Adipose Tissue-Derived Stem Cell Yield Depends on Isolation Protocol and Cell Counting Method.

In plastic surgery, lipofilling is a frequent procedure. Unsatisfactory vascularization and impaired cell vitality can lead to unpredictable take rates in the fat graft. The proliferation and neovascularization inducing properties of adipose tissue-derived stem cells may contribute to solve this problem. Therefore, the enrichment of fat grafts with stem cells is studied intensively. However, it is difficult to compare these studies because many factors-often not precisely described-are influencing the results. Our study summarizes some factors which influence the cell yield like harvesting, isolation procedure and quantification. Stem cells were isolated after liposuction. Quantification was done using a cell chamber, colony counting, or flow cytometry with changes to one parameter, only, for each comparison. Quantification of cells isolated after liposuction at the same harvesting site from the same patient can vary greatly depending on the details of the isolation protocol and the method of quantification. Cell yield can be influenced strongly by many factors. Therefore, a comparison of different studies should be handled with care.

Pérdida permisible de grasa en liposucción: fórmula y aplicación informática para cuantificar un nuevo concepto / Permissible loss of fat in liposuction: formula and computer application to quantify a new concept

INTRODUCCIÓN Y OBJETIVO: Existe poca evidencia científica de cuánta grasa se debería retirar en una lipoescultura, sólo parámetros rígidos recomendados. El concepto actual del volumen de grasa a retirar no puede ser generalizado, pues cada paciente tiene características intrínsecas distintas, por lo cual, el cálculo del volumen aspirado de grasa debería individualizarse para cada paciente. El objetivo de este trabajo es crear una fórmula matemática predictiva para conocer la máxima cantidad de grasa a aspirar en una liposucción (pérdida permisible de grasa) en función de un volumen permisible sanguíneo seguro y de la edad (sin necesidad de transfusiones y previniendo complicaciones hemodinámicas). MATERIAL Y MÉTODO: Estudio cuantitativo, analítico, retrospectivo y de diseño no experimental. La población de estudio estuvo formada por pacientes operados de liposucción por un mismo cirujano en 3 clínicas privadas de Lima (Perú). Determinamos el tamaño mínimo de muestra con un nivel de confianza del 95% y margen de error del 5%; la muestra final fue de 102 pacientes. Empleamos una base de datos en Microsoft Excel v19.00 para recolección de datos y técnicas descriptivas para homogeneizarlos. Luego, análisis multivariado teniendo en cuenta además edad del paciente y riesgo quirúrgico. Realizamos el análisis estadístico con el programa SPSS versión 25. RESULTADOS: Contamos con 97 mujeres entre 18 a 54 años y 5 hombres entre 23 a 48 años (media de 32.5 años); el índice de masa corporal promedio (IMC) fue 22.06. El estudio de regresión lineal para las variables aspirado total de grasa y volumen permisible sanguíneo obtuvo un coeficiente de determinación muy importante (R2=47%) (fuerte asociación de predecibilidad). Dado este resultado, ampliamos el estudio a uno multivariable con las variables edad y riesgo quirúrgico, donde no determinamos asociación con respecto a riesgo quirúrgico, sin embargo, para edad la asociación se volvió más fuerte (R2=49%), permitiendo construir una fórmula predictiva para la asociación de estas 3 variables y una aplicación informática para celulares y tabletas capaz de mejorar la aplicación de esta relación en la práctica clínica. CONCLUSIONES: El presente estudio determinó que las variables aspirado total de grasa y pérdida permisible de sangre son predictoras de la pérdida permisible de grasa. Así mismo, el análisis multivariable permitió aumentar el poder predictivo de esta relación al incluir la variable edad. De esta forma desarrollamos un método estadístico que permite determinar estas predicciones (fórmula) a fin de ayudar a los cirujanos a una mejor planificación quirúrgica de la lipoescultura. Para facilitar su uso, desarrollamos además una aplicación móvil gratuita que permite este cálculo de manera rápida y sencilla

BACKGROUND AND OBJECTIVE: There is little scientific evidence of how much fat should be removed in a liposculpture, only rigid recommended parameters. The current concept of the volume of fat that should be removed cannot be generalized, since each patient has different intrinsic characteristics, therefore, the calculation of the aspirated volume of fat should be individualized for each patient. The objective of this work is to create a predictive mathematical formula that allows us to know what is the maximum amount of fat that can be aspirated in liposuction (allowable fat loss) based on a safe allowable blood volume and age (without the need for blood transfusions and preventing hemodynamic complications). METHODS: A quantitative, analytical, retrospective study that responds to a non-experimental design was conducted. The study population was made up of patients undergoing liposuction by the same surgeon in 3 private clinics in Lima (Peru). The minimum sample size was determined with a confidence level of 95% and a margin of error of 5%, where the final sample consisted of 102 patients. A database in Microsoft Excel v19.00 was used for data collection, likewise descriptive techniques were used to homogenize them. Then, the multivariate analysis was carried out, taking into account the patient's age and surgical risk. Statistical analysis was performed with the SPSS version 25 statistical program. RESULTS: We collected 97 women between 18 to 54 years old and 5 men between 23 to 48 years old (average age 32.5 years); the average body mass index (BMI) was 22.06. A linear regression study was carried out for the variables total fat aspirate and permissible blood volume, obtaining a very important coefficient of determination (R2=47%) (strong association of predictability). Given this result, it was decided to extend the study to a multivariate one, with the variables age and surgical risk, where no association was determined with respect to surgical risk, however for age the association became stronger (R2=49%), allowing the construction of a predictive formula for the association of these 3 variables, creating a computer application for cell phones and tablets to improve the application of this relationship in clinical practice. CONCLUSION: The present study determined that the variables total fat aspiration and permissible blood loss are predictive variables of permissible fat loss. Likewise, the multivariate analysis allowed us to increase the predictive power of this relationship, as the age variable was included. In this way, it is possible to develop a statistical method that allows us to determine these predictions (formula), which will help surgeons to have a better surgical planning of liposculpture. To make this easier, a free mobile application was developed that allows this calculation quickly and easily

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[Application of liposuction technique assisted superomedial pedicle with vertical incision in reduction mammaplasty].

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.

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.

Lipedema: A Call to Action!

Lipedema is a chronic progressive disease characterized by abnormal fat distribution resulting in disproportionate, painful limbs. It almost exclusively affects women, leading to considerable disability, daily functioning impairment, and psychosocial distress. Literature shows both scarce and conflicting data regarding its prevalence. Lipedema has been considered a rare entity by several authors, though it may be a far more frequent condition than thought. Despite the clinical impact on women's health, lipedema is in fact mostly unknown, underdiagnosed, and too often misdiagnosed with other similarly presenting diseases. Polygenic susceptibility combined with hormonal, microvascular, and lymphatic disorders may be partly responsible for its development. Furthermore, consistent information on lipedema pathophysiology is still lacking, and an etiological treatment is not yet available. Weight loss measures exhibit minimal effect on the abnormal body fat distribution, resulting in eating disorders, increased obesity risk, depression, and other psychological complaints. Surgical techniques, such as liposuction and excisional lipectomy, represent therapeutic options in selected cases. This review aims to outline current evidence regarding lipedema epidemiology, pathophysiology, clinical presentation, differential diagnosis, and management. Increased awareness and a better understanding of its clinical presentation and pathophysiology are warranted to enable clinicians to diagnose and treat affected patients at an earlier stage.

Clinical outcome after lipectomy in the management of patients with human immunodeficiency virus-associated dorsocervical fat accumulation: An observational cohort study.

Lipo-accumulation of the dorsocervical fat pad ("buffalo hump") is a complication observed in people living with human immunodeficiency virus (HIV). We described the clinical outcome of people living with HIV with "buffalo hump" treated by excisional lipectomy.From April 2013 to March 2018, medical records of people living with HIV, who received care in our hospital have been evaluated. Among them, patients with dorsocervical fat accumulation treated by excisional lipectomy have been retrospectively assessed.Nine patients with "buffalo hump" among 2886 people living with HIV (3.1‰, 9/2886) were included. Eight were women with a mean age of 47.9 ±â€Š8.0 years old (range, 36-60). Most of them have been infected by blood transfusion (77%, 7/9) and the mean duration of HIV infection was 14.1 ±â€Š5.5 years (range, 6-22). The mean duration for antiretroviral therapy was 8.8 ±â€Š2.1 years (range, 6-11). The mean pre-ART CD4+ T cell count was 91.3 ±â€Š76.5 cells/µL (range, 4-233) and 477.4 ±â€Š271.8 cells/µL (range, 114-926) at the time of surgery. All 9 patients underwent excisional lipectomy of their hypertrophied dorsocervical fat pad. The mean size of the excised specimens was 14 × 11 × 6 cm. The median follow-up time was 24 months (range, 2-60), all 9 patients reported satisfaction with their results, with no recurrence has been observed.Corrective surgery used to treat localized fat accumulations in people living with HIV with "buffalo hump" showed a favorable effect and can therefore be considered when necessary. Whereas drugs such as integrase inhibitors may avoid lipo-accumulation related syndrome and should be given to people living with HIV in China.

Evidence-Based Practice in Liposuction.

BACKGROUND: The goal of this study is to examine the existing peer reviewed literature comparing modern adjunctive techniques in liposuction including laser-assisted liposuction (LAL) and ultrasound-assisted liposuction (UAL) to standard suction-assisted liposuction (SAL). We intend to interpret these findings into a literature-based clinical application to influence practice patterns. METHODS: A literature review was conducted using a keyword search in PubMed. Keyword search items included liposuction, lipoplasty, suction assisted liposuction, ultrasound assisted liposuction, laser assisted liposuction, tumescent, liposuction comparison, liposuction review, and combinations therein. Exclusion criteria included articles with a primary focus on histologic effects of energy devices, primary animal models, primary opinion papers with no reference to available data, and industry-sponsored publications. Inclusion criteria included articles with direct comparison of liposuction modalities, randomized or blinded studies, and studies with objective outcomes. RESULTS: Twenty-five articles that met the inclusion criteria comparing SAL to UAL or LAL out of 9972 articles identified were obtained. The selected literature was assigned into 3 categories: evidence demonstrating an advantage of 1 modality (SAL, UAL, or LAL) over another, evidence that showed no benefit of 1 modality over another, and evidence that demonstrated risks of complications of 1 modality over another. CONCLUSIONS: The benefits of UAL and LAL over SAL include the following: (1) UAL over SAL in the treatment of gynecomastia, (2) LAL and UAL over SAL with decreased hemoglobin/hematocrit in high-volume lipoaspirates, and (3) LAL over SAL with skin tightening in select areas specifically the submental area. Otherwise, the literature demonstrates equivocal results among the described techniques with no clear benefit to set one apart from the other. There appears to be no demonstrable added benefit to the addition of either UAL or LAL that would urge a change in practice patterns outside the exceptions listed.

Patient safety in plastic surgery: identifying areas for quality improvement efforts.

Improving quality of health care is a global priority. Before quality benchmarks are established, we first must understand rates of adverse events (AEs). This project assessed risk-adjusted rates of inpatient AEs for soft tissue reconstructive procedures.Patients receiving soft tissue reconstructive procedures from 2005 to 2010 were extracted from the Nationwide Inpatient Sample. Inpatient AEs were identified using patient safety indicators (PSIs), established measures developed by Agency for Healthcare Research and Quality.We identified 409,991 patients with soft tissue reconstruction and 16,635 (4.06%) had a PSI during their hospital stay. Patient safety indicators were associated with increased risk-adjusted mortality, longer length of stay, and decreased routine disposition (P < 0.01). Patient characteristics associated with a higher risk-adjusted rate per 1000 patients at risk included older age, men, nonwhite, and public payer (P < 0.05). Overall, plastic surgery patients had significantly lower risk-adjusted rate compared to other surgical inpatients for all events evaluated except for failure to rescue and postoperative hemorrhage or hematoma, which were not statistically different. Risk-adjusted rates of hematoma hemorrhage were significantly higher in patients receiving size-reduction surgery, and these rates were further accentuated when broken down by sex and payer. In general, plastic surgery patients had lower rates of in-hospital AEs than other surgical disciplines, but PSIs were not uncommon. With the establishment of national basal PSI rates in plastic surgery patients, benchmarks can be devised and target areas for quality improvement efforts identified. Further prospective studies should be designed to elucidate the drivers of AEs identified in this population.

Local anesthetics in liposuction: considerations for new practice advisory guidelines to improve patient safety.

The Practice Advisory on Liposuction published by the American Society of Plastic Surgeons provides a thorough review of anesthetic techniques and guidelines for surgeons who perform liposuction. However, there is evidence to support several changes to the anesthetic infiltrate guidelines that will improve patient safety. These proposed recommendations will have the most impact on patients undergoing office-based procedures, where dedicated anesthesia providers may not be present, but they should also guide practice in both ambulatory care centers and hospitals. The primary foci of the proposed changes include restrictions on bupivacaine use and creation of lidocaine concentration guidelines.

Patient safety in plastic surgery.

LEARNING OBJECTIVES: After reading this article, the participant should be able to: 1. Recognize risk factors for venous thromboembolism and identify patients who would benefit from prophylactic anticoagulation; 2. Describe the effects of hypothermia in the perioperative period. 3. Understand the importance of blood pressure control in the plastic surgery patient. SUMMARY: This article provides a summary of important factors that contribute to improved patient safety in plastic surgery. The identification of patients and procedures that have an increased risk of complications enables the physician to carry out prophylactic measures to reduce the rate of these complications. Venous thromboembolism, hypothermia, bleeding diathesis, and perioperative hypertension are identifiable risks of plastic surgery, which can lead to significant morbidity and mortality. An evidence-based system and individual practice measures can help to decrease these risks. Thorough preoperative patient evaluation, detailed informed consent, and perioperative care delivered in a safe environment can contribute to improved safety in plastic surgery.

[Prevention of complications after surgery in patients with upper limbs' lymphedema].

The results of surgical treatment of patients with the fourth stage of the upper limbs' lymphedema was studied. Of all 170 patients with lymphedema, 16 (9.4%) had the fourth stage of the disease. The debulking procedures were performed in 15 patients (8 had standart operations, 7 - simultaneous rwo-stage operations). Beeing a preliminary stage of the radical surgical excision of lymphoedematously changed tissues, the liposuction allows a more precisional hemostasis for the accurate vessel visualization. It led to the 4,4 times decrease of the postoperative morbidity rate and shortened the time of the operation.

[Current perspective and limitations of autologous fat transplantation--"consensus meeting" of the German Society of Plastic, Reconstructive and Aesthetic Surgeons at Hannover; September 2009]. / Möglichkeiten und Grenzen der autologen Fetttransplantation--"Consensus Meeting" der DGPRAC in Hannover, September 2009.

One hundred years after the first description of autologous fat transplantation, this technique is receiving renewed attention. Initially, critically reviewed by plastic surgery societies, particularly those in the United States, the transfer of autologous fat was recently addressed at the September 2009 annual meeting of the German Society of Plastic Reconstructive and Aesthetic Surgeons in Hannover. In this consensus meeting, the panel reviewed both the current status of autologous fat transfer as well as established data concerning this evolving practice. In Germany, autologous fat transplantation is regulated by the Law on Tissue Transfer and Processing (Gewebegesetz). In an effort to facilitate future comparisons it is mandatory to describe harvesting, processing and reinjection techniques in detail. The consensus panel concluded that fat should be harvested using low vacuum settings and then transplanted in thin layers (Evidence V). Quantification of transplanted fat can best be performed by MRI (Evidence level III). Limited clinical studies are available with only some reaching a level of evidence II. At present, risk associated with autologous fat transplantation is considered to be minor. Tumor induction by autologous fat grafting is not proven. New techniques like stem cell enriched fat grafts may offer new promise for the Plastic and Reconstructive Surgeon.