Tissue temperatures during ultrasound-assisted lipoplasty.

Removing excess subcutaneous fat with the assistance of ultrasonic energy has recently become a technique of interest in the United States after nearly a decade of use in Europe. There are a number of reported advantages of ultrasound-assisted lipoplasty over traditional liposuction, and there are also some theoretical concerns. Ultrasound-assisted lipoplasty involves the conversion of electrical energy to mechanical energy and transfer to the tissues through acoustic pressure waves, with the formation of heat as a by-product. Heat generated in this process dissipates through the body's own cooling mechanisms and conduction to the surrounding tissues, and it does not contribute to the clinical treatment of the adipose tissue. Reports of "burns" and ischemic skin injuries in the literature, and concerns for potential heat-related problems, prompted us to investigate whether significant temperature elevations occur in the clinical setting. Subcutaneous tissue temperature determinations during ultrasound-assisted lipoplasty were begun in February of 1996, and data were collected from 55 patients who had the procedure performed during a 6-month period. Intraoperatively, temperature measurements were made with a data-logging instrument and a needle microprobe inserted into the subcutaneous tissues. Temperatures were taken in the area of liposuction before the infusion of tumescent fluid, after tumescent fluid infusion, and at 5-minute intervals until the end of the procedure. The patient's core body temperature remained stable during the procedure within a narrow range (35.7 degrees C to 36.3 degrees C). There was a gradual increase in the temperature of the subcutaneous tissues over time during the application of ultrasonic energy; however, average subcutaneous temperatures remained below the core temperature (p < 0.05) at all time intervals. Room-temperature tumescent fluid further enhanced the thermal safety zone without lowering core body temperature. There were no temperature related complications in our study population and no untoward effects of performing temperature measurements. We conclude that there is no clinically significant elevation of subcutaneous temperatures during ultrasound-assisted lipoplasty. Reported ischemic skin complications are more likely the result of injury to the subdermal plexus rather than a temperature-induced thermal injury. Although heat is a natural by-product of the energy transfer involved in ultrasound-assisted lipoplasty, the risk of thermal injury is negligible when the procedure is performed by experienced operators. Complete understanding of the technique along with strict adherence to basic principles of flap vascularity will ensure safe and effective performance of ultrasound-assisted lipoplasty.

Positioning the nasal oxygen cannula.

A technique is proposed for positioning the nasal oxygen cannula during facial surgery performed under local anesthesia and intravenous sedation. By placing the nasal prongs in the nostrils, and passing the tubing along the alar grooves, nasal dorsum, and forehead, the surgeon has full access to the preauricular areas, temporal regions, cheeks, nasolabial folds, and oral commissures. This method is easy to perform, provides secure positioning of the nasal oxygen, and allows access to areas of the face not possible with conventional placement of the oxygen cannula.

Ultrasound assisted lipoplasty--Part 1: An overview for nurses.

The use of ultrasound assisted lipoplasty (UAL) to assist in the removal of subcutaneous fat has been practiced in Europe for nearly a decade but has only recently been practiced in the United States. This article will discuss the UAL procedure, its history, regulatory issues, instrumentation and equipment needed, clinical protocol, case reports, complications, and future considerations.

An alternative treatment for the split skin-graft donor site.

There are a variety of methods employed in the postoperative management of the partial thickness donor site created during harvest of a split thickness skin graft. Each technique may be associated with potential complications of fluid loss, excessive pain, prolonged period for healing and delayed mobility, hypertrophic scarring, undesirable pigment aesthetics, and thin skin poorly resistant to everyday trauma. Thompson, and Converse and Robb-Smith have previously shown improved donor site outcome with the application of thin split skin grafts. Based on these studies, we present a technique that involves 1.5:1 meshing of a split skin graft and dividing it into equal halves so that one half is used to cover the defect and the other half is immediately returned to the donor site. Patients who are elderly, debilitated, or who have thin, poor-quality skin can expect less discomfort, reduction of fluid loss, improved durability and elasticity, and lower incidence of hypertrophic scarring with the proposed donor site regrafting.