The Journal of dermatologic surgery and oncology最新文献

Liposuction is now a well-established procedure in dermatologic surgery. The relative advantages and risks of the various forms of primary anesthesia and supplemental analgesia used for liposuction surgery in the office by dermatologic surgeons is described. Effective anesthetic techniques include infiltration of local anesthesia (LA) with or without intramuscular (IM), intravenous (IV), or nitrous oxide sedation, cryoanesthesia, and IV or inhalation general anesthesia (GA). Local anesthesia, using large volumes of dilute anesthetic solution containing lidocaine (0.05%), epinephrine (1:1,000,000), and sodium bicarbonate (12.5 meq/L), is a safe and effective modality for liposuction by dermatologists. In a study of 12 liposuction patients treated with this technique, the average lidocaine dose was 1181 mg (9.4 mg/kg/hr). The highest peak lidocaine blood level among all patients was 0.484 microgram/ml. Dermatologists should not assume the dual responsibility of surgeon and of monitoring patients given IV sedation. Any form of anesthesia has the potential for serious complications. The surgeon and office staff must be well trained and equipped to perform emergency resuscitation.

Efforts continue to expand the role of blunt liposuction cannulae in flap elevation and reconstructive surgery. Suction-assisted lipectomy to reduce the actual volume of fat tissue present may allow the further reach and compressibility of mobilized flaps. These instruments find the safest possible plane for continued undermining dissection even at great distances. Applications yet unknown await discovery.

Liposuction is the most frequently performed invasive cosmetic procedure in the United States. The vast majority of liposuctions are performed using mechanical aspirators that are connected by sterile tubing to a cannula. Although liposuction cannula shaft designs have been modified and "perfected" to various extents, little attention has been paid to the handle and handle/shaft junction. Herein we present an inherent design-induced difficulty of traditional liposuction cannulas, the inability to be optimally cleaned. In addition, we present a solution.

A large volume of lidocaine with epinephrine can be administered in dilute concentrations into the subcutaneous space, resulting in minimal blood lidocaine levels. This allows large-volume, multiple-area liposuction to be done painlessly under local anesthesia with only oral and intramuscular sedation and analgesia. Other advantages include minimal blood loss, decreased patient morbidity and expense, and elimination of the risks of general anesthesia and intravenous anesthesia/sedation.

While liposuction can be used to change the contour of practically the entire body, it has limitations. Because of the nature of the technique employed during the procedure, it also has a certain inherent possibility for complications. One hopes to avoid these by using sound judgment in choosing patients and by employing prudence and good technique during surgery. In addition, the surgeon's artistry is of paramount importance; one truly performs plastic (plastikos = to mold) surgery when resculpturing a patient's body.

Noncosmetic applications of liposuction have continued to appear since its introduction into the United States in 1982. Although the most common use is in removing lipomas, liposuction has also been used for benign symmetric lipomatosis, flap undermining, flap defatting, gynecomastia, pseudogynecomastia, breast reduction, buffalo hump, hypertrophic insulin lipodystrophy, lymphedema, evacuating hematomas, emergency neck defatting for airway restoration, and axillary hyperhidrosis. Other uses remain to be discovered.

We report our experience in 50 patients who underwent liposuction surgery of the lateral thighs with or without concomitant liposuction surgery of the hip and buttock areas. This procedure has proven to be a remarkably safe and effective method for removal of fat in properly selected individuals. The operation avoids the problems of blood loss and scarring associated with other operations used to remove fat and makes for extremely satisfied patients.

Limiting liposuction volumes to avoid transfusion is sound surgical practice. Although the plastic surgery literature reports frequent use of transfusions in liposuction surgery, dermatologists almost never use blood replacement after liposuction. Techniques which favor less bleeding include sufficient use of fresh epinephrine, cryoanesthesia, use of smaller cannulas, fluid preloading, proper preoperative evaluation, serial liposuction, intramuscular steroids, and rapid application of pressure garments. A review of the literature and personal experience are detailed.