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Poster4_lipo.qxd

HIGH RISK SUCTION ASSISTED LIPECTOMY:
PRE–OPERATIVE CONSIDERATIONS AND MANAGEMENT
German Newall MD, FACS • Amado Ruiz–Razura, MD, FACS • Christopher K. Patronella MD, FACS • Henry A. Mentz, III, MD, FACS
From the Aesthetic Center for Plastic Surgery— Houston, Texas, U.S.A.
complication encountered (4.3%). The incidence of DVT Present the clinical experience of a retrospective study in was equal to the one reported in the literature. Patients which patients considered to be high risk candidates were transferred from the outpatient facility to the hospital underwent an abdominal reconstruction and suction and received anti-coagulation treatment.
assisted lipectomy. A review of the pre operative This study indicated the need to develop a new post- considerations is made and a description of the operative protocol and start a prospective study to assess BEFORE AND AFTER IMAGES—
TERAL, AND BACK
A

the risk management in the future care of these patients.
MATERIALS AND METHODS
Final recommendations based on results of this study:
The 120 patients operated upon by the lead author are part > Adequate patient selection (ASA I or II of the anesthesia
of the private practice of the Aesthetic Center for Plastic
Surgery in Houston, TX. The study includes the period of
January 1998 to December 2003. The longest follow-up
> Use of a hospital or fully certified outpatient facility
was 4 years; the shortest was 9 months. Ages ranged from > Experienced O.R. team with board-certified
19 to 65 years. Ninety percent of the patients were female.
anesthesiologists and Registered Nurses on staff Due to pre-operative conditions and other associated > Pre-operative internal medicine consultation is
factors such as age, excessive weight, and daily BEFORE AND AFTER IMAGES—
recommended if a volumen of more than 6 liters is medications used, patients were considered by the surgeon and the anesthesia team to be high-risk candidates for these procedures. Patients were all ASA I–II, with realistic expectations and a willingness to • Robert’s Formula for fluid replacement TECHNIQUE
• Warm tumescent fluid to 37° C before infusion.
Pre-operative markings were done in a standing position.
• Overnight stay for aspirate greater than 5 liters General endotracheal anesthesia was administered. After > Use of heating devices and warm, humidified, inhaled
the patient was safely intubated and hydration was stabilized by monitoring vitals signs, urine output was BEFORE AND AFTER IMAGES—
> Use of antibiotics pre- and post-operatively
controlled by placement of a Foley catheter. Maintenance of body temperature was achieved using warm, humidified, > Close and strict post-op follow-up:
inhaled oxygen and inhaled anesthetics. In addition, warm air by convection with either a “Bair Nugger” or “Warm COMPLICATIONS
Touch” system, and a heating pad on the bed were Key points in the management of these patients:
The most common complication was seroma formation, > Strict monitoring of body temperature during and after
provided. After induction, patients received an intravenous followed by infection (less than 0.1%), and localized skin surgery is of paramount importance to prevent bolus of Decadron. Tumescent infiltration was performed > Trans-operative intermittent compression stockings
with Klein solution, which allows increased fat extraction > Trans-operative and post-operative heating devices
We had transient pulmonary edema due to fluid overload CONCLUSION
and minimal blood loss. A “super wet” technique is (2 cases), which responded to intravenous administration preferred by the author, with a 1:1 ratio of infiltrate to > Patient positioning with unique padded areas
This study covers the clinical experience of 120 patients of Furosemide and required 23 hours of close observation.
aspirate. Suction lipectomy was performed with a considered to be high-risk candidates for abdominoplasty > Use of anti-embolic stockings post-op for 48 hours
We have not had a case of pulmonary embolus, which we conventional machine using 4 and 5mm blunt cannulas. and suction-assisted lipectomy. The authors believe that with prevent with the use of intermittent compression > Use of patient-controlled pain relief systems (PCA
careful selection of patients and the technical considerations Post-op care involved home visits by an experienced nurse stockings. Blood loss has not being significant enough to described herein, these procedures can be performed following the day of discharge. A 23-hour, onsite require transfusions. In addition, we have not had safely and reliably and can be undertaken by a competent, observation period was mandatory in cases over 5 liters.
> Body temperature stringently maintained at 37°
Lidocaine toxicity, fat emboli, or intraabdominal viscus Patient received SinEcch (Homeopathic Arnica Montana) perforations (which have been reported to cause general one day prior to surgery, and up to 3 days post-op, to sepsis and death). We believe this can be prevented by REFERENCES
reduce bruising. Compression garments were used for 4–6 Our results indicate an average of 3–4 hours of operating performing a careful evaluation for hernias before surgery, Umeda T., Ohara, H., Hayashi, O., Ueki, Masato and weeks. Aggressive body massage was administered once time, with an average volumen of 5 liters and a range of coupled with the use of blunt suction cannulas. Deep Hata Y.: “Toxic Shock Syndrome after Suction a week for the first month after surgery.
venous thrombosis (DVT) was the most serious Lipectomy” Plast. Reconstr Surg. 106:204, July 2000

Source: http://www.drnewall.com/attachments/articles/9/Poster%204%20High%20risk%20Lipo%20Newall.pdf

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