Blood loss in major liposuction procedures: a comparison study using suction-assisted versus ultrasonically assisted lipoplasty.

The blood loss that accompanies liposuction procedures has always been a concern. Tumescent injection of the targeted area of liposuction with dilute lidocaine and epinephrine solution has minimized intraoperative blood loss. Proponents of a newer ultrasonically assisted lipoplasty technique have claimed many benefits over traditional suction-assisted lipoplasty. However, few quantitative data are available on the intraoperative blood loss and the significance of postoperative anemia using the ultrasonic method. A prospective clinical observational design was used to investigate 38 patients undergoing suction-assisted lipoplasty and 37 patients undergoing ultrasound-assisted lipoplasty in whom the liposuction aspirate was expected to be more than 1000 ml. These patients were investigated with preoperative measurement of hemoglobin, platelet count, prothrombin time, partial thromboplastin time, and postoperative measurement of hemoglobin on the seventh postoperative day. In addition, hemoglobin concentration and whole blood volume were calculated from the infranatant portion of the liposuction aspirate. The mean +/- SD volume of the liposuction aspirate was 2901 +/- 1471 ml for suction-assisted compared with 2741 +/- 1086 ml for ultrasound-assisted lipoplasty. The mean +/- SD of whole blood volume in liposuction aspirate per case was 36 +/- 50.82 ml for suction-assisted lipoplasty and 36 +/- 28.62 ml for ultrasound-assisted lipoplasty. The mean +/- SD of the preoperative hemoglobin concentration was 13.93 +/- 0.99 g/dl for suction-assisted lipoplasty and 14.05 +/- 1.16 g/dl for ultrasound-assisted lipoplasty, whereas the mean +/- SD of the postoperative hemoglobin concentration was 13 +/- 1.42 g/dl for suction-assisted lipoplasty and 13.05 +/- 1.32 g/dl for ultrasound-assisted lipoplasty. The mean decrease in hemoglobin on the seventh postoperative day was 0.93 +/- 0.92 g/dl for suction-assisted lipoplasty and 1 +/- 0.64 g/dl for ultrasound-assisted lipoplasty. The volume of whole blood loss was estimated to be 12.4 ml in each 1000 ml of liposuction aspirate when using suction-assisted lipoplasty versus 13.1 ml when using ultrasound-assisted lipoplasty. All procedures were done under general anesthesia, and patients were discharged home on the same day. No blood transfusion was required. This study shows that blood loss using the ultrasonic technique is slightly higher, though insignificant, than when using suction. However, this study did not demonstrate a difference in the postoperative hemoglobin decrease between the two techniques.

Blood loss in major lipoplasty procedures with the tumescent technique.

BACKGROUND: Intraoperative blood loss and postoperative anemia have been a concern when more than 1500 ml of lipoplasty material is aspirated. Blood loss is minimal when the targeted area is infiltrated with large volumes of dilute lidocaine and epinephrine. However, little quantitative data are available regarding the intraoperative blood loss and postoperative hemoglobin drop. METHODS: In this prospective study 38 consecutive women were investigated with preoperative measurement of hemoglobin, platelet count, prothrombin time, activated partial thromboplastin time, and postoperative measurement of hemoglobin. Hemoglobin and whole blood volume were calculated from the infranatant portion of the lipoplasty aspirate. All procedures were done with the patient under general anesthesia. RESULTS: The mean (+/-SD) volume of lipoplasty aspirate material was 2900+/-14702.8 ml (range 1000 to 5800 ml). The mean (+/-SD) whole blood volume in lipoplasty aspirate per case was 36+/-50.82 ml (range 1.2 to 251 ml). The mean (+/-SD) fall in hemoglobin was 0.93+/-0.92 gm/dl (range 0.2 to 4.3 gm/dl). The volume of whole blood loss was estimated to be 12.4 ml in each 1000 ml of lipoplasty aspirate. No blood transfusions were required. CONCLUSION: Data show that blood loss with the tumescent technique is remarkably low. Use of this technique permits large-volume lipoplasty aspirate and minimizes the need for blood transfusion.

Scleroderma en coup de sabre.

Five cases of scleroderma en coup de sabre are reported, along with a brief review of the literature [3, 10, 11]. Surgical management was tailored to the defects. Involved discolored skin was excised and the resultant wound repaired by direct closure (forehead, lower lip) or with full-thickness skin grafts. Soft tissues were augmented with dermal or dermal-fat grafts. Bony defects were corrected with prefabricated silicone implants (forehead) or autogenous bone (mandible).