RESUMEN
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.
RESUMEN
Post mastectomy seroma remains an unresolved quandary as the risk factors for its formation have still not been identified. Seromas of the axillary space following breast surgery can lead to significant morbidity and delay in the initiation of adjuvant therapy. Various techniques and their modifications have been practiced and published in English literature, but there seems to be no consensus. In this article, all aspects of seroma formation from pathogenesis to prevention including drug therapies have been discussed.