Complicações em cirurgias e procedimentos lipoaspirativos: uma revisão da literatura / Complications in surgeries and lipoaspirative procedures: a review of the literature / Complicaciones en cirugías y procedimientos lipoaspirativos: una revisión de la literatura

O atual estudo objetiva evidenciar as complicações surgidas a partir de uma cirurgia de lipoaspiração no que diz respeito aos seus impactos na saúde dos pacientes. Trata-se de uma revisão integrativa, realizada por meio da pesquisa dos seguintes Descritores em Ciências da Saúde (DeCS): complications and liposuction. Sendo selecionados artigos de 2019 a 2023 que foram publicados até o dia 26/05/2023, selecionando-se 22 artigos, dos quais foram excluídos 15 e restaram apenas 7 artigos revisados. Lipoaspiração se resume em uma técnica cirúrgica que é utilizada para a remoção dos depósitos de gordura, sendo que possui finalidade estética, no entanto este procedimento pode cursar com consequências danosas à saúde dos pacientes como tromboembolismo, sepse e dentre outros. Tendo em vista essas complicações, a melhor opção é o investimento na formação de profissionais de qualidade e uma maior fiscalização aos centros e salas cirúrgicas.

The current study aims to highlight the complications arising from liposuction surgery with regard to its impacts on patients' health. This is an integrative review, carried out through the research of the following Descriptors in Health Sciences (DeCS): complications and liposuction. We selected articles from 2019 to 2023 that were published until 26/05/2023, selecting 22 articles, of which 15 were excluded and only 7 revised articles remained. Liposuction is summarized in a surgical technique that is used for the removal of fat deposits, being that it has aesthetic purpose, however this procedure can occur with harmful consequences to the health of patients such as thromboembolism, sepsis and among others. In view of these complications, the best option is to invest in the training of quality professionals and greater supervision of the operating centers and operating rooms.

El presente estudio tiene como objetivo destacar las complicaciones derivadas de la cirugía de liposucción con respecto a sus impactos en la salud de los pacientes. Se trata de una revisión integradora, realizada a través de una encuesta de los siguientes descriptores en Ciencias de la Salud (DeCS): complicaciones y liposucción. Con los artículos seleccionados de 2019 a 2023 que se publicaron antes del 26/05/2023, se seleccionaron 22 artículos, de los cuales 15 quedaron excluidos y sólo quedaban siete revisados. La lipoaspiración se resume en una técnica quirúrgica que se utiliza para la remoción de depósitos de grasa, y tiene un propósito estético, aunque este procedimiento puede tener consecuencias perjudiciales para la salud de los pacientes como tromboembolismo, sepsis y otros. En vista de estas complicaciones, la mejor opción es invertir en la formación de profesionales de calidad y en una mayor supervisión de los centros y salas quirúrgicos.

Clinical application of minimal invasive liposuction system in thigh areas of liposuction / 中华医学美学美容杂志

Objective:To investigate the clinical application and surgical effect of minimal invasive liposuction system (MILS) method in the thighs liposuction.Methods:From July 2019 to March 2021, 868 patients were selected for thigh liposuction. Local anesthesia and intravenous anesthesia were used in all operations. The preoperative design and intraoperative procedures were carried out according to the requirements of MILS ? method. There was an average of 2 154.4 ml fat aspirated, and the average operation time was 156.8 min. Results:After 2-18 months of follow-up, 83.3% of the patients were discharged on the day of operation. The thigh line curve of the patients was fluent and the perimeter of upper thigh was significantly reduced. The satisfactory rate was 92.3%, and the incidence of complications was 2.8%. No severe complication occurred.Conclusions:MILS method is a safe and effective procedure to partition thighs liposuction area scientifically and finely. The MILS method makes the lumbar abdominal liposuction operation standardized, reduces unnecessary operation, shortens the liposuction learning curve, reduces the occurrence of complications, and achieves the best aesthetic effect.

Embolismo graso fulminante por lipoinyección glútea. Reporte de un caso con enfoque Médico Legal / Fulminant fat embolism due to gluteal lipoinjection. Report of a case with a Medical Legal approach

Resumen La liposucción es uno de los procedimientos estéticos que se realizan con mayor frecuencia a nivel mundial, con una baja incidencia de complicaciones y una mortalidad de 20 por cada 100 000 procedimientos y cuando se realiza en conjunto con una lipoinyección glútea la principal causa de muerte el embolismo graso. Se presenta el caso de una femenina de 32 años, sin patologías crónicas conocidas, la cual se asistió a un centro médico para que le realizaran una liposucción con lipoinyección glútea y falleció casi al finalizar la cirugía; en la autopsia Médico Legal se observó la presencia de material de aspecto adiposo en el tronco principal de la arteria pulmonar y en sus ramificaciones, en las cuales se obstruía por completo el lumen, mediante un estudio histopatológico se confirmó el diagnostico de embolismo graso, el cual se estableció como causa de muerte. Se realizó una revisión de la literatura sobre embolismo graso asociado a liposucción con lipoinyección glútea.

Abstract Liposuction is one of the most frequently performed cosmetic procedures worldwide, with a low incidence of complications and a mortality of 20 per 100 000 procedures, and when it is performed in conjunction with gluteal lipoinjection, the main cause of death is fat embolism. This article presents a case of a 32-year-old female, with no known chronic pathologies, who was attended at a medical center to undergo liposuction with gluteal lipoinjection and died almost at the end of the surgery; In the Medico-Legal autopsy, the presence of adipose-like material was observed in the main trunk of the pulmonary artery and in its ramifications, in which the lumen was completely obstructed, a histopathological study confirmed the diagnosis of fat embolism, which was established as the cause of death. A review of the literature about fat embolism associated with liposuction with gluteal lipoinjection was made.

Reporte de casos sobre el uso de ácido tranexámico para reducir el sangrado perioperatorio en liposucción y abdominoplastia / Cases report on the use of tranexamic acid to reduce perioperative bleeding in liposuction and abdominoplasty procedures

Resumen Introducción: La liposucción y la abdominoplastia son dos de las cirugías estéticas más realizadas en el mundo. Una de las complicaciones más frecuentes de estos procedimientos es el sangrado perioperatorio, el cual puede conllevar a postoperatorios inadecuados y con mayores complicaciones. Por esta razón, se deben buscar nuevos métodos que permitan reducir las pérdidas sanguíneas en este tipo de cirugías. Objetivo: Evaluar la efectividad del ácido tranexámico en reducir el sangrado perioperatorio en liposucción y abdominoplastia. Materiales y métodos: Estudio retrospectivo consistente en un reporte de serie de casos en el que se mencionan un grupo de pacientes a las cuales se aplicó 1 gramo de ácido tranexámico previo a la realización de liposucción y abdominoplastia. En estas pacientes se revisó un hemograma pre quirúrgico y otro post quirúrgico y se comparó la disminución de la hemoglobina y hematocrito. Así mismo, se revisó si las pacientes presentaron la necesidad de transfusión de componentes sanguíneos. Resultados: Se obtuvo una población de 37 pacientes femeninas. Ninguna de las pacientes presentó una hemoglobina postquirúrgica menor de 8 g/dl ni requirió transfusión de hemoderivados después de la cirugía. Se realizó una correlación de Spearman entre las variables, en las cuales no se evidenció asociación entre el lipoaspirado y la hemoglobina o hematocrito postoperatorio. Conclusión: El ácido tranexámico es un medicamento que puede ser útil para reducir el sangrado perioperatorio en liposucción y abdominoplastia ya que ninguna de las pacientes que recibió este medicamento requirió transfusión de hemoderivados.

Abstract Introduction: Liposuction and abdominoplasty are two of the most common aesthetic surgeries practiced in the world. One of the most frequent complications of these procedures is the perioperative blood loss, which has negative effects on the recovery of the patients after the surgery. For this reason, it is important to search for new possibilities that reduce blood loss during this type of surgery. Objective: To evaluate the effectiveness of tranexamic acid in reducing perioperative bleeding in liposuction and abdominoplasty procedures. Methods: We present a retrospective case series report in which 1 gram of tranexamic acid was applied to a group of patients before the surgery. Later we reviewed and compared an hemogram taken before and after the surgery. Additionally, we evaluate if the patients required blood transfusion after the procedure. Results: A population of 37 female patients was studied. None of the patients presented a postsurgical hemoglobin level lower than 8 g/dl nor required blood transfusion products after surgery. A Spearman's rank correlation was performed between the variables, in which there was no evidence of association between lipoaspirate, and hemoglobin or postoperative hematocrit. Conclusion: The tranexamic acid is a medicament that can be useful for reducing perioperative blood loss in liposuction and abdominoplasty, such results were proved since none of the patients who received the medication required transfusion of red blood cells.

Lipedema: más que un problema de "piernas gordas": actualización en la fisiopatología, diagnóstico y tratamiento quirúrgico / Lipedema: more than a problem of "fat legs": update in the pathophysiology, diagnosis and surgical treatment

Resumen El lipedema es una enfermedad común, frecuentemente subdiagnosticada, crónica y progresiva, que genera un gran deterioro en la calidad de vida. Consiste en el depósito anormal de tejido adiposo subcutáneo principalmente en las extremidades inferiores, afectando casi exclusivamente a mujeres. Sus síntomas principales son el dolor, la sensibilidad y la facilidad para producir equimosis. Desde el punto de vista fisiopatológico, existiría una susceptibilidad poligénica combinada con trastornos hormonales, microvasculares y linfáticos que pueden ser en parte responsables del desarrollo del lipedema. Se clasifica, según la distribución de la grasa en cinco tipos y, según la gravedad de la enfermedad, en cuatro etapas. El diagnóstico es eminentemente clínico y se debe diferenciar de otras patologías que producen aumento de volumen de las extremidades, especialmente el linfedema y obesidad. Es importante realizar un estudio funcional del sistema linfático cuando el diagnóstico es dudoso o para la etapificación del lipedema, por lo que la correcta interpretación de estos resultados es fundamental. El tratamiento está enfocado en disminuir la discapacidad y evitar la progresión, con el fin de mejorar la calidad de vida. Actualmente, la liposucción es un tratamiento efectivo para el lipedema, sin embargo, las técnicas empleadas para la lipectomía en el lipedema son diferentes a las técnicas utilizadas para la liposucción con fines estéticos. Las técnicas selectivas que respetan los vasos linfáticos tienen mejor rendimiento para reducir el volumen de grasa, retrasar la progresión, reducir el dolor, reducir la alteración marcha y mejorar la calidad de vida en estos pacientes.

Lipedema is a common, frequently under-diagnosed, chronic and progressive disease that generates an important detriment in quality of life. It consists in an abnormal deposit of subcutaneous adipose tissue mainly in the lower extremities, almost exclusively affecting women. Its main symptoms are pain, sensitivity and the ease of causing bruising. From the pathophysiological point of view, there would be a polygenic susceptibility combined with hormonal, microvascular and lymphatic disorders that may be partly responsible for the development of lipedema. It is classified according to the distribution of fat into five types and, according to the severity of the disease, in four stages. The diagnosis is eminently clinical and must be differentiated from other diseases that cause an increase in the volume of the extremities, especially lymphedema and obesity. It is important to carry out a study of the lymphatic system functionality when the diagnosis is not clear or for lipedema staging, so the correct interpretation of these results is essential. Treatment is focused on reducing disability and preventing progression, in order to improve quality of life. Liposuction is currently an effective treatment for lipedema, however, the techniques used for lipectomy in lipedema are different from the techniques used for liposuction for cosmetic purposes. Selective techniques that spare the lymphatic vessels have better results reducing fat volume, delaying progression, reducing pain, reducing gait disturbance, and improving quality of life of these patients.

Effect of bipolar radio frequency in combination with small incision on lower facial lifting and shaping / 中华医学美学美容杂志

Objective:To discuss the effect of bipolar radio frequency (RF) in combination with small incision on lower facial (cheek, chin and neck) shaping and rejuvenation.Methods:From August 2019 to June 2020, 26 patients (aged 35-60 years, with mean 45 years) required for facial rejuvenation and received the fine liposuction in the lower cheek, mandibular margin and submental neck area in Beijing Huangsi Plastic Surgery Hospital. With the help of bipolar RF device - EMBRACE RF (diamond carving), the facetite face and hand radiofrequency were adopted for the subcutaneous tissue to tighten the skin. A concealed small incision was made from the front of the ear to the posterior ear. The superficial layer of the superficial muscular aponeuritic system (SMAS) was stripped, folded, tightened and suspended. The excessive skin was removed while reducing multilayer tension. The incision was cosmetically sutured.Results:All 26 patients had their wounds primary healing, with no complications such as skin necrosis and sensory disorder. All the 24 patients were followed up for 6-12 months. Their scars were concealed and tiny, the skin was tight, the lifting effect was obvious, and the pouch of mouth corners disappeared or alleviated. The contour of the mandibular margin was defined and the mental cervical angle was clear. The shape of the neck was slender and the fat chin was significantly improved. The effect of facial rejuvenation was distinct. Two patients felt it worked but did not achieve the expected results. They were satisfactory after giving the second surgery 6 months later. The satisfactory rate of the first surgery was 92.3% in 24 patients.Conclusions:Bipolar RF in combination with small incision lifting surgery is effective in lower facial (cheek, chin and neck) shaping and rejuvenation. The trauma is little and the wound is recovered fast. The scar is concealed and tiny. It is worthy of clinical application.

Clinical effect of facial and neck liposuction combined with bipolar radiofrequency in mandibular margin shaping / 中华医学美学美容杂志

Objective:To investigate the effect of liposuction combined with low-energy bipolar radiofrequency Bodytite in the treatment of facial and neck fat accumulation with unclear mandibular margin.Methods:From November 2020 to August 2021, 60 female patients with facial and neck fat accumulation and unclear mandibular margin, aged 19-45 (26.5±8.6) years, were included in the cosmetic surgery of Baiyu Medical Cosmetic Hospital of Chengdu High Tech Milan. The patients had the body mass index (21.3±3.2) kg/m 2. Liposuction was performed in the operation area of the opposite neck, and then radiofrequency skin tightening treatment was performed through the liposuction incision. The patients were followed up for 6 months to evaluate the postoperative effect. Results:The maximum liposuction volume of face and neck was 130 ml, the minimum liposuction volume was 26 ml, and the liposuction volume of face and neck was (43±9.8) ml. There was no scald reaction immediately after operation. The skin was flat, without unevenness, infection and other serious complications after 3 months of operation. Six months after operation, 57 patients were satisfied with the mandibular margin (95%) and 56 third-party plastic surgeons were satisfied (93%).Conclusions:Liposuction combined with low-energy bipolar RF Bodytite can solve the problem of skin relaxation while shaping the face and neck. It has obvious advantages in the plasticity of mandibular margin, and it is worthy of clinical application.

Application of liposuction technique assisted superomedial pedicle with vertical incision in reduction mammaplasty / 中国修复重建外科杂志

Objective: To explore the effectiveness of liposuction technique assisted superomedial pedicle with a vertical incision in reduction mammaplasty. Methods: Between March 2014 and March 2019, 65 patients (127 sides) with breast hypertrophy had undergone breast reduction by using liposuction technique assisted superomedial pedicle with a vertical incision. The patients were 21 to 58 years old, with an average of 42.2 years. Body mass index ranged from 18.8 to 26.5 kg/m 2, with an average of 21.3 kg/m 2. Among them, 62 cases were bilateral operations and 3 cases were unilateral operation. The degree of mastoptosis was rated as degreeⅡ in 73 sides and degree Ⅲ in 54 sides according to the Regnault criteria. Results: The unilateral breast removed 432 g on average (range, 228-932 g); the distance of nipple upward was 4.5-9.5 cm (mean, 6.5 cm); the volume of unilateral liposuction was 50-380 mL (mean, 148 mL). There were 2 sides (1.58%) of unilateral intramammary hematomas after operation, 4 sides (3.15%) of bilateral breast vertical incisions slightly split, and 1 side (0.79%) of the nipple-areola epidermis necrosis. All patients were followed up 6 months to 5 years, with an average of 18 months. During the follow-up, there was no evident re-dropping of the breast and no enlargement of the areola. No patient underwent scar excision. At last follow-up, the effectiveness was evaluated by the surgeons. There were 52 cases with very satisfactory, 10 cases with satisfactory, and 3 cases with unsatisfactory for the breast shape and symmetry. There were 51 cases with very satisfactory, 11 cases with satisfactory, and 3 cases with unsatisfactory for the nipple position and areola diameter. The incision scar was obvious in 25 cases and was not obvious in 40 cases. The results of self-assessment showed very satisfactory for the breast shape in 48 cases, satisfactory in 12 cases, and unsatisfactory in 5 cases; very satisfactory for the incision scar in 40 cases, satisfactory in 17 cases, and unsatisfactory in 8 cases. Overall evaluation of the patient was very satisfactory in 52 cases, satisfactory in 7 cases, and unsatisfactory in 6 cases. Conclusion: The liposuction technique assisted superomedial pedicle with a vertical incision in reduction mammaplasty is a safe and reliable surgical method with a satisfactory result.

Application and safety of bupivacaine undergoing tumescent liposuction in general anesthesia / 中华医学美学美容杂志

Objective To explore the safety,composition and effectiveness of bupivacaine in swelling fluid and to understand the safe use of the swelling fluids contained bupivacaine as local anesthetics in liposuction.Methods The liposuction was completed in 149 patients,aged 18-63 years with the swelling fluid contained bupivacaine in different proportions by negative pressure liposuction for exploring the method and safe use of the swelling fluid contained bupivacaine in general anesthesia.Results The dose range of bupivacaine at 1.14-1.87 mg/kg did not show toxicity.Bupivacaine combined with lidocaine as a part of swelling fluid was suitable for all range of liposuction in general anesthesia.There was no pain sensation first day after the operation.The pain was obvious on the day after surgery in lidocaine group.The advantage using bupivacaine as swelling fluid was that the postoperative recovery was fast,the healing was good,and the complications were few.Conclusions Bupivacaine as the main anesthetic agent for swelling fluid shows the advantages of long analgesic effect,good anesthetic effect,and no pain after operation.It is worth further application.

Onfaloplastia em triângulo isósceles e com dupla fixação na abdominoplastia / Omphaloplasty based on an isosceles triangle with double fixation in abdominoplasty

Introdução: Na abdominoplastia convencional, a cicatriz do novo umbigo representa o ponto de maior desafio. Em sua execução, já foram descritas e utilizadas várias técnicas e táticas cirúrgicas, com resultados nem sempre satisfatórios, sob o ponto de vista do paciente e também do médico. O objetivo é demonstrar a aplicabilidade e satisfação com a onfaloplastia em triângulo isósceles e com dupla fixação na abdominoplastia. Métodos: Foram selecionadas 97 pacientes do sexo feminino, com idades entre 25 e 65 anos. Todas foram submetidas à dermolipectomia abdominal clássica associada à lipoaspiração moderada de todo abdome anterior e flancos e avaliadas com 90, 180 e 360 dias pós-operatórios, pelo mesmo cirurgião. Resultados: Observou-se um índice de resultados satisfatórios das cicatrizes umbilicais na maioria dos casos (92,8%). Algumas cicatrizes umbilicais apresentaram estenoses (3,1%) e outras, cicatrizes inestéticas (4,1%). Não se observaram necroses. Conclusão: A utilização desta técnica demonstrou ser eficaz, de fácil execução e com resultados muito satisfatórios na estética da cicatriz umbilical nas dermolipectomias abdominais.

Introduction: In conventional abdominoplasty, the creation of a new umbilical scar is challenging. Several surgical techniques and approaches have previously been described and applied, but not always with satisfactory results. The objective is to demonstrate the applicability and satisfaction with omphaloplasty based on an isosceles triangle with double fixation in abdominoplasty. Methods: The study included 97 female patients aged between 25 and 65 years. All underwent classic abdominal dermolipectomy with moderate abdominal liposuction of the entire anterior abdomen and flanks by the same surgeon and were evaluated at 90, 180, and 360 days postoperatively. Results: Patients were satisfied with the umbilicus in most cases (92.8%). Some umbilical scars had contracted (3.1%) and others appeared unsightly (4.1%). No necrosis was observed. Conclusion: This technique was effective and easy to perform, with satisfactory umbilical scar aesthetic outcomes in abdominal dermolipectomy.

Clinical application and effects of two different liposuction methods in breast augmentation by autologous fat grafting / 中华医学美学美容杂志

Objective To explore the effect of different harvest methods of liposuction on the autologous fat grafting.Methods The clinical data of 60 patients with fat grafting for breast augmentation from January 2014 to January 2017 were analyzed retrospectively.According to the method of liposuction,60 patients were divided into the water-jet assisted liposuction group (30 cases) and negative-pressure machine liposuction group (30 cases).The surgical time of different liposuctions and the fat survival were compared after breast augmentation.The clinical effect of different liposuction methods was analyzed by follow-up one year after operation.Results Sixty patients completed the surgery.The fat survival rate of water-jet assisted liposuction was (66.71±2.68) ％,and the fat survival rate of the negative-pressure machine liposuction was (51.44 ± 1.16) ％.There were statistically significant difference between the two groups (P＜0.05).As for the operation time of liposuction,the water-jet assisted liposuction group was (33.28 ± 2.96) min,the negative-pressure machine liposuction group was (52.91± 5.03) min;there were statistically significant difference between the two groups (P ＜ 0.05).There was no statistically significant difference in satisfactory rate (P＞0.05).Conclusions Compared with negative pressure liposuction,water-jet assisted liposuction using autologous fat grafting in breast augmentation can improve the survival rate of fat transplantation.This technique has good clinical application value.

Abdominoplasty with simultaneous liposuction / 中华整形外科杂志

Abdominoplasty procedures have dramatically increased over the past decade or more. The American Society for Aesthetic Plastic Surgery (ASAPS) Cosmetic Surgery National Data Bank reported in 2005 an increase of 344%[1]. Saldanha introduced Lipoabdominoplasty in the early 2000[2]. Over the past two decades, Abdominoplasty, a common procedure performed by plastic surgeons worldwide has undergone progressive gradual changes with the inclusion of liposuction contouring of the trunk. The author discusses his experience and technical preferences in the performance and management of complete/full abdominoplasty patients, including the floating umbilicus technique, with simultaneous liposuction obtained over the past 40 years in private practice.

Clinical application and observation of an improved upper limb liposuction / 中华整形外科杂志

Objective@#To describe an extended whole upper limb liposuction technique and evaluate its clinical effect.@*Methods@#34 patients who underwent upper limb liposuction from February 2018 to February 2019 were selected and the clinical data were retrospectively summarized. Patients were treated with upper arm ring/upper arm ring + forearm 1/3 rings/whole arm ring aspiration combined with accessory mammary gland, armpit, scapula and other adjacent aesthetic parts of extended liposuction. The preoperative and postoperative maximum circumference, thickness of the anterior and posterior subcutaneous tissue and skin laxity were measured and compared. analysis of complications, and evaluation of patients′ satisfaction through satisfaction questionnaire.@*Results@#The arm shape of all patients was significantly improved, the maximum circumference of the arm was reduced (16.2±4.0)%, the distance of the upper arm was reduced (29.5±8.9)%, the thickness of the posterior subcutaneous tissue was reduced (56.6 ±6.2)%, and the thickness of the anterior subcutaneous tissue was reduced (44.7±9.6)%. There were three cases of mild anemia after operation, and no other serious complications occurred. Patient satisfaction was very high.@*Conclusions@#This is an innovative arm liposuction technique with hidden incision. The effect of improvement is remarkable. The patient′s satisfaction is high.

Anatomical, imaging and histological observations of the circumferential full-length of superficial fascia structure of the upper limb / 中华整形外科杂志

Objective@#To describe the general and histological features of the full-length superficial fascia of the circumferential upper limb.@*Methods@#Fresh frozen arm specimens were dissected, and then MRI imaging in vivo, enhanced CT angiography and HE histological staining were used to describe the characteristics of the full-length superficial fascia of the circumferential arm and its relationship with important blood vessels.@*Results@#The four typical structures of the superficial fascia of the arm were divided into subcutaneous superficial fat, membrane-like substance, deep fat and deep fascia from superficial to deep. The thickness and stratification, fusion degree and histological characteristics of the superficial fascia of these four layers were obviously different in different levels and regions of the arm. MRI confirmed that the total thickness of superficial fascia gradually decreased from shoulder to wrist. Venography showed that the cephalic vein ran below the second layer of superficial fascia and above the deep fascia. The basilic vein originated from the dorsal vein network of the hand and always lied below the second layer of membranous material until the basilic vein penetrates below the deep fascia of the upper arm.@*Conclusions@#The deep understanding of the circumferential full-length of superficial fascia structure of the upper limb provides an important theoretical basis for improving the surgical safety and fine operation for the Dynamic Arm Circumferential Liposuction.

Application of three-incision circumferential thigh liposuction in thigh contouring / 中华整形外科杂志

Objective@#To investigate the clinical efficacy of circumferential thigh liposuction with three incisions in thigh.@*Methods@#From April 2017 to October 2018, 31 patients received circumferential thigh liposuction with three incisions. All patients were females at 17-42 years old, with the mean age of 25.6± 0.8 years. An incision was designed in the pubic area, two in right and left inferior gluteal folds respectively. After injecting tumescent liquid into operation area, blunt and bent cannulas with 2.5-3.5 mm in diameter and 20-45 cm in length were used to extract deep subcutaneous fat, but 0.5 cm thick subcutaneous superficial fat was preserved. Elastic pants were dressed for 3 months after surgery. The thigh contour improvement was evaluated by the patients and 2 doctors.@*Results@#All the patients recovered uneventfully, without complications of fat embolism or infection. Satisfaction ratios of overall thigh and inner thigh contour increased from 81.7% to 80.6%, evaluated by patients. Ten patients completed postoperative outpatient revisit after 2 months. Satisfaction ratios of overall thigh and inner thigh contour increased from 80% to 75%, evaluated by doctors.@*Conclusion@#Three-incision circumferential thigh liposuction is an effective method in thigh contouring with concealed incision scar.

Application of liposuction in treating the primary end-stage lymphedema of lower extremities / 中华整形外科杂志

Objective@#To investigate outcome and clinical value of liposuction in primary lymphedema of lower extremities.@*Methods@#Thirty patients with primary lymphedema in unilateral lower extremity were recruited in this study from July 2016 to August 2017 in Beijing Shijitan Hospital. There were 13 male and 17 female patients, with the average age of (36±16.3) years. All the patients were underwent liposuction. The volume of hemorrhage and lipid, operation time and the volume changes of affected extremity were recorded. The subjective evaluation of the patients were also proceed. The patients were divided into different groups according to gender, stage and erysipelas history.@*Results@#Total lipid volume is 900-3 900 ml. The hemorrhage volume is 160-1 100 ml during liposuction. The ipsilateral-contralateral percent volume of lower extremity was decreased immediately after surgery (6.6%±10.0%, t=7.050, P=0.000), and 3 months postoperatively (12.2%±10.7%, t=5.365, P=0.000), when compared with preoperative (31.4%±16.4%). However, the percent volume was increased 3 months after surgery, compared to immediately postoperative measurements (t=-2.088, P=0.041). Female patients had more lipid volume and higher liposuction rate than males, whereas male patients show more affected extremities volume before, after and in 3-month follow-up. The hemorrhage volume was also higher in male than female patients. Patients with erysipelas had higher volume of hemorrhage, with lower lipid volume and liposuction rate. Stage Ⅱpatients show higher lipid volume and liposuction rate than stage Ⅲ patients in operation, with lower hemorrhage and affected extremity volume changes in before, after and 3-month follow-up. In subjective assessment, the experienced heaviness and fatigue was alleviated in all patients, while the pain and tightness was increased.@*Conclusions@#Liposuction is an effective therapy for primary lymphedema in lower extremity. It is necessary to combine with other therapies to improve lymph circulation. Patients′ gender, stage and the history of erysipelas are the main influencing factors of operation difficulty and prognosis.

A Study of Application of Tumescent Technique for Liposuction Surgery in Tertiary Care Centre

The tumescent technique of liposuction is a modification of the wet technique. A large volume of very dilute epinephrine is infiltrated into a targeted fat compartment prior to liposuction, producing a swelling and firmness. This tumescence of fat permits an increased accuracy in liposuction and minimizes postsurgical irregularities or rippling of the skin. Epinephrine- induced vasoconstriction minimizes blood loss, bruising, and postoperative soreness. Safe, rapid infiltration of large volumes of solution is achieved using a closed sterile system featuring a newly designed blunt-tipped, 30-cm-long, 4.7-mm-diameter needle having a hollow handle that accommodates a 60-cc syringe. Attached to a liter bottle of anesthetic solution by an intravenous line, the needle is inserted via the same incision and deposits the solution along the same path as that intended for the liposuction cannula. Thus, the solution is infiltrated exactly where it is needed for hemostasis or local anesthesia. Used in conjunction with general anesthesia, the tumescent technique saves time in achieving maximal vasoconstriction of the targeted fat compartment. If dilute lidocaine (0.1%) is added to the solution, the technique permits liposuction of more than 2 liters of fat totally by local anesthesia. Twenty-six patients, having received a mean lidocaine dose of 1250 mg (18.4 mg/kg or 8.5 mg/kg/hr) infiltrated into subcutaneous fat, had a mean serum lidocaine level of less than 0.36 ųg/ml 1 hour after completion of the infiltration.

Avaliação da limpeza e esterilização de cânulas de lipoaspiração após contaminação com gordura, Mycobacteroides abscessus subespécie bolletii e Geobacillus stearothermophilus: estudo experimental / Evaluation of liposuction cannulas cleaning and sterilization after contamination with fat, Mycobacteroides abscessus subspecies bolletii and Geobacillus stearothermophilus: an experimental study

Introdução: A lipoaspiração ou lipossucção é a intervenção cirúrgica destinada a remover depósitos superficiais e profundos de gordura subcutânea do tecido adiposo localizado. Em alguns casos, para obter o resultado estético desejado, é realizada a lipoenxertia. Neste processo, faz-se um transplante autólogo de tecido gorduroso para preencher, aumentar ou modelar as estruturas flácidas, depressões ou áreas com pouco tecido adiposo. As cânulas utilizadas para realizar a lipoaspiração apresentam um design desafiador para os processos de limpeza, favorecendo o acúmulo de resíduos de gordura em seu interior. Há registros de surtos infecciosos causados por microrganismos que sobreviveram ao processo de esterilização, relacionados à falha na limpeza dos instrumentais cirúrgicos, reforçando a premente necessidade de investigar se os resíduos de gordura no lúmen das cânulas são passíveis de remoção, garantindo assim, a eficácia da esterilização e a segurança em seu reuso. Objetivos: Fase I - avaliar a eficácia da remoção da gordura humana do lúmen das cânulas submetidas a seis diferentes Procedimentos Operacionais Padrão (POP) de limpeza, comparando-os com os grupos controle positivos e negativos. Fase II - Avaliar o alcance do nível de segurança de esterilidade de 10-6 , quando submetida à esterilização por vapor saturado sob pressão as cânulas de lipoaspiração intencionalmente contaminadas com 6 L(residual mínimo após limpeza) e 50 L (residual máximo após limpeza) de gordura ----------------|a humana, ao serem desafiados frente à cepa de Mycobacteroides abscessus subespécie massiliense (INCQS no 00594) e a cepa do esporo Geobacillus stearothermophilus (ATCC no 7.953). Método: a pesquisa caracterizou-se como pesquisa experimental laboratorial. A Fase I dos experimentos consistiu em submeter as cânulas de lipoaspiração de 3mm e 5mm de diâmetro com lúmen intencionalmente contaminado com gordura humana, a seis distintos POP de limpeza com variações na inclusão/exclusão/sequência dos passos básicos de limpeza, atualmente, adotados pela Enfermagem em Centros de Material e Esterilização (CME), quais sejam: 1. Flush inicial com água por meio de seringa de 10mL com detergente no lúmen das cânulas; 2. Flush automatizado a alta pressão e alta temperatura por meio do sistema de vapor fluente; 3. Imersão em solução de detergente enzimático com lipase e alternativamente no detergente alcalino; 4. Limpeza manual como o método que antecedeu a limpeza automatizada; 5. Limpeza automatizada em lavadora ultrassônica com retrofluxo intermitente com conectores para canulados. A gordura contaminante nos corpos de prova permaneceu por 120 minutos de contato, e após a drenagem do contaminante as cânulas ficaram expostas ao ar ambiente por 60 minutos. Após a aplicação dos seis distintos POP de limpeza, procedeu-se a extração e quantificação dos resíduos de gordura humana pela técnica de extração com solvente éter de petróleo a quente. A partir dos resultados obtidos nesta fase, realizou-se a Fase II caracterizada como microbiológica - utilizando a maior (50 L) e a menor (6,0 L ) média dos valores obtidos do resíduo de gordura para avaliar se esses quantitativos constituir-se-iam como fator protetor para os microrganismos no processo de esterilização por vapor saturado sob pressão alcançando o nível de segurança de esterilidade de 10-6 . Resultados: a Fase I da pesquisa demonstrou que mesmo utilizando todos os recursos atualmente, disponíveis no CME, não foi possível remover totalmente os resíduos de gordura inoculada nas cânulas de lipoaspiração restando valores residuais mínimos e máximos de gordura de 6,00 mg e 52 mg respectivamente. O POP que apresentou melhor desempenho na remoção de resíduo de gordura foi o método que empregou os seguintes recursos e sequência: 1. Flush inicial com água por meio de seringa de 10mL com detergente enzimático com lipase no lúmen das cânulas; 2. Imersão em solução de detergente enzimático com lipase; 3. Limpeza manual como o método que antecedeu a limpeza automatizada; 4. Limpeza automatizada em lavadora ultrassônica com retrofluxo intermitente com conectores para canulados; 5. Flush automatizado a alta pressão e alta temperatura por meio do sistema de vapor fluente. Os resultados microbiológicos da Fase II comprovaram a premissa de que a sujidade pode proteger microrganismos, constatando-se a sobrevivência, tanto da Mycobacteroides abscessus subespécie massiliense como do Geobacillus stearothermophilus, em ciclos de esterilização por vapor saturado sob pressão a 134o C, nos tempos de 1,30 minuto (meio ciclo) e 3 minutos (ciclo completo). Conclusões: As cânulas de lipoaspiração não são passíveis de limpeza pelos recursos atuais disponíveis pelos CME e houve recuperação dos microrganismos testados Mycobacteroides abscessus subespécie massiliense e Geobacillus stearothermophilus, demonstrando o risco de infecção relacionada ao reuso deste produto para saúde (PPS). Ressalta-se que dentre resíduos de matéria orgânica a serem removidos dos PPS, a gordura merece uma atenção especial porquanto há evidências de que os microrganismos em presença de óleos e gorduras necessitam de um tempo de exposição ao agente esterilizante até oito vezes maior que se estivesse na presença de água.

Introduction: Liposuction is the surgical intervention intended to remove superficial and deep deposits of subcutaneous fat from localized adipose tissue. In some cases, fat grafting is used to achieve the desired aesthetic result. In this process, an autologous fat tissue transplant is performed to fill, augment, or model flaccid structures, depressions, or areas with little adipose tissue. The cannulas used to perform liposuction have a challenging design for the cleaning processes, favoring the accumulation of fat residues inside. There are records of infectious outbreaks from microorganisms that survived the sterilization process, related to failure in cleaning surgical instruments, reinforcing the urgent need to investigate whether fat residues in the cannula lumen can be removed, thus ensuring the efficacy of sterilization and safety in its reuse. Objectives: Phase I to evaluate the efficacy of removing human fat from the cannula lumen undergoing six different cleaning standard operating procedures (SOPs), comparing them with the positive and negative control groups. Phase II - to evaluate the safety level of sterility reached of 10-6 , when liposuction cannula intentionally contaminated with 6 L (minimum residual after cleaning) and 50 L (maximum residual after cleaning) of human fat undergo sterilization with saturated steam, and are challenged with a strain of Mycobacteroides abscessus subspecies massiliense (INCQS no. 00594) and a strain of Geobacillus stearothermophilus spore (ATCC no. 7953). Method: the research was characterized as laboratorial and experimental. Phase I of the experiments consisted of submitting the 3mm- and 5mm- diameter liposuction cannula - with lumen intentionally contaminated with human fat, to six different cleaning SOPs with variations in the inclusion/exclusion/sequence of basic cleaning steps currently adopted by the nursing staff in sterile processing department, namely: 1. Initial flush with water using a 10mL syringe with detergent in the cannula lumen; 2. High-pressure, high-temperature automated flush through a flowing steam system; 3. Immersion in an enzymatic detergent solution with lipase, and alternatively in an alkaline detergent; 4. Manual cleaning as the method that preceded the automated cleaning; 5. Automated cleaning in ultrasonic washer with intermittent backflow with connectors for cannula. The contaminant fat in the specimens remained for 120 minutes of contact, and after draining the contaminant the cannulas were exposed to ambient air for 60 minutes. After the application of the six different cleaning SOPs, extraction and quantification of human fat residues were carried out using the hot petroleum ether extraction technique. Based on the results obtained in this phase, Phase II - characterized as microbiological - was performed using the largest (52L) and the lowest (6.0 L) average of values obtained from the fat residue to evaluate whether these quantitative values were a protective factor for microorganisms in the saturated steam sterilization process, reaching the sterile assurance level of 10-6 . Results: Phase I of the research demonstrated that even using all the currently available technologies in sterile processing department, it was not possible to completely remove fat residues inoculated in the liposuction cannula, with remaining minimum and maximum fat residual values of 6.0 mg and 52 mg, respectively. The SOP presenting better performance in the removal of fat residues was the method that used the following features and sequence: 1. Initial flush with water using a 10mL syringe with enzymatic detergent with lipase in the lumen of the cannula; 2. Immersion in an enzymatic detergent solution with lipase; 3. Manual cleaning using the method that preceded the automated cleaning; 4. Automated cleaning in ultrasonic washer with intermittent backflow with cannula connectors; 5. High-pressure and high-temperature automated flush using fluent steam system. The minimum and maximum residual fat values extracted were 6.0 mg and 52 mg. The microbiological results of Phase II have confirmed the premise that soil can protect microorganisms, with survival of both Mycobacteroides abscessus subspecies massiliense and Geobacillus stearothermophilus being observed after steam sterilization cycles under pressure at 134o C for 1,30 minute (half cycle) and 3 minutes (complete cycle). Conclusions: Liposuction cannula cannot be cleaned with the current resources available in Sterile Processing Departments, and the microorganisms tested, and Mycobacteroides abscessus subspecies massiliense and Geobacillus stearothermophilus, were recovered, demonstrating risk of infection related to the reuse of this health product. It should be emphasized that among the residues of organic matter to be removed from health products, fat deserves special attention because there is evidence that microorganisms in the presence of oils and fats need a time of exposure to the sterilizing agent up to eight times greater than if they were in the presence of water.

The round-the-clock technique for correction of gynecomastia

BACKGROUND: Gynecomastia is a common condition that can cause severe emotional and physical distress in both young and older men. Patients in whom symptomatic recalcitrant gynecomastia persists for a long time are potential candidates for surgery. METHODS: From January 2014 to January 2016, 15 patients underwent correction of gynecomastia through a single 3-mm incision at our institution. Only patients with true gynecomastia underwent surgery with this new technique. Through the small incision, sharp dissection was performed in a clockwise and counterclockwise direction describing two half-circles. Health-related quality of life and aesthetic outcomes were evaluated using a modified version of the Breast Evaluation Questionnaire (BEQ). RESULTS: The patients’ average age was 23.5 years (range, 18–28 years), and their average body mass index was 23.2 kg/m² (range, 19.2–25.3 kg/m²). One case was unilateral and 14 cases were bilateral. The weight of glandular tissue resected from each breast ranged from 80 to 170 g. No excess skin was excised. Bleeding was minimal. The mean operating time was 25 minutes (range, 21–40 minutes). No complications were recorded. All lesions were histologically benign. The patients’ average score was 3.5 (on a 5-point Likert scale) in all domains of the BEQ for themselves and their partners. CONCLUSIONS: In this study, we demonstrated the safety and reliability of a new technique that allows mastectomy through an imperceptible 3-mm incision. We obtained high patient satisfaction scores using our surgical technique, and patients reported considerable improvement in their social, physical, and psychological well-being after surgery.

Treatment of an abscess after massive autologous fat transplantation for breast augmentation with real-time ultrasonography-guided liposuction

Many studies have demonstrated that an autologous fat graft (AFG) can be a successful alternative to prosthetic breast augmentation; however, with the increasing use of this method, there are also increasing reports of complications. We report a case of severe infection after augmentation mammoplasty with a massive AFG. A 23-year-old woman had undergone primary AFG for breast augmentation. The remaining fat was reused for secondary graft 46 days after the primary transplantation. The patient was referred to our hospital with infectious signs on both breasts. Antibiotics were administered according to the bacterial culture result of the abscess aspirated with ultrasonography (US) guidance. During antibiotic treatment, two US-guided abscess aspirations were performed. Although follow-up magnetic resonance imaging demonstrated reduced abscess and fluid collection after aspiration, the skin of the lower pole of the right breast was perforated. We performed liposuction with real-time US guidance for abscess localization. The abscess and necrotic fat tissue were removed through liposuction. Thereafter, the symptoms, signs, and laboratory and radiologic findings demonstrated complete improvement. The patient was successfully treated while maintaining the breast contour through localized abscess removal, with a much smaller liposuction scar than would have resulted from aggressive excision or drainage.