Methaemoglobinemia after Liposuction under Tumescent Local Anaesthesia - Diagnostic Value of Pulse Oximetry.

Background: Tumescent local anaesthesia with prilocain can lead to clinically significant methemoglobin levels. New generation multiple wavelength pulse oximeters (e. g. Masimo Radical 7®) can measure methemoglobin levels. Methods: In this prospective observational study we compared the venous methemoglobin levels and the corresponding pulse oximetric values of the Radical 7® in patients undergoing tumescent local anaesthesia for liposuction procedures. The measurements were performed in Hanseklinik, Luebeck, Germany between 2008 and 2011. Results: In 133 patients, we measured a maximum methemoglobin level of 18 per cent. In a Bland-Altman analysis we found a mean bias of +2.2 % (-4.1 to 8.4 limits of agreement) for pulse oximetric values compared to hemoximetry. Conclusion: Pulse oximetric measurement of methemoglobin is an early-warning tool for the detection of clinically significant methaemoglobinemia in patients with tumescent local anaesthesia.

Improvements in patients with lipedema 4, 8 and 12 years after liposuction.

BACKGROUND: Long-term results following liposuction in patients with lipedema were available only for an average period of 8 years. OBJECTIVE: To find out whether the improvements persist for a further 4 years. METHODS: In 60 patients with lipedema a single-centre study with a mail questionnaire - often in combination with clinical controls - was performed after an average period of 12 years following liposuction(s). All patients in this group had already been surveyed 4 and 8 years after surgery. RESULTS: Compared with the earlier results improvement persisted with regard to spontaneous pain, sensitivity to pressure, edema, bruising and restriction of movement; similar outcomes were observed for self-assessment of cosmetic impairment, reduction in quality of life and overall impairment. While in the period from 4 to 8 years postoperatively complaints slightly increased, this was not the case for the period 8 to 12 years postoperatively. In addition a similar reduction of conservative treatment (decongestive therapy, compression garments) was observed as after 4 and 8 years postoperatively. Compared with the body weight before liposuction, 55% of the patients showed a reduction of 6.2 kg on average and 43.3% had a weight increase with an average of 7.9 kg. CONCLUSION: The results show, that the positive effects of liposuction last 12 years postoperatively without relevant worsening. They imply that liposuction for lipedema leads to a permanent reduction of symptom severity and need for conservative therapy.

Prevention of Progression of Lipedema With Liposuction Using Tumescent Local Anesthesia: Results of an International Consensus Conference.

BACKGROUND: Lipedema is a chronic, progressive disorder of subcutaneous adipose tissue that usually affects the lower extremities of women. Also known as "two-body syndrome," the fat accumulations in lipedema are unsightly and painful. The disorder is well-known in Europe but is largely unrecognized and underdiagnosed in the United States. OBJECTIVE: To hold the First International Consensus Conference on Lipedema with the purpose of reviewing current European guidelines and the literature regarding the long-term benefits that have been reported to occur after lymph-sparing liposuction for lipedema using tumescent local anesthesia. METHODS: International experts on liposuction for lipedema were convened as part of the First International Congress on Lipedema in Vienna, Austria, June 9 to 10, 2017. RESULTS: Multiple studies from Germany have reported long-term benefits for as long as 8 years after liposuction for lipedema using tumescent local anesthesia. CONCLUSION: Lymph-sparing liposuction using tumescent local anesthesia is currently the only effective treatment for lipedema.

S1 guidelines: Lipedema.

The present, revised guidelines on lipedema were developed under the auspices of and funded by the German Society of Phlebology (DGP). The recommendations are based on a systematic literature search and the consensus of eight medical societies and working groups. The guidelines contain recommendations with respect to diagnosis and management of lipedema. The diagnosis is established on the basis of medical history and clinical findings. Characteristically, there is a localized, symmetrical increase in subcutaneous adipose tissue in arms and legs that is in marked disproportion to the trunk. Other findings include edema, easy bruising, and increased tenderness. Further diagnostic tests are usually reserved for special cases that require additional workup. Lipedema is a chronic, progressive disorder marked by the individual variability and unpredictability of its clinical course. Treatment consists of four therapeutic mainstays that should be combined as necessary and address current clinical symptoms: complex physical therapy (manual lymphatic drainage, compression therapy, exercise therapy, and skin care), liposuction and plastic surgery, diet, and physical activity, as well as psychotherapy if necessary. Surgical procedures are indicated if - despite thorough conservative treatment - symptoms persist, or if there is progression of clinical findings and/or symptoms. If present, morbid obesity should be therapeutically addressed prior to liposuction.

S1-Leitlinie Lipödem.

Die vorliegende überarbeitete Leitlinie zum Lipödem wurde unter der Federführung der Deutschen Gesellschaft für Phlebologie (DGP) erstellt und finanziert. Die Inhalte beruhen auf einer systematischen Literaturrecherche und dem Konsens von acht medizinischen Fachgesellschaften und Berufsverbänden. Die Leitlinie beinhaltet Empfehlungen zu Diagnostik und Therapie des Lipödems. Die Diagnose ist dabei auf der Basis von Anamnese und klinischem Befund zu stellen. Charakteristisch ist eine umschriebene, symmetrisch lokalisierte Vermehrung des Unterhautfettgewebes an den Extremitäten mit deutlicher Disproportion zum Stamm. Zusätzlich finden sich Ödeme, Hämatomneigung und eine gesteigerte Schmerzhaftigkeit der betroffenen Körperabschnitte. Weitere apparative Untersuchungen sind bisher besonderen Fragestellungen vorbehalten. Die Erkrankung ist chronisch progredient mit individuell unterschiedlichem und nicht vorhersehbarem Verlauf. Die Therapie besteht aus vier Säulen, die individuell kombiniert und an das aktuelle Beschwerdebild angepasst werden sollten: komplexe physikalische Entstauungstherapie (manuelle Lymphdrainage, Kompressionstherapie, Bewegungstherapie, Hautpflege), Liposuktion und plastisch-chirurgische Interventionen, Ernährung und körperliche Aktivität sowie ggf. additive Psychotherapie. Operative Maßnahmen sind insbesondere dann angezeigt, wenn trotz konsequent durchgeführter konservativer Therapie noch Beschwerden bestehen bzw. eine Progredienz des Befundes und/oder der Beschwerden auftritt. Eine begleitend zum Lipödem bestehende morbide Adipositas sollte vor einer Liposuktion therapeutisch angegangen werden.

Evaluation and application of a high performance liquid chromatographic method for prilocaine analysis in human plasma.

BACKGROUND: Prilocaine, a local anesthetic of the amide type, is frequently applied in substantial doses during tumescent liposuction. Although it cannot be excluded that the subcutaneously infiltrated narcotic may enter the circulation and trigger adverse systemic reactions, prilocaine plasma levels have rarely been measured during routine tumescent surgery. We established and evaluated a high performance liquid chromatography (HPLC) method for analysis of this narcotic and used it to measure the drug in plasma samples drawn in the course of tumescent liposuction with prilocaine local anesthesia. METHODS: After approval by the local ethics committee and written informed consent, 283 heparin plasma samples were collected from 132 patients during and about 6, 12, and 24 hours after tumescent liposuction with prilocaine infused at doses of 19 +/- 5 mg/kg body weight. Calibrators and controls were prepared by spiking blank plasma with prilocaine. Following addition of internal standard and sodium hydroxide, plasma was extracted with diisopropyl ether. For HPLC analysis, dried extracts were dissolved in methanol - 4.35 mmol/L ammonium phosphate, pH7.0, (60:40 v/v) and applied to a Synergy 4 microm Fusion-RP column (250 x 4.6 mm) rinsed with the same buffer. Analytes were detected by absorption at 237 nm. For liquid chromatography mass spectrometry (LC-MS), extracts were dissolved in acetonitrile - 2 mmol/L ammonium acetate - formic acid (5:95:0.2 v/v/v), applied to a Synergy 4 microm Polar-RP column (75 x 2 mm), and eluted with a gradient of acetonitrile in 2 mmol/L ammonium acetate - formic acid. Analytes were detected by an ion trap mass spectrometer with electrospray ionization run in a MS/MS mode. RESULTS: In the HPLC assay established, prilocaine and the internal standard lidocaine eluted at about 14 and 25 minutes, respectively. The limit of detection of prilocaine was 0.002 mg/L, the measurable range extended to 30 mg/L. At prilocaine concentrations between 0.08 and 10.0 mg/L, inter-assay coefficients of variation of 6.2 to 9.9% were obtained. Analyses of plasma pools spiked with variable amounts of prilocaine showed recoveries of 91-101%. Results measured in 20 plasma samples by both HPLC and an independent LC-MS assay agreed acceptably (Y(HPLC) = 0.07 + 1.19x(LC-MS), R 0.98). Prilocaine plasma concentrations measured by HPLC in 132 plasma samples drawn in the late phase of liposuction ranged between 0.01 and 32.0 mg/L, roughly one third of all samples exhibiting levels above 5 mg/L. About 6 hours later, prilocaine levels measured in 46 plasma samples were lower (0.13 - 1.56 mg/L) and decreased further in the evening of the operative day (n = 49, 0.10 - 0.62 mg/L) and on the morning of the first postoperative day (n = 55, 0.03 - 0.25 mg/L). CONCLUSIONS: An HPLC method for determination of prilocaine was established and successfully applied to analysis of this drug in human plasma. Our results clearly indicate that during tumescent liposuction a significant portion of the subcutaneously infiltrated prilocaine enters the circulation, resulting in potentially harmful blood levels in about one third of the patients studied. 6 hours after liposuction, however, all samples exhibited prilocaine plasma levels far below a critical concentration and these levels further decreased in the evening of the day of treatment and on the next morning.

Liposuction - a surgical procedure in dermatology.

Liposuction is an integral part of the wide range of surgical procedures in dermatology. Dermatologists established tumescent local anesthesia in combination with the use of micro-cannulas; especially dermatologists from Germany and Austria actively designed and developed these new techniques. In this position paper, we discuss the history, various interdisciplinary aspects, the significance, and the treatment indications for this procedure as well as its role within dermatologic training programs and research. For quality reasons, members of the Germany Society of Dermatologic Surgery and the Austrian Society of Dermatologic Surgery discuss several fundamental professional aspects as well as the historical development of liposuction.

Tumescent liposuction: a new and successful therapy for lipedema.

BACKGROUND: Lipedema is a rare and painful disease in women. Until recently, it could be treated only by conservative methods (combined physical therapy). OBJECTIVE: To determine the efficacy and safety of surgery (liposuction) concerning appearance and associated complaints. METHODS: Twenty-eight patients, who had undergone conservative therapy over a period of years, were treated by liposuction under tumescent local anesthesia with vibrating microcannulas. Twenty-one could be reevaluated after an average of 12.2 (1-26) months. RESULTS: All showed great improvement, with normalization of body proportions. Additionally, spontaneous pain, sensitivity to pressure, and bruising either disappeared completely or improved markedly. Other than minor swelling for a few days, no complications could be observed following surgery. All patients reported a tremendous increase in their quality of life. Physical therapy had to be continued to a much lower degree. CONCLUSION: Tumescent liposuction has proved to be a safe and effective treatment for lipedema.

[10 years "Doctors in Aid of Children with Skin Diseases in Africa"--personal impressions]. / 10 Jahre "Arzte helfen hautkranken Kindern in Afrika e.V."--Persönliche Eindrücke.

Within the scientific establishment of dermatology, it is difficult to initiate or to support basic dermatology services in Third World countries. The author describes his experiences over 10 years in backing a community-based health care project in western Kenya. The problems with supporting tropical dermatology in Germany are also discussed.

[Lipoedema--current status, new perspectives]. / Lipödem--aktueller Stand, neue Perspektiven.

Because of the lifelong and often progressive course and the mental trauma to the patients, lipoedema is an important dermatologic disorder. Complex physical therapy programs were introduced as a standard therapy years ago and can achieve an impressive oedema reduction. Liposuction in tumescent local anesthesia with vibrating microcannulas has proved to be a new effective treatment. A targeted and permanent reduction of the fat tissue leads to an increased quality of life due to an improved appearance, reduced tendency to swelling and less pain.