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Comerci AJ, Arellano JA, Alessandri-Bonetti M, Mocharnuk JW, Marangi GF, Persichetti P, Rubin JP, Egro FM. Risks and Complications Rate in Liposuction: A Systematic Review and Meta-Analysis. Aesthet Surg J 2024; 44:NP454-NP463. [PMID: 38563572 DOI: 10.1093/asj/sjae074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/17/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
Liposuction is a surgical procedure used to remove localized excess adipose tissue. According to The Aesthetic Society's latest annual report, liposuction is the most commonly performed cosmetic procedure. Despite its popularity, the existing literature lacks a unified understanding of the risks associated with liposuction. The aim of this study was to measure complications of liposuction. A systematic review and meta-analysis was reported according to PRISMA guidelines and registered on the PROSPERO database (CRD42023471626). The primary outcome was overall complication rate. The absolute risk for individual complications was also assessed. From 2957 articles, 39 studies were selected for analysis. In total, 29,368 patients were included, with a mean age of 40.62 years and mean BMI of 26.36 kg/m2. Overall, the rate of any complication was 2.62 (95% CI, 1.78-3.84). The most common complication was contour deformity, with a prevalence of 2.35% (95% CI, 1.05%-5.16%). The prevalence of hyperpigmentation was 1.49% (95% CI, 1.12%-1.99%), seroma 0.65% (95% CI, 0.33%-1.24%), hematoma 0.27% (95% CI, 0.12%-0.60%), superficial burn 0.25% (95% CI, 0.17%-0.36%), allergic reaction 0.16% (95% CI, 0.050%-0.52%), skin necrosis 0.046% (95% CI, 0.013%-0.16%), generalized edema 0.041% (95% CI, 0.0051%-0.32%), infection 0.020% (95% CI, 0.010%-0.050%), venous thromboembolism 0.017% (95% CI, 0.0060%-0.053%), and local anesthesia toxicity 0.016% (95% CI, 0.0040%-0.064%). Liposuction is a safe procedure with low complications, of which contour deformity is the most common. Raising awareness of specific risks can enhance surgical outcomes and improve patient-physician understanding. LEVEL OF EVIDENCE: 3
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Zhang M, Wang L, Tan L, Sun C, Xiao Y, Zhang T, Tan G, Long X, Wang H, Wang Y. Effects of Heated Infiltration Solutions and Forced-Air Heating Blankets on Intraoperative Hypothermia During Liposuction: A Factorial Randomized Controlled Trial. Aesthetic Plast Surg 2024; 48:1956-1963. [PMID: 38238567 DOI: 10.1007/s00266-023-03801-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/05/2023] [Indexed: 05/30/2024]
Abstract
BACKGROUND This study was conducted to compare the effects of heat preservation by two recommended methods, heated infiltration solutions and forced-air heating blankets, in patients undergoing liposuction under general anesthesia. METHODS Forty patients were divided into four groups based on whether heated infiltration solutions or forced-air heating blankets were used. Group A received general anesthesia liposuction plastic surgery routine temperature care. Based on the care measures of group A, heated infiltration solutions were used in group B; forced-air heating blanket was used in group C; and heated infiltration solutions and forced-air heating blankets were both used in group D. The primary end point was intraoperative and perioperative temperature measured with an infrared tympanic membrane thermometer. Secondary end points included surgical outcomes, subjective experience, and adverse events. RESULTS Compared with group A, the intraoperative body temperatures of groups B, C, and D were significantly higher, indicating that the two intervention methods were helpful on increasing the core body temperature. Pairwise comparisons of these three groups showed that there was no significant difference between group C and group D. However, using forced-air heating blankets had a marked effect compared with using heated infiltration solutions alone at three time points. The same trend could be seen in other surgical outcomes. CONCLUSIONS Heated infiltration solutions and forced-air heating blankets could reduce the incidence of intraoperative hypothermia and improve patients' prognosis after liposuction under general anesthesia. Compared with the heated infiltration fluid, the forced-air heating blanket may have a better thermal insulation effect. LEVEL OF EVIDENCE I 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)
- Mengfei Zhang
- Department of Anesthesia, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Liquan Wang
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Linjuan Tan
- Department of Anesthesia, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Chen Sun
- Department of Anesthesia, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Yiding Xiao
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Tong Zhang
- Department of Anesthesia, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Gang Tan
- Department of Anesthesia, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Xiao Long
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Huizhen Wang
- Department of Anesthesia, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| | - Yang Wang
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
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Aljerian A, Abi-Rafeh J, Hemmerling T, Gilardino MS. Complications of Aesthetic Liposuction Performed in Isolation: A Systematic Literature Review and Meta-Analysis. Plast Surg (Oakv) 2024; 32:19-32. [PMID: 38433796 PMCID: PMC10902471 DOI: 10.1177/22925503221078693] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Introduction: Aesthetic liposuction represents one of the most commonly performed cosmetic procedures worldwide. The purpose of this article is to examine and synthesize reported complication rates and explore the analytical prospect of possible patient or procedure-related predictive factors associated with specific complications. Methods: A systematic review was performed using the Pubmed, Cochrane, and Embase databases in line with specific criteria set to ensure an accurate assessment of complication rates; extracted data was synthesized through a random-effects model and meta-analysis of proportions. Results: A total of 60 studies were included in the meta-analysis, representing 21,776 patients undergoing aesthetic liposuction. Most studies followed an observational design. The overall complication rate was 12% (95% confidence interval [CI] 8%, 16%). When stratifying according to specific complications, the incidence of contour irregularities was determined to be 2% (95% CI 1%, 2%), seroma 2% (95% CI 1%; 2%), hematoma 1% (95% CI 0%, 1%), surgical site infection 1% (95% CI 1%, 2%), fibrosis or induration 1% (95% CI 1%, 2%), and pigmentary changes 1% (95% CI 1%, 1%), among others. A meta-regression to identify patient- or procedure-related factors associated with greater complication rates proved infeasible given the nature of the available data. Conclusion: Overall, liposuction demonstrated a relatively low complication rate profile, however, a considerable degree of heterogeneity exists within the examined literature preventing the recognition of predictive risk factors. While this calls for efforts to establish consensus on unified methods of outcomes reporting, the present meta-analysis can serve to provide practitioners with an evidence-based reference to improve informed consent and inform clinical guidelines, specifically pertaining to the incidence of commonly encountered complications in aesthetic liposuction, of which presently available survey studies and database queries remain devoid.
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Affiliation(s)
- Albaraa Aljerian
- Division of Plastic and Reconstructive Surgery, McGill University, Montreal, Quebec, Canada
- Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada
| | - Jad Abi-Rafeh
- Division of Plastic and Reconstructive Surgery, McGill University, Montreal, Quebec, Canada
| | - Thomas Hemmerling
- Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada
| | - Mirko S. Gilardino
- Division of Plastic and Reconstructive Surgery, McGill University, Montreal, Quebec, Canada
- Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada
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Massiah G, De Palma G, Negri A, Mele F, Loisi D, Paradiso AV, Ressa CM. Cryopreservation of adipose tissue with and without cryoprotective agent addition for breast lipofilling: A cytological and histological study. Cryobiology 2021; 103:141-146. [PMID: 34333035 DOI: 10.1016/j.cryobiol.2021.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
In the second reconstructive phase of the breast after mastectomy, lipofilling is often necessary. Currently, lipofilling occurs immediately after autologous adipose tissue harvesting procedure, but most of the patients, usually, require multiple sessions to obtain a satisfactory result. Therefore, the need of repeated surgical harvesting outputs implies high risk of patients' morbidity and discomfort as well as increasing medical time and costs. The aim of our pilot study was to find out a feasible method to cryopreserve adipose tissue, in order to avoid reiterated liposuctions. Lipoaspirates samples have been harvested from 10 women and preserved by three methods: (1) the first one, using 10% Me2SO and 20% human albumin from human plasma as cryoprotective agents; (2) the second one, adding 5% Me2SO as cryoprotective agent; 3) the last one, without any cryoprotective agent. Fresh and cryopreserved fat samples, obtained through the aforementioned processes, have been analyzed ex vivo. The efficiency of the cryopreservation methods used was determined by adipocyte viability and the expression of adipocytes surface markers. Lipoaspirates stored at -196 °C for 3 months, after thawing, retained comparable adipocyte viability and histology to fresh tissue and no significant differences were found between the three methods used. Although the current results, differences between the methodologies in terms of viability may not become evident until breast lipofilling using frozen-thawed cryopreserved tissue.
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Affiliation(s)
- Grace Massiah
- Plastic and Reconstructive Surgery Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Viale Orazio Flacco 65, 70124, Bari, BA, Italy.
| | - Giuseppe De Palma
- Institutional BioBank, Experimental Oncology and Biobank Management Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Viale Orazio Flacco 65, 70124, Bari, BA, Italy.
| | - Antonio Negri
- Haematology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Viale Orazio Flacco 65, 70124, Bari, BA, Italy.
| | - Fabio Mele
- Pathological Anatomy Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Viale Orazio Flacco 65, 70124, Bari, BA, Italy.
| | - Donato Loisi
- Pathological Anatomy Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Viale Orazio Flacco 65, 70124, Bari, BA, Italy.
| | - Angelo Virgilio Paradiso
- Institutional BioBank, Experimental Oncology and Biobank Management Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Viale Orazio Flacco 65, 70124, Bari, BA, Italy.
| | - Cosmo Maurizio Ressa
- Plastic and Reconstructive Surgery Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Viale Orazio Flacco 65, 70124, Bari, BA, Italy.
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Sakai Y, Fukunishi S, Takamura M, Inoue O, Takashima S, Usui S, Seki A, Nasti A, Ho TTB, Kawaguchi K, Asai A, Tsuchimoto Y, Yamashita T, Yamashita T, Mizukoshi E, Honda M, Imai Y, Yoshimura K, Murayama T, Wada T, Harada K, Higuchi K, Kaneko S. Regenerative Therapy for Liver Cirrhosis Based on Intrahepatic Arterial Infusion of Autologous Subcutaneous Adipose Tissue-Derived Regenerative (Stem) Cells: Protocol for a Confirmatory Multicenter Uncontrolled Clinical Trial. JMIR Res Protoc 2020; 9:e17904. [PMID: 32229470 PMCID: PMC7319609 DOI: 10.2196/17904] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/02/2020] [Accepted: 03/11/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Liver cirrhosis results from chronic hepatitis, and is characterized by advanced fibrosis due to long-term hepatic inflammation. Cirrhosis ultimately leads to manifestations of jaundice, ascites, and encephalopathy, and increases the risk of hepatocellular carcinoma. Once cirrhosis is established, resulting in hepatic failure, no effective treatment is available. Therefore, novel therapies to inhibit disease progression of cirrhosis are needed. OBJECTIVE The objective of this investigator-initiated clinical trial is to assess the safety and efficacy of autologous adipose tissue-derived regenerative (stem) cell therapy delivered to the liver via the hepatic artery in patients with liver cirrhosis. METHODS Through consultation with the Japan Pharmaceuticals and Medical Devices Agency, we designed a clinical trial to assess a therapy for liver cirrhosis based on autologous adipose tissue-derived regenerative (stem) cells, which are extracted using an adipose tissue dissociation device. The primary endpoints of the trial are the serum albumin concentration, prothrombin activity, harmful events, and device malfunction. RESULTS Enrollment and registration were initiated in November 2017, and the follow-up period ended in November 2019. Data analysis and the clinical study report will be completed by the end of March 2020. CONCLUSIONS Completion of this clinical trial, including data analysis, will provide data on the safety and efficacy of this novel liver repair therapy based on autologous adipose tissue-derived regenerative (stem) cells using an adipose tissue dissociation device. TRIAL REGISTRATION UMIN Clinical Trials Registry UMIN000022601; https://tinyurl.com/w9uqw3q. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/17904.
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Affiliation(s)
- Yoshio Sakai
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
| | - Shinya Fukunishi
- Department of Gastroenterology, Osaka Medical College, Takatsuki, Japan
| | - Masayuki Takamura
- Department of Cardiovascular Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Oto Inoue
- Department of Cardiovascular Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Shinichiro Takashima
- Department of Cardiovascular Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Soichiro Usui
- Department of Cardiovascular Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Akihiro Seki
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
| | | | | | - Kazunori Kawaguchi
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
| | - Akira Asai
- Department of Gastroenterology, Osaka Medical College, Takatsuki, Japan
| | - Yusuke Tsuchimoto
- Department of Gastroenterology, Osaka Medical College, Takatsuki, Japan
| | - Taro Yamashita
- Department of General Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Tatsuya Yamashita
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
| | - Eishiro Mizukoshi
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
| | - Masao Honda
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
| | - Yasuhito Imai
- Innovative Clinical Research Center, Kanazawa University, Kanazawa, Japan
| | - Kenichi Yoshimura
- Innovative Clinical Research Center, Kanazawa University, Kanazawa, Japan.,Center for Integrated Medical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Toshinori Murayama
- Innovative Clinical Research Center, Kanazawa University, Kanazawa, Japan
| | - Takashi Wada
- Department of Nephrology, Kanazawa University Hospital, Kanazawa, Japan
| | - Kenichi Harada
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Kazuhide Higuchi
- Department of Gastroenterology, Osaka Medical College, Takatsuki, Japan
| | - Shuichi Kaneko
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan.,System Biology, Kanazawa University, Kanazawa, Japan
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Prevention of Progression of Lipedema With Liposuction Using Tumescent Local Anesthesia: Results of an International Consensus Conference. Dermatol Surg 2020; 46:220-228. [DOI: 10.1097/dss.0000000000002019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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van de Pas CB, Boonen RS, Stevens S, Willemsen S, Valkema R, Neumann M. Does tumescent liposuction damage the lymph vessels in lipoedema patients? Phlebology 2019; 35:231-236. [PMID: 31674863 PMCID: PMC7178148 DOI: 10.1177/0268355519885217] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Lymphatic insufficiency might play a significant role in the pathophysiology
of lipoedema. Liposuction is up to now the best treatment. As liposuction is
invasive, the technique could destruct parts of the lymphatic system and by
this aggravate the lymphatic component and/or induce lymphoedema. We
investigated the function of the lymphatic system in lipoedema patients
before and after tumescent liposuction and thus whether tumescent
liposuction can be regarded as a safe treatment. Methods Lymphoscintigraphy was performed to quantify the lymph outflow of 117
lipoedema patients. Mean clearance percentages of radioactive protein loaded
after 1 min with respect to the total injected dose and corrected for decay
of the radiopharmaceutical in the subcutaneous lymphatics were used as
functional quantitative parameters as well as the clearance percentages and
inguinal uptake 2 h post injection. The results of lymphatic function in
lipoedema patients were compared with values obtained from normal healthy
volunteers. We also compared 50 lymphoscintigraphies out of the previous 117
lipoedema patients before and six months after tumescent liposuction. Results In 117 lipoedema patients clearance 2 h post injection in the right and left
foot was disturbed in 79.5 and 87.2% respectively. The inguinal uptake 2 h
post injection in the right and left groin was disturbed in 60.3 and 64.7%
respectively. In 50 lipoedema patients mean clearance and inguinal uptake
after tumescent liposuction were slightly improved, 0.01 (p = 0.37) versus
0.02 (p = 0.02), respectively. This is statistically not relevant in
clearance. Conclusion Lipoedema legs have a delayed lymph transport. Tumescent liposuction does not
diminish the lymphatic function in lipoedema patients, thus tumescent
liposuction can be regarded as a safe treatment.
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Affiliation(s)
- Chantalle B van de Pas
- Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands.,Polikliniek de Blaak, Rotterdam, The Netherlands.,Kliniek De Medici, Blaricum, The Netherlands
| | | | | | - Sten Willemsen
- Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands
| | - Roelf Valkema
- Department of Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Martino Neumann
- Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands
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Abstract
PURPOSE OF REVIEW Although both cost and patient preference tend to favor the office-based setting, one must consider the hidden costs in managing complications and readmissions. The purpose of this review is to provide an update on safety outcomes of office-based procedures, as well as to identify common patient-specific factors that influence the decision for office-based surgery or impact patient outcomes. RECENT FINDINGS Office-based anesthesia (OBA) success rates from the latest publications of orthopedic, plastic, endovascular, and otolaryngologic continue to improve. A common thread among these studies is the ability to predict which patients will benefit from going home the same day, as well as identifying comorbid factors that would lead to failure to discharge or readmission after surgery. Specifically, patients with active infection, cardiovascular disease, coagulopathy, insulin-dependent diabetes, obesity, obstructive sleep apnea, poorly controlled hypertension, and thromboembolic disease are presumed to be poor candidates for outpatient office procedures. SUMMARY Overall, anesthesia and surgery in the office is becoming increasingly safe. Recent data suggest that the improved safety in the office-based setting is attributable to proper patient selection. Anesthesiologists play a critical role in prescreening eligible patients to ensure a safe and productive process. Patients treated in the office seem to be selected based on their low risk for complications, and our review reflects this position.
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Tumescent Liposuction-Induced Koebnerization of Lichen Planus. Dermatol Surg 2019; 45:1342-1344. [PMID: 30608289 DOI: 10.1097/dss.0000000000001752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Yanina IY, Svenskaya YI, Prikhozhdenko ES, Bratashov DN, Lomova MV, Gorin DA, Sukhorukov GB, Tuchin VV. Optical monitoring of adipose tissue destruction under encapsulated lipase action. JOURNAL OF BIOPHOTONICS 2018; 11:e201800058. [PMID: 29900686 DOI: 10.1002/jbio.201800058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/12/2018] [Indexed: 06/08/2023]
Abstract
Enzymatic destruction of adipose tissue has been achieved by encapsulation of lipase into the polymeric microcapsules. Adipose tissue destruction was delayed while lipase is encapsulated comparing with the direct lipase action as demonstrated by optical microscopy and optical coherence tomography in in vitro studies. Raman spectroscopy confirms that triglycerides in fat tissue were cleaved into free fatty acids, glycerol, and possible di- and monoglyceride residues. The results underpin the concept of local and controlled treatment of tissues via encapsulation. Effect of lipase encapsulation into the polymeric microcapsules on adipose tissue destruction compared to free lipase application.
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Affiliation(s)
- Irina Yu Yanina
- Research-Educational Institute of Optics and Biophotonics, Saratov State University, Saratov, Russia
- Education and Research Institution of Nanostructures and Biosystems, Saratov State University, Saratov, Russia
- Interdisciplinary Laboratory of Biophotonics, Tomsk State University, Tomsk, Russia
| | - Yulia I Svenskaya
- Education and Research Institution of Nanostructures and Biosystems, Saratov State University, Saratov, Russia
| | - Ekaterina S Prikhozhdenko
- Education and Research Institution of Nanostructures and Biosystems, Saratov State University, Saratov, Russia
| | - Daniil N Bratashov
- Education and Research Institution of Nanostructures and Biosystems, Saratov State University, Saratov, Russia
| | - Maria V Lomova
- Education and Research Institution of Nanostructures and Biosystems, Saratov State University, Saratov, Russia
| | - Dmitry A Gorin
- Education and Research Institution of Nanostructures and Biosystems, Saratov State University, Saratov, Russia
- Skoltech Center of Photonics and Quantum Materials, Skolkovo Institute of Science and Technology, Skolkovo Innovation Center, Moscow, Russia
| | - Gleb B Sukhorukov
- Education and Research Institution of Nanostructures and Biosystems, Saratov State University, Saratov, Russia
- Queen Mary University of London, London, UK
| | - Valery V Tuchin
- Research-Educational Institute of Optics and Biophotonics, Saratov State University, Saratov, Russia
- Interdisciplinary Laboratory of Biophotonics, Tomsk State University, Tomsk, Russia
- Laboratory of Laser Diagnostics of Technical and Living Systems, Institute of Precision Mechanics and Control of the Russian Academy of Sciences, Saratov, Russia
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Liposuction in the Treatment of Lipedema: A Longitudinal Study. Arch Plast Surg 2017; 44:324-331. [PMID: 28728329 PMCID: PMC5533060 DOI: 10.5999/aps.2017.44.4.324] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/27/2017] [Accepted: 05/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background Lipedema is a condition consisting of painful bilateral increases in subcutaneous fat and interstitial fluid in the limbs with secondary lymphedema and fibrosis during later stages. Combined decongestive therapy (CDT) is the standard of care in most countries. Since the introduction of tumescent technique, liposuction has been used as a surgical treatment option. The aim of this study was to determine the outcome of liposuction used as treatment for lipedema. Methods Twenty-five patients who received 72 liposuction procedures for the treatment of lipedema completed a standardized questionnaire. Lipedema-associated complaints and the need for CDT were assessed for the preoperative period and during 2 separate postoperative follow-ups using a visual analog scale and a composite CDT score. The mean follow-up times for the first postoperative follow-up and the second postoperative follow-up were 16 months and 37 months, respectively. Results Patients showed significant reductions in spontaneous pain, sensitivity to pressure, feeling of tension, bruising, cosmetic impairment, and general impairment to quality of life from the preoperative period to the first postoperative follow-up, and these results remained consistent until the second postoperative follow-up. A comparison of the preoperative period to the last postoperative follow-up, after 4 patients without full preoperative CDT were excluded from the analysis, indicated that the need for CDT was reduced significantly. An analysis of the different stages of the disease also indicated that better and more sustainable results could be achieved if patients were treated in earlier stages. Conclusions Liposuction is effective in the treatment of lipedema and leads to an improvement in quality of life and a decrease in the need for conservative therapy.
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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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Sakai Y, Takamura M, Seki A, Sunagozaka H, Terashima T, Komura T, Yamato M, Miyazawa M, Kawaguchi K, Nasti A, Mochida H, Usui S, Otani N, Ochiya T, Wada T, Honda M, Kaneko S. Phase I clinical study of liver regenerative therapy for cirrhosis by intrahepatic arterial infusion of freshly isolated autologous adipose tissue-derived stromal/stem (regenerative) cell. Regen Ther 2017; 6:52-64. [PMID: 30271839 PMCID: PMC6134901 DOI: 10.1016/j.reth.2016.12.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/12/2016] [Accepted: 12/08/2016] [Indexed: 12/14/2022] Open
Abstract
Introduction Adipose tissue stromal cells contain a substantial number of mesenchymal stem cells. As such, their application to regeneration of miscellaneous impaired organs has attracted much attention. Methods We designed a clinical study to investigate freshly isolated autologous adipose tissue-derived stromal/stem (regenerative) cell (ADRC) therapy for liver cirrhosis and conducted treatment in four cirrhotic patients. ADRCs were isolated from autologous subcutaneous adipose tissue obtained by the liposuction method, followed with use of the Celution system adipose tissue dissociation device. The primary endpoint is assessment of safety one month after treatment. We also characterized the obtained ADRCs. Results Two patients had type C cirrhosis, one had nonalcoholic steatohepatitis-cirrhosis, and one had type B cirrhosis. No serious adverse events were observed during the 1-month study period after freshly isolated ADRC infusion. Serum albumin concentrations were maintained or improved during this period as well as during the succeeding follow-up of approximately 1 year in two patients and 6 months in another patient. Liver regeneration-related factors, namely hepatocyte growth factor and interleukin-6, were elevated 1 day after ADRC treatment in all patients. The obtained freshly isolated ADRCs were expanded in culture and found to express mesenchymal stem cell markers. Gene expression profile analysis of ADRCs was shown to involve inflammatory features, suggesting that characteristics of the obtained ADRCs were related to immunomodulatory biological effects. Conclusion This clinical study treatment for liver cirrhosis using ADRCs was proven to be safely conductible, and can be further investigated in future for regeneration/repair of liver cirrhosis. Clinical study of liver cirrhosis therapy using adipose tissue-derived stromal cells. Autologous adipose tissue-derived stromal/stem (regenerative) cells were administered via intrahepatic arterial transfusion into cirrhotic patients. The obtained adipose tissue-derived stromal cells were shown to contain mesenchymal stem cells.
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Affiliation(s)
- Yoshio Sakai
- Department of Gastroenterology, Kanazawa University Hospital, Japan.,Department of Laboratory Medicine, Kanazawa University, Japan
| | - Masayuki Takamura
- Department of Cardiology, Kanazawa University Hospital, Japan.,System Biology, Kanazawa University, Japan
| | | | - Hajime Sunagozaka
- Department of Gastroenterology, Kanazawa University Hospital, Japan.,System Biology, Kanazawa University, Japan
| | | | | | - Masatoshi Yamato
- Department of Gastroenterology, Kanazawa University Hospital, Japan.,System Biology, Kanazawa University, Japan
| | | | | | | | | | - Soichiro Usui
- Department of Cardiology, Kanazawa University Hospital, Japan.,System Biology, Kanazawa University, Japan
| | | | - Takahiro Ochiya
- Division of Molecular and Cellular Medicine, National Cancer Institute, Japan
| | - Takashi Wada
- Department of Laboratory Medicine, Kanazawa University, Japan
| | - Masao Honda
- Department of Gastroenterology, Kanazawa University Hospital, Japan
| | - Shuichi Kaneko
- Department of Gastroenterology, Kanazawa University Hospital, Japan.,System Biology, Kanazawa University, Japan
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Lamprou DAA, Voesten HGJ, Damstra RJ, Wikkeling ORM. Circumferential suction-assisted lipectomy in the treatment of primary and secondary end-stage lymphoedema of the leg. Br J Surg 2016; 104:84-89. [DOI: 10.1002/bjs.10325] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/25/2016] [Accepted: 08/23/2016] [Indexed: 01/15/2023]
Abstract
Abstract
Background
The treatment of end-stage lymphoedema of the leg is challenging, especially when conservative treatment fails and there is a large volume difference between the affected and unaffected legs. Circumferential suction-assisted lipectomy (CSAL) has been described as a treatment option for end-stage lymphoedema of the leg. Here, the long-term results of CSAL in end-stage primary and secondary lymphoedema of the leg were analysed.
Methods
This was a descriptive study of patients treated with CSAL for unilateral chronic irreversible lymphoedema of the leg. Compression therapy was resumed after surgery. Leg volumes were measured before surgery, and at 1, 6, 12 and 24 months after the procedure.
Results
A total of 47 patients with primary lymphoedema had a median preoperative volume difference between affected and unaffected legs of 3686 (i.q.r. 2851–5121) ml. Two years after surgery, this volume difference was reduced to 761 ml, a 79 per cent reduction. In the 41 patients treated for secondary lymphoedema, the median preoperative volume difference was 3320 (i.q.r. 2533–4783) ml, decreasing after 2 years to −38 ml (101 per cent reduction). The preoperative volume difference and the sex of the patient significantly influenced the final outcome after 2 years. The outcome was not related to BMI or other patient characteristics.
Conclusion
CSAL is an effective method for treating both primary and secondary lymphoedema of the leg.
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Affiliation(s)
- D-A A Lamprou
- Expert Centre of Lympho-Vascular Medicine, Departments of Vascular Surgery, Nij Smellinghe Hospital, Drachten, The Netherlands
| | - H G J Voesten
- Expert Centre of Lympho-Vascular Medicine, Departments of Vascular Surgery, Nij Smellinghe Hospital, Drachten, The Netherlands
| | - R J Damstra
- Departments of Dermatology, Nij Smellinghe Hospital, Drachten, The Netherlands
| | - O R M Wikkeling
- Expert Centre of Lympho-Vascular Medicine, Departments of Vascular Surgery, Nij Smellinghe Hospital, Drachten, The Netherlands
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Abstract
Supplemental Digital Content is available in the text. Published ahead of print February 18, 2016 BACKGROUND: Tumescent lidocaine anesthesia consists of subcutaneous injection of relatively large volumes (up to 4 L or more) of dilute lidocaine (≤1 g/L) and epinephrine (≤1 mg/L). Although tumescent lidocaine anesthesia is used for an increasing variety of surgical procedures, the maximum safe dosage is unknown. Our primary aim in this study was to measure serum lidocaine concentrations after subcutaneous administration of tumescent lidocaine with and without liposuction. Our hypotheses were that even with large doses (i.e., >30 mg/kg), serum lidocaine concentrations would be below levels associated with mild toxicity and that the concentration-time profile would be lower after liposuction than without liposuction. METHODS: Volunteers participated in 1 to 2 infiltration studies without liposuction and then one study with tumescent liposuction totally by local anesthesia. Serum lidocaine concentrations were measured at 0, 2, 4, 6, 8, 10, 12, 14, 16, 18, and 24 hours after each tumescent lidocaine infiltration. Area under the curve (AUC∞) of the serum lidocaine concentration-time profiles and peak serum lidocaine concentrations (Cmax) were determined with and without liposuction. For any given milligram per kilogram dosage, the probability that Cmax >6 μg/mL, the threshold for mild lidocaine toxicity was estimated using tolerance interval analysis. RESULTS: In 41 tumescent infiltration procedures among 14 volunteer subjects, tumescent lidocaine dosages ranged from 19.2 to 52 mg/kg. Measured serum lidocaine concentrations were all <6 μg/mL over the 24-hour study period. AUC∞s with liposuction were significantly less than those without liposuction (P = 0.001). The estimated risk of lidocaine toxicity without liposuction at a dose of 28 mg/kg and with liposuction at a dose of 45 mg/kg was ≤1 per 2000. CONCLUSIONS: Preliminary estimates for maximum safe dosages of tumescent lidocaine are 28 mg/kg without liposuction and 45 mg/kg with liposuction. As a result of delayed systemic absorption, these dosages yield serum lidocaine concentrations below levels associated with mild toxicity and are a nonsignificant risk of harm to patients.
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Affiliation(s)
- Jeffrey A Klein
- From the *Department of Dermatology, University of California, Irvine, Medical Sciences, Irvine, California; and †Department of Statistics, University of California, Riverside, Riverside, California
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Abstract
Lipedema is an uncommon disorder characterized by localized adiposity of the lower extremities, often occurring in females with a family history of the condition. The adiposity extends from hips to ankles and is typically unresponsive to weight loss. In addition to the aesthetic deformity, women also describe pain in the lower extremities, particularly with pressure, as well as easy bruising. Although the condition is well described, it is relatively rare and often misdiagnosed. The purpose of this review is to describe the initial evaluation and diagnosis of lipedema and discuss treatment options.
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Affiliation(s)
- Anne Warren Peled
- Private Plastic and Reconstructive Surgery Practice, San Francisco, CA, USA
| | - Elisabeth A Kappos
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital, Basel, Switzerland
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Pavlović MD. Regarding "Tumescent technique without epinephrine for endovenous laser therapy and serum lidocaine concentration". J Vasc Surg Venous Lymphat Disord 2016; 3:345. [PMID: 26992319 DOI: 10.1016/j.jvsv.2015.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/01/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Miloš D Pavlović
- Parmova Dermatology Center, Division of Phlebology, Ljubljana, Slovenia
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Systemic exposure to monoethylglycinexylidide in extensive tumescent liposuction. EUROPEAN JOURNAL OF PLASTIC SURGERY 2015. [DOI: 10.1007/s00238-015-1166-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lawver J, Thaler R. Ultrasound-guided lipoaspiration for mesenchymal stromal cell harvest in the horse. EQUINE VET EDUC 2015. [DOI: 10.1111/eve.12398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J. Lawver
- Metamora Equine PC; Metamora Michigan USA
| | - R. Thaler
- Metamora Equine PC; Metamora Michigan USA
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Wollina U, Graf A, Hanisch V. Acute pulmonary edema following liposuction due to heart failure and atypical pneumonia. Wien Med Wochenschr 2015; 165:189-94. [DOI: 10.1007/s10354-014-0333-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 11/10/2014] [Indexed: 11/24/2022]
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Safe Extensive Tumescent Liposuction With Segmental Infiltration of Lower Concentration Lidocaine Under Monitored Anesthesia Care. Ann Plast Surg 2015; 74:6-11. [DOI: 10.1097/sap.0b013e3182933de7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Tumescent anesthesia refers to the percutaneous administration of large volume anesthetic to cause the target tissue to become swollen or firm. The use of tumescent anesthesia is essential for the treatment of refluxing truncal veins using endothermal technologies. In order to obviate the use of tumescent anesthesia as an adjunct to treatment, one has to evaluate the technologies that do not employ thermal energy as the modality for treatment. These technologies include foam sclerotherapy, mechanicochemical ablation (MOCA), and the use of glue (Sapheon™ closure system). The following review juxtaposes the literature supporting the use of tumescent-based techniques to the literature supporting the use of tumescent-less techniques
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Abstract
LEARNING OBJECTIVES After reading this article, the participant should be able to: 1. Perform preoperative assessment and patient selection for liposuction surgeries. 2. Explain the differences among the various types of anesthesia and wetting solutions used in liposuction. 3. Identify the available literature about skin-tightening procedures. 4. Convey to patients the complication profile for various modalities of liposuction. 5. Recall important ASPS consensus guidelines when discussing liposuction. SUMMARY The article was prepared to feature recent evidence-based publications pertaining to liposuction. The authors placed special emphasis on the most clinically relevant data. In addition, they highlighted current data regarding liposuction-related fields, including autologous fat transfer and minimally invasive skin tightening.
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Affiliation(s)
- Jayashree Venkataram
- Venkat Charmalaya Centre for Advanced Dermatology and Postgraduate Training, Bangalore, Karnataka, India
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Hanke CW, Moy RL, Roenigk RK, Roenigk HH, Spencer JM, Tierney EP, Bartus CL, Bernstein RM, Brown MD, Busso M, Carruthers A, Carruthers J, Ibrahimi OA, Kauvar ANB, Kent KM, Krueger N, Landau M, Leonard AL, Mandy SH, Rohrer TE, Sadick NS, Wiest LG. Current status of surgery in dermatology. J Am Acad Dermatol 2013; 69:972-1001. [PMID: 24099730 DOI: 10.1016/j.jaad.2013.04.067] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 04/16/2013] [Accepted: 04/17/2013] [Indexed: 02/08/2023]
Abstract
An article titled "Current issues in dermatologic office-based surgery" was published in the JAAD in October 1999 (volume 41, issue 4, pp. 624-634). The article was developed by the Joint American Academy of Dermatology/American Society for Dermatologic Surgery Liaison Committee. A number of subjects were addressed in the article including surgical training program requirements for dermatology residents and selected advances in dermatologic surgery that had been pioneered by dermatologists. The article concluded with sections on credentialing, privileging, and accreditation of office-based surgical facilities. Much has changed since 1999, including more stringent requirements for surgical training during dermatology residency, and the establishment of 57 accredited Procedural Dermatology Fellowship Training Programs. All of these changes have been overseen and approved by the Residency Review Committee for Dermatology and the Accreditation Committee for Graduate Medical Education. The fertile academic environment of academic training programs with interaction between established dermatologic surgeons and fellows, as well as the inquisitive nature of many of our colleagues, has led to the numerous major advances in dermatologic surgery, which are described herein.
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De Hert S, De Baerdemaeker L, De Maeseneer M. What the phlebologist should know about local anesthetics. Phlebology 2013; 29:428-41. [PMID: 23942729 DOI: 10.1177/0268355513501303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An increasing number of phlebological interventions are performed under local and tumescent anesthesia. Although the modern local anesthetic agents are generally perceived as being effective and safe drugs, the administration of these drugs may be associated with a number of adverse events. It is therefore mandatory that everyone who uses these compounds has insight into the pharmacological actions of these drugs and is capable of recognizing and adequately treating potential adverse events. The present narrative review summarizes the current knowledge on mechanisms of action of the most important local anesthetic drugs and reviews the potential adverse effects as well as their treatment.
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Affiliation(s)
- Stefan De Hert
- Department of Anesthesiology, Ghent University Hospital, Ghent, Belgium
| | | | - Marianne De Maeseneer
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Kaur RR, Glick JB, Siegel D. Achieving hemostasis in dermatology - Part 1: Preoperative, intraoperative, and postoperative management. Indian Dermatol Online J 2013; 4:71-81. [PMID: 23741660 PMCID: PMC3673397 DOI: 10.4103/2229-5178.110575] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
As dermatological procedures continue to become increasingly complex, improved methods and tools to achieve appropriate hemostasis become necessary. The methods for achieving adequate hemostasis are variable and depend greatly on the type of procedure performed and the unique characteristics of the individual patient. In Part 1 of this review, we discuss the preoperative, intraoperative, and postoperative management of patients undergoing dermatologic surgery. We address oral medications and supplements that affect hemostasis, hemostatic anesthesia, and intraoperative interventions such as suture ligation and heat-generating cautery devices. In Part 2 of this review, we will discuss topical hemostats. The authors conducted an extensive literature review using the following keywords: “hemostasis,” “dermatology,” “dermatological surgery,” “dermatologic sutures,” “electrosurgery,” “hemostatic anesthesia,” and “laser surgery.” Sources for this article were identified by searching the English literature in the Pubmed database for the time period from 1940 to March 2012. A thorough bibliography search was also conducted and key references were examined.
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Affiliation(s)
- Ravneet Ruby Kaur
- Department of Dermatology, SUNY Downstate Medical Center, 450 Clarkson Avenue Brooklyn, NY 11203, USA
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Chang SL, Huang YL, Lee MC, Chang CH, Chung WH, Wu EH, Hu S. Combination therapy of focused ultrasound and radio-frequency for noninvasive body contouring in Asians with MRI photographic documentation. Lasers Med Sci 2013; 29:165-72. [DOI: 10.1007/s10103-013-1301-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 03/05/2013] [Indexed: 10/27/2022]
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1,000 consecutive cases of laser-assisted liposuction and suction-assisted lipectomy managed with local anesthesia. Aesthetic Plast Surg 2012; 36:795-802. [PMID: 22447150 DOI: 10.1007/s00266-012-9885-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 02/09/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Advances in suction-assisted lipectomy (SAL) include improved instrumentation, better understanding of fluid dynamics, and an improved concept of appropriate indications. The tumescent technique uses subcutaneous injection of isotonic fluid containing vasoconstrictive and analgesic agents and is proved to be safe, with low morbidity and mortality rates. Laser-assisted liposuction (LAL) using local infiltration of an anesthetic and no general anesthesia or sedation has been developed, with claims of fat destruction and skin tightening. This study aimed to review 1,000 consecutive cases of LAL and SAL performed with the patient under local anesthesia and to determine whether this represents a safe technique with few complications. METHODS During a period of 22 months, 581 consecutive patients (486 females and 95 males) underwent 1,000 LAL/SAL operations, 545 of whom had multiple procedures performed. None of the patients had a body mass index (BMI) higher than 30 kg/m2. The patients ranged in age from 18 to 62 years. The fat aspirate ranged from 50 to 1,400 ml. Patients were given an oral sedative, an antibiotic, and an analgesic. Ringer's lactate solution containing lidocaine and epinephrine was injected into the subcutaneous space. The 1,064-nm and/or 1,320-nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser was used for laser lipolysis followed by SAL using standard and/or power-assisted liposuction (PAL) cannulas. The treated areas included the neck, triceps, male breast, midback, flanks, axilla, abdomen, mons pubis, thighs, presacrum, and knees. No patient was administered intravenous sedation or general anesthesia. RESULTS The average number of areas treated was 1.8, and no major complications or mortalities were observed. There were three burns, two infections, one hematoma, and one seroma. A total of 73 secondary procedures were performed (7.3%). No tertiary procedures were required. CONCLUSION For appropriately selected patients, comparable results can be obtained with an excellent safety profile and short recovery period using LAL and SAL with the patient under local anesthesia. The awake patient is able to participate in body positioning and to provide physiologic monitoring. No major complications occurred in this series. The burn and hematoma complications occurred in the first 25 cases and may have been related to a learning curve. One case of cellulitis occurred in the triceps region, and a second infection occurred in the abdomen. Both responded to antibiotics. Altogether, 73 touch-up procedures (7.3%) were performed. The amounts of fat removal were comparable with the volumes obtained using traditional liposuction. In conclusion, this series demonstrated that LAL/SAL using local anesthesia is a safe procedure for selected patients, with acceptably low morbidity and revision rates. 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 at www.springer.com/00266.
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Davila P, Garcia-Doval I. Tumescent Anesthesia in Dermatologic Surgery. ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/j.adengl.2012.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Davila P, Garcia-Doval I. Anestesia tumescente en cirugía dermatológica. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:285-7. [DOI: 10.1016/j.ad.2011.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Revised: 06/08/2011] [Accepted: 06/24/2011] [Indexed: 10/17/2022] Open
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Girard C, Debu A, Bessis D, Blatière V, Dereure O, Guillot B. Treatment of Gorlin syndrome (nevoid basal cell carcinoma syndrome) with methylaminolevulinate photodynamic therapy in seven patients, including two children: interest of tumescent anesthesia for pain control in children. J Eur Acad Dermatol Venereol 2012; 27:e171-5. [PMID: 22500823 DOI: 10.1111/j.1468-3083.2012.04538.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report our experience of methylaminolevulinate photodynamic therapy (MAL-PDT) in the treatment of multiple basal cell carcinoma (BCC) in adults and children with Gorlin syndrome (GS). DESIGN Report of cases. SETTING University of Montpellier, Department of Dermatology. PATIENTS Seven Gorlin patients (41 superficial or nodular carcinomas), including two children. INTERVENTIONS Prior superficial curettage for superficial BBCs or debulking for nodular BCCs was systematically performed. Methylaminolevulinic acid was applied topically to lesions 3 h before illumination with 635 nm red light for 10 min (37 J/cm(2)). To prevent treatment discomfort, analgesics and/or cooling by sprayed water were most often provided, and occasionally 1% lidocaine local anesthesia. A ropivacaine-lidocaine tumescent anesthesia was performed on the youngest patient. MAIN OUTCOME MEASURES The initial response rate; tolerance, particularly in children; cosmetic outcome. RESULTS Overall clearance in patients was 60% after one session of MAL-PDT and 78% after three sessions. Resolution of the lesions was accompanied by an excellent cosmetic outcome in all patients. Treatments were well tolerated in adults with moderate pain sensation during illumination. In a child, tumescent anesthesia assured excellent tolerance in all treatment stages. CONCLUSION We add our experience to previous articles that consider PDT as an interesting option in the treatment of GS. To our knowledge, this study is the first report of MAL-PDT in GS children using tumescent anesthesia. Specific guidelines for adult and pediatric patients remain to be established.
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Affiliation(s)
- C Girard
- Department of Dermatology, Saint-Eloi Hospital, University of Montpellier, Montpellier, France.
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Abstract
The vast majority of dermatologic surgery is performed with local anesthesia. The different methods provide safe and effective analgesia in circumscribed areas of skin and subcutaneous tissue and allow patients to tolerate otherwise painful diagnostic or therapeutic procedures while remaining conscious. Some forms of local anesthesia are unique, such as topical anesthesia with EMLA® or cryoanesthesia; others offer options to general anesthesia. Tumescent local anesthesia has gained widespread acceptance in the past decade for many indications other than cosmetic liposuction and is used for excising benign and malignant tumors, for extensive skin and soft tissue procedures (such as excision of acne inversa or sweat gland curettage) and in phlebologic surgery.
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Alam M, Olson JM, Asgari MM. Needs Assessment for Cosmetic Dermatologic Surgery. Dermatol Clin 2012; 30:177-87, x. [DOI: 10.1016/j.det.2011.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Schmeller W, Hueppe M, Meier-Vollrath I. Tumescent liposuction in lipoedema yields good long-term results. Br J Dermatol 2011; 166:161-8. [DOI: 10.1111/j.1365-2133.2011.10566.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pomerantz RG, Lee DA, Siegel DM. Risk assessment in surgical patients: balancing iatrogenic risks and benefits. Clin Dermatol 2011; 29:669-77. [DOI: 10.1016/j.clindermatol.2011.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Starling J, Thosani MK, Coldiron BM. Determining the safety of office-based surgery: what 10 years of Florida data and 6 years of Alabama data reveal. Dermatol Surg 2011; 38:171-7. [PMID: 22093178 DOI: 10.1111/j.1524-4725.2011.02206.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND This is a continued examination of 10 years of prospectively collected Florida in-office adverse event data and new comparable data from mandatory Alabama in-office adverse event data reporting. OBJECTIVE To determine which office surgical procedures have resulted in reported complications. METHODS This study is a compilation of mandatory reporting of office surgical complications by Florida and Alabama physicians to a central agency. Reports resulting in death or a hospital transfer were further investigated over the telephone or on-line to determine the reporting physician's board certification status, hospital privilege status, and office accreditation status. RESULTS In 10 years in Florida, there were 46 deaths and 263 procedure-related complications and hospital transfers; 56.5% (26/46) of deaths and 49.8% (131/263) of hospital transfers were associated with non-medically necessary (cosmetic) procedures. The majority of deaths (67%) and hospital transfers (74%) related to non-medically necessary (cosmetic) procedures were from procedures performed on patients under general anesthesia. Liposuction and liposuction with abdominoplasty or other cosmetic procedure resulted in 10 deaths and 34 hospital transfers. Thirty-eight percent of offices reporting adverse events were accredited by an independent accrediting agency, 93% of physicians were board certified, and 98% of physicians had hospital privileges. The most common specialty of physicians reporting adverse events was plastic surgery (45% of all reported complications). Dermatologists reported four total complications (no deaths) and accounted for 1.3% of all complications over the 10-year period. In 6 years in Alabama, there were three deaths and 49 procedure-related complications and hospital transfers; 42% (22/52) of hospital transfers and no deaths were associated with non-medically necessary (cosmetic) procedures. The majority of hospital transfers related to cosmetic procedures (86%) were from procedures performed on patients under general anesthesia. Liposuction accounted for no deaths and two hospital transfers. Seventy-one percent of offices reporting adverse events were accredited by an independent accrediting agency, and 100% of physicians were board-certified. Plastic surgery was the most common specialty represented in adverse event reporting (42.3% of all reported complications). Dermatologists reported one complication (no deaths) and accounted for 1.9% of all complications over the 6-year period. CONCLUSIONS Continued analysis reveals that medically necessary office surgery does not represent an emergent hazard to patients. The data obtained from 10 and 6 years of adverse event reporting in Florida and Alabama, respectively, are comparable and consistent. Medically necessary surgical procedures performed in the office setting by dermatologists have an exceedingly low complication rate, and complications that arose were largely unexpected, isolated, and possibly unpreventable. Cosmetic procedures performed in offices by dermatologists under local and dilute local anesthesia yielded no reported complications. Complications from cosmetic procedures accounted for nearly half of all reported incidents in Florida and Alabama, and in both states, plastic surgeons were most represented in adverse event reports. Liposuction performed under general anesthesia requires further investigation because deaths from this procedure continue to occur despite the ability to use dilute local anesthesia for this procedure. Requiring physician board certification and physician hospital privileges does not seem to increase safety of patients undergoing surgical procedures in the office setting. Mandatory reporting of adverse events in the office setting should continue to be championed. Reporting of delayed deaths after hospital outpatient and ambulatory surgery center procedures should be implemented. All data should be made available for scientific analysis after protecting patient confidentiality.
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Park SY, Kim TJ, Kim MJ. Acute hyperkalemia induced by hyperglycemia in non-diabetic patient. Korean J Anesthesiol 2011; 61:175-6. [PMID: 21927694 PMCID: PMC3167143 DOI: 10.4097/kjae.2011.61.2.175] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Sun Young Park
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital, Seoul, Korea
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Boeni R. Safety of tumescent liposuction under local anesthesia in a series of 4,380 patients. Dermatology 2011; 222:278-81. [PMID: 21606638 DOI: 10.1159/000327375] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 03/09/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Liposuction is increasingly performed under local anesthesia and in an outpatient setting. The term 'tumescent liposuction' has been used in the literature in patients receiving other forms of anesthesia as well, hence the confusion regarding the safety profile of liposuction performed under local anesthesia alone. OBJECTIVE To analyze the safety of tumescent liposuction performed under local anesthesia in a larger group of patients. METHODS Between 2003 and 2010, 4,380 consecutive patients underwent tumescent liposuction by the same surgeon. The occurrence of complications was recorded in detail. RESULTS There were no serious complications requiring hospitalization. There were no injuries, no nerve damage or permanent lymphedema, no deep venous thrombosis or seroma. Seven patients needed closer follow-up due to large hematoma (n = 3; no drainage needed), allergic drug reaction to doxycycline (n = 2), erysipelas (n = 1) and generalized edema (n = 1). CONCLUSIONS Tumescent liposuction under local anesthesia is a safe method, providing it is performed by an experienced surgeon and the guidelines of care for liposuction are strictly followed.
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Affiliation(s)
- Roland Boeni
- White House Center for Liposuction, Zurich, Switzerland.
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CHUANG GARYS, LEACH BRIANC, WHELESS LEE, LANG PEARONG, COOK JOEL. Preoperative Expectations and Values of Patients Undergoing Mohs Micrographic Surgery. Dermatol Surg 2011; 37:311-9. [DOI: 10.1111/j.1524-4725.2011.01878.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sasaki GH. Water-assisted liposuction for body contouring and lipoharvesting: safety and efficacy in 41 consecutive patients. Aesthet Surg J 2011; 31:76-88. [PMID: 21239675 DOI: 10.1177/1090820x10391465] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Water-assisted liposuction (WAL) is a new technique for body contouring and fat harvesting that relies on a fan-shaped jet of tumescent solution to anesthetize fatty for liposuction and grafting. As with any new technology, safety and efficacy are paramount. OBJECTIVE The author evaluates the technique and outcomes for small-to-moderate volume liposuction cases treated with WAL in an office setting. METHODS Forty-one consecutive patients were treated with WAL (Body-Jet; Human Med, Eclipse Ltd., Dallas, Texas) in the author's private practice for mild-to-moderate body contouring. Patients were given local anesthesia (standardized tumescent solutions) during all three phases of the surgery. During the latter two phases, irrigation of tumescent solution was accompanied simultaneously by suction aspiration. Fat harvesting was accomplished by collecting and separating the aspirated adipose tissue in a sterile container, without need for washing or centrifugation. Fat grafting by microdroplet technique was performed within two hours of collection. Fat aliquots from five randomly-selected patients were assessed with a trypan blue dye exclusion test within one hour and again six to eight hours after collection. RESULTS A total of 37 females and four males underwent WAL in this series; average body mass index (BMI) was 25.5. Among the 41 patients, 166 areas involving twelve anatomic sites were treated. Patients were divided into two groups based on the volume of treatment: Group 1 contained 19 patients with small-volume WAL and Group 2 had 22 cases of moderate-volume WAL. All patients experienced uneventful recovery periods with minimal side effects and no significant complications. Although large volumes of tumescent solution were required during the three phases of the technique, the total volume of infiltration almost equaled the final volume of aspiration. The average infiltration-to-aspiration ratio was 1.1 to 1.0 in all cases over both groups. On the other hand, the average infiltration-to-fat ratio was 2.8 to 1.0 in Group l and 2.4 to 1.0 in Group 2. Lidocaine dosage averaged 10.5mg/kg in Group 1 and 20.0mg/kg in Group 2. Patients were monitored for at least 24 hours without adverse signs or symptoms that required fluid resuscitation, blood transfusions, or interventional treatments for lidocaine side effects or toxicity. Twenty-three patients elected to save their fat for autologous fat grafting in nine anatomical sites with thirty-nine procedures. The augmented sites were clinically assessed between three and eight months postoperatively. Trypan blue dye exclusion testing indicated that about 90% of adipocytes expelled the dye after one hour of extraction, while an estimated 10% of cells per patient were observed to be free of dye six to eight hours after removal. CONCLUSIONS The amount of instilled tumescent fluid, lidocaine dosage, and aspiration volumes appeared to be safe, with minimal blood loss in small and moderate volume liposuction cases. The early experience with fat grafting was encouraging, but requires more sophisticated evaluation, longer follow-up, and a larger number of cases.
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Affiliation(s)
- Gordon H Sasaki
- Loma Linda University Medical Center, Loma Linda, California, USA.
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Efficacy of tumescent local anesthesia with variable lidocaine concentration in 3430 consecutive cases of liposuction. J Am Acad Dermatol 2010; 62:988-94. [DOI: 10.1016/j.jaad.2009.09.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 08/25/2009] [Accepted: 09/03/2009] [Indexed: 11/30/2022]
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Who is providing aesthetic surgery? A detailed examination of the geographic distribution and training backgrounds of cosmetic practitioners in Southern California. Plast Reconstr Surg 2010; 125:1257-1262. [PMID: 20335878 DOI: 10.1097/prs.0b013e3181d0accf] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In recent years, there has been a significant increase in the number of non-plastic surgeons performing cosmetic procedures. This has the potential to have an impact on the plastic surgery practitioner by increasing competition and bringing into question the assurance of patient safety. In this study, a demographic analysis was performed of providers of invasive and minimally invasive cosmetic treatments in the Southern California region. METHODS Providers of minimally invasive aesthetic procedures were catalogued using the sales lists from the manufacturers of the hyaluronic acid fillers Juvéderm and Restylane. The data set was further analyzed to enumerate the providers of surgical treatments, with a focus on the provision of liposuction. Data were analyzed using Environmental Systems Research Institute ArcGIS to focus on the Southern California area. Physician board certification and training background were detailed exhaustively. RESULTS In the 45,238-square mile area encompassing the San Diego/Los Angeles megalopolis, there are 1867 cosmetic practitioners offering hyaluronic acid injections. Of this number, 495 are trained in plastic surgery. In the same geographic region, there are 834 individuals offering liposuction. Practitioners are concentrated in downtown Los Angeles and San Diego, where the potential patient-to-provider ratios are 1088:1 and 1185:1, respectively. Interestingly, primary care physicians comprise the third largest group providing hyaluronic acid fillers and the fourth largest group of liposuction providers. CONCLUSIONS The authors' data demonstrate that there are numerous non-plastic surgeons performing cosmetic procedures, especially in the field of minimally invasive therapies. In addition, there is a growing contingent of non-surgery-trained individuals providing surgical cosmetic treatments, especially liposuction.
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Dillane D, Finucane BT. Local anesthetic systemic toxicity. Can J Anaesth 2010; 57:368-80. [DOI: 10.1007/s12630-010-9275-7] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Accepted: 01/14/2010] [Indexed: 11/30/2022] Open
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