic surgeons with consensus recommendation. The aim is to identify best practice to maximise the safety of patients. This article summarises current practices and safety considerations and outlines recommendations covering various aspects of patient care.
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Affiliation(s)
- Marc Pacifico
- Purity Bridge, 19 Mount Ephraim, Tunbridge Wells, Kent TN4 8AE, United Kingdom.
| | - Muholan Kanapathy
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London NW3 2QG, United Kingdom; Division of Surgery & Interventional Science, University College London, London WC1E 6BT, United Kingdom.
| | - Anne Dancey
- Parkway Hospital, 1 Damson Parkway, Solihull B91 2PP, United Kingdom.
| | | | - Gary Ross
- University of Manchester, Oxford Rd, Manchester M13 9PL, United Kingdom
| | - Afshin Mosahebi
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London NW3 2QG, United Kingdom; Division of Surgery & Interventional Science, University College London, London WC1E 6BT, United Kingdom.
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25
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Flores González EA, Pérez Chávez F, Ramírez Guerrero OR, Gracida Mancilla NI, Vázquez Apodaca RA. A New Surgical Approach to Body Contouring. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3540. [PMID: 34046290 PMCID: PMC8143746 DOI: 10.1097/gox.0000000000003540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/29/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND The success of body contouring surgery will largely depend on the correct choice and performance of the technique, and utilization of the necessary scientific measures. Thus, this study sought to highlight the combination and evolution of the abdominoplasty-assisted liposuction technique, while individualizing each case for the patient's benefit. METHOD We present a series of 188 cases from the past 3 years (2017-2019), using our modification to the surgical technique: performing 360-degree liposuction first, and then abdominoplasty in the same surgical time. We show our aesthetic results, surgical time, and complications, so as to compare them with the literature. RESULTS Of the 188 cases, 184 were women (97.9%) and 4 were men (2.1%). In 11 cases (5.8%), we recorded 4 hours as a minimum surgical time and 8 hours in 16 cases (8.5%) as a maximum time. Regarding complications, hematomas were recorded in 1 case (0.5%) as the least frequent complication and seromas in 18 cases (9.6%) as the most frequent complication. The aesthetic results, although not objectively measurable, are flattering for both the patient and the surgeon, as shown by documented evidence (photographs) before and after surgery. CONCLUSIONS Our study supports favorable results. Modification of this technique has resulted in outstanding body contouring surgery. We hope this procedure can be reproduced because of its few complications and the pleasant results it yields.
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Affiliation(s)
| | | | - Oliver René Ramírez Guerrero
- Hospital General de México “Dr. Eduardo Liceaga” Department of Plastic and Reconstructive Surgery, Mexico City, Mexico
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Azab SS, Hamed HA, Elseginy A, Elzawahry HM, Ismail NN. Increase apparent penile length by cryolipolysis in the reduction of male suprapubic fat. Andrologia 2021; 53:e13963. [PMID: 33426693 DOI: 10.1111/and.13963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 11/28/2022] Open
Abstract
The buried or hidden penis in adults is troublesome in males, whereas the length of the penile shaft is buried under the skin surface of the suprapubic fat to a degree that reveals the concept of a little penis. We aimed to assess a new modality of treatment to increase the apparent penile length by using the cryolipolysis in the reduction of male suprapubic fat as a noninvasive procedure. This prospective study was performed on 46 male patients complaining of buried short apparent small size penis. All patients were subjected to full medical history, body mass index and examination of penile (length, size and abnormalities). The measures of the apparent penile length from the skin to the tip of the glans penis and suprapubic skin fold thickness using (adipometer) were recorded before the three consecutive suprapubic cryolipolysis sessions. The mean apparent stretched penile length at session 1, 2 and 3 were 12.1 ± 0.5 cm, 12.66 ± 0.48 and 12.88 ± 0.72, respectively, with a statistically significant increase between three sessions (p < .001), whereas the mean skin fold suprapubic fat at session 1, 2 and 3 was 2.99 ± 0.49 cm, 2.37 ± 0.48 and 2 ± 0.37, respectively, with a statistically significant decrease (p < .001). The cryolipolysis of suprapubic fat is a safe, effective, noninvasive and applicable procedure that successfully decreases the suprapubic fat in males and increases the apparent length of the buried penises.
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Affiliation(s)
- Sherif Salah Azab
- Urology Department, Faculty of Medicine, October 6 University, Cairo, Egypt
| | | | - Amgad Elseginy
- Andrology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Nashaat Nabil Ismail
- Andrology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
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27
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Pohlan J, Miller H, Lerchbaumer MH, Krenzien F, Benzing C, Mogl MT, Diekhoff T. Multiple liver perforations: complication of an outpatient liposuction procedure. Radiol Case Rep 2021; 16:906-910. [PMID: 33603942 PMCID: PMC7873377 DOI: 10.1016/j.radcr.2021.01.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 11/26/2022] Open
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Güven A, Schaffartzik W, Allert S. [Liposuctions in the ambulatory setting]. HANDCHIR MIKROCHIR P 2021; 53:400-406. [PMID: 33525036 DOI: 10.1055/a-1333-2696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Liposuctions are among the most frequently performed operations in plastic surgery worldwide. They are offered as inpatient as well as outpatient procedures. In the outpatient setting, tumescent anaesthesia is used in various forms. There is ambiguity about the amount of lipoaspirate that can be removed safely in an outpatient setting, and also about the monitoring of parameters and the duration of postoperative care. MATERIAL AND METHODS A systematic literature review was conducted with the help of the MEDLINE data base of the U. S. National Library of Medicine (NLM) and the bibliographic search engine Google Scholar (https://scholar.google.com) of Google LLC. The key words "Liposuction Anesthesia" and "Liposuction Guidelines" were used. All items resulting from the search were checked for thematic concordance and further analysed by their level of evidence, significance and availability. RESULTS After the literature review, a total of 197 items were identified for further analysis. The analysis of the international and German literature yielded a systematic overview of recommendations. CONCLUSIONS Tumescence anaesthesia in an outpatient setting has various advantages, e. g. cost reduction for provider and patient as well as avoidance of the risk profile of general anaesthesia. Also patients can change their position autonomously, which can be beneficial for surgery. However, there are limitations in terms of the lipoaspirate volume that can be removed safely. With increasing lipoaspirate volumes, more local anaesthetic is needed, which also increases the postoperative monitoring time. In the authors view, tumescent anaesthesia should only be used for small-volume and localised liposuctions. Liposuction in general anaesthesia offers more advantages, especially with increasing lipoaspirate volumes.
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Affiliation(s)
- Asim Güven
- Sana Klinikum Hameln-Pyrmont, Plastische und Ästhetische Chirurgie, Handchirurgie
| | | | - Sixtus Allert
- Sana Klinikum Hameln-Pyrmont, Plastische und Ästhetische Chirurgie, Handchirurgie
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29
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Myckatyn TM. Commentary on: Primary Breast Augmentation With Autologous Fat Grafting Alone: Evaluation of Patient Satisfaction Using the BREAST-Q. Aesthet Surg J 2020; 40:1205-1207. [PMID: 31915827 DOI: 10.1093/asj/sjz370] [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)
- Terence M Myckatyn
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO
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Water-jet-assisted liposuction for the treatment of lipedema: Standardized treatment protocol and results of 63 patients. J Plast Reconstr Aesthet Surg 2020; 73:1637-1644. [DOI: 10.1016/j.bjps.2020.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/22/2020] [Accepted: 03/07/2020] [Indexed: 01/05/2023]
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Spreading Awareness: Bowel Perforation with Liposuction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2715. [PMID: 32537364 PMCID: PMC7253287 DOI: 10.1097/gox.0000000000002715] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/28/2020] [Indexed: 11/26/2022]
Abstract
Complications with liposuction are not uncommon; some of these are very serious and can be life-threatening. In this case report, we represent a case of bowel perforation with liposuction.
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Gardener C, Pandis L, Grigatti M, Vindigni V, Bassetto F, Brambullo T. Bowel perforation after liposuction in abdominal contouring surgery: Case report. Int J Surg Case Rep 2020; 72:5-9. [PMID: 32506029 PMCID: PMC7276379 DOI: 10.1016/j.ijscr.2020.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/03/2020] [Accepted: 05/03/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Liposuction is one of the most performed procedures in aesthetic plastic surgery worldwide, and its spectrum of applications covers almost all body areas. Systemic or visceral complications following liposuction are rare, but unfortunately, they can be very serious. PRESENTATION OF CASE We discuss the case of a 69 y.o. woman who underwent abdominal contouring surgery consisting in flank pseudohernia correction, liposuction and short scar abdominoplasty, which was complicated by intestinal perforation. Bowel perforation was suspected on the 3rd day following surgery after a CT-scan and was treated with exploration through a median laparotomy, resection of the perforated bowel and subsequent ileo-ileal anastomosis. The 10 cm-long resected segment of the small intestine presented multiple 2 mm-large holes at the microscopic examination. DISCUSSION We assume that patient position on the operating table and abdominal wall laxity during surgery as well as the timing of each specific procedure played an important role in the occurrence of bowel perforation. CONCLUSION To our knowledge, this is the first case report of an accidental visceral perforation during a combined procedure of flank bulging correction and abdominal liposuction. Overall the increased risk of combined procedures in plastic surgery is linked to increased operative time. In the current case timing of surgery sequence more than operative time itself was relevant in increasing anterior abdominal wall pressure and thus setting the patient at a higher risk of bowel perforation.
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Affiliation(s)
- Caterina Gardener
- Clinic of Plastic and Reconstructive Surgery, Neuroscience Department, University of Padua, Italy.
| | - Laura Pandis
- Clinic of Plastic and Reconstructive Surgery, Neuroscience Department, University of Padua, Italy
| | - Martina Grigatti
- Clinic of Plastic and Reconstructive Surgery, Neuroscience Department, University of Padua, Italy
| | - Vincenzo Vindigni
- Clinic of Plastic and Reconstructive Surgery, Neuroscience Department, University of Padua, Italy
| | - Franco Bassetto
- Clinic of Plastic and Reconstructive Surgery, Neuroscience Department, University of Padua, Italy
| | - Tito Brambullo
- Clinic of Plastic and Reconstructive Surgery, Neuroscience Department, University of Padua, Italy
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Severe and massive necrosis following high definition power-assisted liposuction: a case report. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-020-01678-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Liposuction fat emboli resulting in myocardial infarction: a case report and review of the literature. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-019-01514-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mrad S, El Tawil C, Sukaiti WA, Bou Chebl R, Abou Dagher G, Kazzi Z. Cardiac Arrest Following Liposuction: A Case Report of Lidocaine Toxicity. Oman Med J 2019; 34:341-344. [PMID: 31360324 PMCID: PMC6642719 DOI: 10.5001/omj.2019.66] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a case of a patient presenting to the emergency department in cardiac arrest following a liposuction procedure, which was performed in a physician office using lidocaine anesthesia. During liposuction of the thighs, using the power-assisted technique, the patient was given a subcutaneous dose of lidocaine equal to 71 mg/kg without any noticeable intraoperative complication. Two hours later, the patient experienced dizziness, a rapid decline in mental status, tonic-clonic seizure, and cardiac arrest. The patient was successfully resuscitated in the emergency department with the return of spontaneous circulation after 22 minutes of continuous advanced cardiovascular life support resuscitation. The patient suffered from subsequent severe hypoxic-ischemic brain injury, and a complicated hospital stay, including brain edema, electrolytes disturbances, and nosocomial infections contributed to her death two months later due to septic shock.
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Affiliation(s)
- Sandra Mrad
- Emergency Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Chady El Tawil
- Emergency Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Waleed A Sukaiti
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ralph Bou Chebl
- Emergency Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Gilbert Abou Dagher
- Emergency Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ziad Kazzi
- Emergency Department, American University of Beirut Medical Center, Beirut, Lebanon.,Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Georgia Poison Center, Atlanta, Georgia, USA
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Marques Álvarez L, Rodríguez-García R, Palomo Antequera C, Escudero Augusto D, González-Pinto I. Intestinal perforation after liposuction. Cir Esp 2019; 97:536-538. [PMID: 30683272 DOI: 10.1016/j.ciresp.2018.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 11/27/2018] [Accepted: 12/15/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Lara Marques Álvarez
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Raquel Rodríguez-García
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
| | - Carmen Palomo Antequera
- Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Dolores Escudero Augusto
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Ignacio González-Pinto
- Servicio de Cirugía General, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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Pak J, Lee JH, Pak NJ, Park KS, Jeon JH, Jeong BC, Lee SH. Clinical Protocol of Producing Adipose Tissue-Derived Stromal Vascular Fraction for Potential Cartilage Regeneration. J Vis Exp 2018. [PMID: 30320755 DOI: 10.3791/58363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Osteoarthritis (OA) is one of the most common debilitating disorders. Recently, numerous attempts have been made to improve the functions of the knees by using different forms of mesenchymal stem cells (MSCs). In Korea, bone marrow concentrates and cord blood-derived stem cells have been approved by the Korean Food and Drug Administration (KFDA) for cartilage regeneration. In addition, an adipose tissue-derived stromal vascular fraction (SVF) has been allowed by the KFDA for joint injections in human patients. Autologous adipose tissue-derived SVF contains extracellular matrix (ECM) in addition to mesenchymal stem cells. ECM excretes various cytokines that, along with hyaluronic acid (HA) and platelet-rich plasma (PRP) activated by calcium chloride, may help MSCs to regenerate cartilage and improve knee functions. In this article, we presented a protocol to improve knee functions by regenerating cartilage-like tissue in human patients with OA. The result of the protocol was first reported in 2011 followed by a few additional publications. The protocol involves liposuction to obtain autologous lipoaspirates that are mixed with collagenase. This lipoaspirates-collagenase mixture is then cut and homogenized to remove large fibrous tissue that may clog up the needle during the injection. Afterwards, the mixture is incubated to obtain adipose tissue-derived SVF. The resulting adipose tissue-derived SVF, containing both adipose tissue-derived MSCs and remnants of ECM, is injected into knees of patients, combined with HA and calcium chloride activated PRP. Included are three cases of patients who were treated with our protocol resulting in improvement of knee pain, swelling, and range of motion along with MRI evidence of hyaline cartilage-like tissue.
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Affiliation(s)
| | - Jung Hun Lee
- Mipro Medical Clinic; National Leading Research Laboratory, Department of Biological Sciences, Myongji University
| | | | - Kwang Seung Park
- National Leading Research Laboratory, Department of Biological Sciences, Myongji University
| | - Jeong Ho Jeon
- National Leading Research Laboratory, Department of Biological Sciences, Myongji University
| | - Byeong Chul Jeong
- National Leading Research Laboratory, Department of Biological Sciences, Myongji University
| | - Sang Hee Lee
- National Leading Research Laboratory, Department of Biological Sciences, Myongji University;
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Kim JL, Shin JY, Roh SG, Chang SC, Lee NH. Buried umbilicus with inflammation due to retained rubber foreign body after liposuction: A case report. Medicine (Baltimore) 2018; 97:e10800. [PMID: 29923971 PMCID: PMC6023665 DOI: 10.1097/md.0000000000010800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Liposuction is one of the most widely performed aesthetic surgeries. It is mainly used for the correction of deep and superficial fat accumulations and remodeling of the body contour. CASE PRESENTATION We present a rare case of unusual rubber foreign body found within the periumbilical area during the reconstruction of buried umbilicus after liposuction.A 61-year-old female had undergone a liposuction surgery 10 years ago. Last year, she experienced signs of inflammation around the periumbilical area. The patient was treated with antibiotics and daily dressing at a local clinic. However, her symptoms did not improve with treatment.After admission, we decided to reconstruct the umbilicus and explore the previous operative site. During reconstruction of umbilicus, we finally discovered a rubber foreign body in the periumbilical area and buried umbilicus. CONCLUSION Retained surgical foreign body can clinically manifest as acute reaction, such as an inflammatory response, infection, or abscess within days or weeks after the operation. Patients may complain of pain and discomfort, even months or years after the procedure.Our patient had suffered from delayed inflammation due to retained surgical foreign body after liposuction surgery. We emphasize the need for excellent communication within the surgical team to prevent the incidence of retained surgical bodies.
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Affiliation(s)
- Jong-Lim Kim
- Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Jin Yong Shin
- Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Si-Gyun Roh
- Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
- Division, of Plastic surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Suk Choo Chang
- Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Nae-Ho Lee
- Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
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Ezzeddine H, Husari A, Nassar H, Kanso M, Nounou GE, Khalife M, Faraj W. Life Threatening Complications Post-Liposuction. Aesthetic Plast Surg 2018; 42:384-387. [PMID: 29387943 DOI: 10.1007/s00266-017-1058-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 12/06/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Liposuction is one of the most commonly performed aesthetic procedures. It is performed worldwide as an outpatient procedure. However, the complications are underestimated and underreported by caregivers. We present a case of delayed diagnosis of bilothorax secondary to liver and gallbladder injury after tumescent liposuction. METHODS A 26-year-old female patient was transferred to our emergency department from an aesthetic clinic with worsening dyspnea, tachypnea and fatigue. She had undergone extensive liposuction of the thighs, buttocks, back and abdomen 5 days prior to presentation. RESULTS A chest X-ray showed significant right-sided pleural effusion. Thoracentesis was performed and drained bilious fluid. CT scan of the abdomen revealed pleural, liver and gall bladder injury. An exploratory laparoscopy confirmed the findings, the collections were drained; cholecystectomy and intraoperative cholangiogram were performed. The patient did very well postoperatively and was discharged home in 2 days. CONCLUSION Even though liposuction is considered a simple office-based procedure, its complications can be fatal. The lack of strict laws that exclusively place this procedure in the hands of medical professionals allow these procedures to still be done by less experienced hands and in outpatient-based settings. Our case serves to highlight yet another unique but potentially fatal complication of liposuction. LEVEL OF EVIDENCE V 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)
- Hiba Ezzeddine
- Department of General Surgery, Liver Transplantation and Hepatopancreaticobiliary Unit, American University of Beirut Medical center, Beirut, Lebanon
| | - Ahmad Husari
- Department of Internal Medicine, Respiratory Diseases and Sleep Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hussein Nassar
- Department of General Surgery, Liver Transplantation and Hepatopancreaticobiliary Unit, American University of Beirut Medical center, Beirut, Lebanon
| | - Mariam Kanso
- Department of General Surgery, Liver Transplantation and Hepatopancreaticobiliary Unit, American University of Beirut Medical center, Beirut, Lebanon
| | - Ghina El Nounou
- Department of General Surgery, Liver Transplantation and Hepatopancreaticobiliary Unit, American University of Beirut Medical center, Beirut, Lebanon
| | - Mohamad Khalife
- Department of General Surgery, Liver Transplantation and Hepatopancreaticobiliary Unit, American University of Beirut Medical center, Beirut, Lebanon
| | - Walid Faraj
- Department of General Surgery, Liver Transplantation and Hepatopancreaticobiliary Unit, American University of Beirut Medical center, Beirut, Lebanon.
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D'Ambrosi R, Indino C, Maccario C, Manzi L, Usuelli FG. Autologous Microfractured and Purified Adipose Tissue for Arthroscopic Management of Osteochondral Lesions of the Talus. J Vis Exp 2018. [PMID: 29443020 DOI: 10.3791/56395] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In recent years, regenerative techniques have been increasingly studied and used to treat osteochondral lesions of the talus. In particular, several studies have focused their attention on mesenchymal stem cells derived from adipose tissue. Adipose-derived stem cells (ADSCs) exhibit morphological characteristics and properties similar to other mesenchymal cells, and are able to differentiate into several cellular lines. Moreover, these cells are also widely available in the subcutaneous tissue, representing 10 - 30% of the normal body weight, with a concentration of 5,000 cells per gram of tissue. In the presented technique, the first step involves harvesting ADSCs from the abdomen and a process of microfracture and purification; next, the surgical procedure is performed entirely arthroscopically, with less soft tissue dissection, better joint visualization, and a faster recovery compared with standard open procedures. Arthroscopy is characterized by a first phase in which the lesion is identified, isolated, and prepared with microperforations; the second step, performed dry, involves injection of adipose tissue at the level of the lesion. Between January 2016 and September 2016, four patients underwent arthroscopic treatment of osteochondral lesion of the talus with microfractured and purified adipose tissue. All patients reported clinical improvement six months after surgery with no reported complications. Functional scores at the latest follow-up are encouraging and confirm that the technique provides reliable pain relief and improvements in patients with osteochondral lesion of the talus.
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Affiliation(s)
- Riccardo D'Ambrosi
- IRCCS Istituto Ortopedico Galeazzi - C.A.S.C.O. Piede e Caviglia; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano;
| | - Cristian Indino
- IRCCS Istituto Ortopedico Galeazzi - C.A.S.C.O. Piede e Caviglia
| | - Camilla Maccario
- IRCCS Istituto Ortopedico Galeazzi - C.A.S.C.O. Piede e Caviglia
| | - Luigi Manzi
- IRCCS Istituto Ortopedico Galeazzi - C.A.S.C.O. Piede e Caviglia
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Abstract
Liposuction began in the 1920s when the Parisian surgeon Charles Dujarier became interested in body shaping and fat removal. Today, it is estimated that 1,453,000 liposuctions are annually performed worldwide. In Germany, 45,000 liposuctions are performed annually. The majority of liposuctions are performed as self-pay services. The aim of this article is to outline the development of liposuction, to explain the various liposuction procedures and methods, to clarify the indications for treatment, and point out the complications and pitfalls described in the literature.
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Affiliation(s)
- D Schlarb
- Hautklinik, Universitätsklinikum Münster, Von Esmarchstr. 58, 48149, Münster, Deutschland.
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Bellini E, Grieco MP, Raposio E. A journey through liposuction and liposculture: Review. Ann Med Surg (Lond) 2017; 24:53-60. [PMID: 29158895 PMCID: PMC5681335 DOI: 10.1016/j.amsu.2017.10.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/17/2017] [Accepted: 10/22/2017] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Nowadays, liposuction is the most frequently performed aesthetic surgery procedure in Western Countries. This technique has had rapid development since the 1970s, when it was experimented for the first time by A. and G. Fischer. It is currently widely used in clinical practice for many different situations in aesthetic, reconstructive and functional fields. MATERIALS AND METHODS This review aims to describe the historical evolution of liposuction by analyzing the transformation of the method in function of the introduction of innovative ideas or instruments. We have also focused on reporting the major clinical applications of this surgical technique, applicable to almost the entire body surface. We finally analyzed the complications, both major and minor, associated with this surgical technique. RESULTS Liposuction is mainly used to correct deep and superficial fat accumulations and remodel the body contour. It has become an essential complementary technique to enhance the aesthetic result of many other aesthetic procedures such as reduction mammoplasty, abdominoplasty, brachioplasty, thigh lift and post bariatric body contouring. However, it can be largely used for the treatment of innumerable pathologies in reconstructive surgery such as lipomas, lipedema, lipodystrophies, pneudogynecomastia and gynecomastia, macromastia e gigantomastia, lymphedema and many others. The complication rate is very low, especially when compared with conventional excisional surgery and the major, complications are generally associated with improper performance of the technique and poor patient management before and after surgery. CONCLUSION Liposuction is a safe, simple and effective method of body contouring. It has enormous potential for its application in ablative and reconstructive surgery, far from the most common aesthetic processes with a very low complication rate.
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Affiliation(s)
- Elisa Bellini
- Department of Medicine and Surgery, Plastic Surgery Section, University of Parma, Cutaneous, Mini-invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
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Lin DJ, Wong TT, Ciavarra GA, Kazam JK. Adventures and Misadventures in Plastic Surgery and Soft-Tissue Implants. Radiographics 2017; 37:2145-2163. [DOI: 10.1148/rg.2017170090] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Dana J. Lin
- From the Department of Radiology, New York-Presbyterian Hospital, Columbia University Medical Center, 622 W 168th St, MC-28, New York, NY 10032 (D.J.L., T.T.W., J.K.K.); and the Department of Radiology, NYU Langone Medical Center–Hospital for Joint Diseases, New York, NY (G.A.C.)
| | - Tony T. Wong
- From the Department of Radiology, New York-Presbyterian Hospital, Columbia University Medical Center, 622 W 168th St, MC-28, New York, NY 10032 (D.J.L., T.T.W., J.K.K.); and the Department of Radiology, NYU Langone Medical Center–Hospital for Joint Diseases, New York, NY (G.A.C.)
| | - Gina A. Ciavarra
- From the Department of Radiology, New York-Presbyterian Hospital, Columbia University Medical Center, 622 W 168th St, MC-28, New York, NY 10032 (D.J.L., T.T.W., J.K.K.); and the Department of Radiology, NYU Langone Medical Center–Hospital for Joint Diseases, New York, NY (G.A.C.)
| | - Jonathan K. Kazam
- From the Department of Radiology, New York-Presbyterian Hospital, Columbia University Medical Center, 622 W 168th St, MC-28, New York, NY 10032 (D.J.L., T.T.W., J.K.K.); and the Department of Radiology, NYU Langone Medical Center–Hospital for Joint Diseases, New York, NY (G.A.C.)
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Müller CSL, Hubner W, Thieme-Ruffing S, Pföhler C, Vogt T, Volk T, Gärtner BC, Bialas P. Pre- and perioperative aspects of dermatosurgery. J Dtsch Dermatol Ges 2017; 15:117-146. [PMID: 28214316 DOI: 10.1111/ddg.13181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 12/13/2016] [Indexed: 12/12/2022]
Abstract
Dermatosurgery occupies an exceptional position among all surgical disciplines. Above all, this includes the fact that, with very few exceptions, the vast majority of surgical interventions can be performed under local or regional anesthesia, usually in smaller procedure rooms that are spatially separated from larger operating suites. Thus, peri- and postinterventional patient monitoring is the responsibility of the dermatosurgeon and his team. Though inherently smaller, this team still has to observe numerous perioperative requirements that - in larger surgical specialties - would be attended to by a host of various specialists working in concert. Said requirements include hygienic aspects, knowledge concerning pre- and intraoperative patient monitoring, managing surgical site infections, adequate postsurgical pain management, as well as detailed pharmacological knowledge with respect to common local anesthetics and the toxic and allergic reactions associated therewith. Not only does this require interdisciplinary collaboration and shared responsibility for the patient. It also necessitates the development and implementation of quality-oriented and evidence-based guidelines that, in the dermatosurgical setting, usually extend far beyond the scope of the specialty per se. The objective of the present CME article is the condensed presentation of interdisciplinary aspects relating to the most important perioperative issues.
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Affiliation(s)
- Cornelia S L Müller
- Department of Dermatology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Wakiko Hubner
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Homburg/Saar, Germany
| | - Sigrid Thieme-Ruffing
- Institute for Medical Microbiology and Hygiene, Saarland University Medical Center, Homburg/Saar, Germany
| | - Claudia Pföhler
- Department of Dermatology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Thomas Vogt
- Department of Dermatology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Thomas Volk
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Homburg/Saar, Germany
| | - Barbara C Gärtner
- Institute for Medical Microbiology and Hygiene, Saarland University Medical Center, Homburg/Saar, Germany
| | - Patric Bialas
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Homburg/Saar, Germany
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Cárdenas-Camarena L, Andrés Gerardo LP, Durán H, Bayter-Marin JE. Strategies for Reducing Fatal Complications in Liposuction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1539. [PMID: 29184746 PMCID: PMC5682182 DOI: 10.1097/gox.0000000000001539] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 08/29/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Liposuction has become one of the most common cosmetic surgical procedures, and severe complications secondary to this procedure have also increased significantly. That is why we carry out a research work to know the most frequent severe complications reported in the scientific literature to indicate criteria for prevention. METHODS English-language scientific publications about liposuction and its complications were analyzed using the PubMed.gov, from the beginning of PubMed's history through June 10, 2017. Five terms were used to define liposuction and its complications: "liposuction," "liposuction AND complications," liposuction AND major complications," "liposuction AND complications AND death," and "liposuction AND death." The quantities of results for the 5 phrases were analyzed, along with their contents. RESULTS One thousand sixty-three results were obtained from 1973 through June 10, 2017 for the phrase "Liposuction and Complications" in humans; for "Liposuction and Major Complications," 153 articles were found; for "Liposuction and Deaths," 89 articles were found; and 42 articles were obtained with the terms "Liposuction and Major Complications and Deaths." After final depuration, all those that were not specific to severe liposuction complications were eliminated, leaving a total of 39 articles that were included in our study. Five problems proved to be the most serious complications when performing liposuction: Thromboembolic disease, fat embolism, pulmonary edema, lidocaine intoxication, and intraabdominal visceral lesion. CONCLUSIONS The 5 most important complications that can cause death in liposuction are easily preventable using simple measures and proper safety protocols that are described in this work.
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Affiliation(s)
- Lázaro Cárdenas-Camarena
- From the INNOVARE, Specialized Plastic Surgery, Division of Plastic Surgery at the Jalisco Institute of Reconstructive Surgery “Dr. José Guerrerosantos,” Zapopan, Jalisco, México; Private Practice, Monterrey, México; Private Practice, Mérida, Yuc, México; and Private Practice, Medical Director of Clínica “EL Pinar” in Bucaramanga, Colombia
| | - Lozano-Peña Andrés Gerardo
- From the INNOVARE, Specialized Plastic Surgery, Division of Plastic Surgery at the Jalisco Institute of Reconstructive Surgery “Dr. José Guerrerosantos,” Zapopan, Jalisco, México; Private Practice, Monterrey, México; Private Practice, Mérida, Yuc, México; and Private Practice, Medical Director of Clínica “EL Pinar” in Bucaramanga, Colombia
| | - Héctor Durán
- From the INNOVARE, Specialized Plastic Surgery, Division of Plastic Surgery at the Jalisco Institute of Reconstructive Surgery “Dr. José Guerrerosantos,” Zapopan, Jalisco, México; Private Practice, Monterrey, México; Private Practice, Mérida, Yuc, México; and Private Practice, Medical Director of Clínica “EL Pinar” in Bucaramanga, Colombia
| | - Jorge Enrique Bayter-Marin
- From the INNOVARE, Specialized Plastic Surgery, Division of Plastic Surgery at the Jalisco Institute of Reconstructive Surgery “Dr. José Guerrerosantos,” Zapopan, Jalisco, México; Private Practice, Monterrey, México; Private Practice, Mérida, Yuc, México; and Private Practice, Medical Director of Clínica “EL Pinar” in Bucaramanga, Colombia
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Interstitial Granulomatous Dermatitis with Granuloma Annulare-Like Pattern Following Liposuction. Arch Plast Surg 2017; 44:470-471. [PMID: 28946733 PMCID: PMC5621822 DOI: 10.5999/aps.2017.44.5.470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/11/2017] [Accepted: 06/22/2017] [Indexed: 11/08/2022] Open
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Zilg B, Råsten-Almqvist P. Fatal Fat Embolism After Penis Enlargement by Autologous Fat Transfer: A Case Report and Review of the Literature. J Forensic Sci 2017; 62:1383-1385. [DOI: 10.1111/1556-4029.13403] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/08/2016] [Accepted: 11/09/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Brita Zilg
- Swedish National Board of Forensic Medicine; Retzius väg 5 SE-171 65 Stockholm Sweden
| | - Petra Råsten-Almqvist
- Swedish National Board of Forensic Medicine; Retzius väg 5 SE-171 65 Stockholm Sweden
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Prevention of Surgical Site Infections and Biofilms: Pharmacokinetics of Subcutaneous Cefazolin and Metronidazole in a Tumescent Lidocaine Solution. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1351. [PMID: 28607871 PMCID: PMC5459654 DOI: 10.1097/gox.0000000000001351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 04/07/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tumescent anesthesia antibiotic delivery (TAAD) consists of subcutaneous infiltration of antibiotic(s) dissolved tumescent lidocaine anesthesia. Tumescent lidocaine anesthesia contains lidocaine (≤ 1 g/L), epinephrine (≤ 1 mg/L), sodium bicarbonate (10 mEq/L) in 0.9% saline. Our aim was to measure cefazolin and metronidazole concentrations over time in subcutaneous tumescent interstitial fluid (TISF) after TAAD, in serum after TAAD and after intravenous antibiotic delivery (IVAD). We hypothesize that the pharmacokinetic/pharmacodynamic profiles of TAAD + IVAD are superior to IVAD alone for the prevention of surgical site infections and biofilms. METHODS Concentrations of cefazolin and metronidazole in TISF and serum following TAAD and in serum following IVAD were compared in 5 female volunteers. Subjects received cefazolin or cefazolin plus metronidazole by IVAD alone and by TAAD alone. One subject also received concomitant IVAD and TAAD of these 2 antibiotics. Sequential samples of serum or subcutaneous TISF were assayed for antibiotic concentration. RESULTS Cefazolin (1 g) by TAAD resulted in an area under the curve of the concentration-time profile and a maximum concentration (Cmax) in subcutaneous tissue that were 16.5 and 5.6 times greater than in serum following 1 g by IVAD. Metronidazole (500 mg) by TAAD resulted in an area under the curve and Cmax that were 8.1 and 24.7 times greater in TISF, than in serum after 500 mg by intravenous delivery. IVAD + TAAD resulted in superior antibiotic concentrations to IVAD alone. CONCLUSIONS TAAD + IVAD produced superior antibiotic bioavailability in both subcutaneous interstitial fluid and serum compared with IVAD alone. There was no evidence that TAAD of cefazolin and metronidazole poses a significant risk of harm to patients.
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