Refinements in split-thickness skin grafting technique

Modifications for split-thickness grafting techniques are discussed, including the use of incontinuity, semipermeable, biologic dressings during harvesting, spiral basting sutures for graft attachment, and meshing to increase graft coverage.     

Syringe-assisted liposuction: a cosmetic surgeon's office technique

Liposuction surgery is the fastest growing cosmetic surgical procedure in the United States. Our goal is to present a clinical review of our last 50 patients. We will present a technique of liposuction void of suction machine that is easily managed as an office surgical technique. The technique is modified from that of Dr. Fournier. We will outline the technique, including patient preoperative evaluation, monitoring, fluid management, postprocedure complications, photographic results, and, most importantly, patient selection.     

Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction

The tumescent technique for local anesthesia permits regional local anesthesia of the skin and subcutaneous tissues by direct infiltration. The tumescent technique uses large volumes of a dilute anesthetic solution to produce swelling and firmness of targeted areas. This investigation examines the absorption pharmacokinetics of dilute solutions of lidocaine (0.1% or 0.05%) and epinephrine (1:1,000,000) in physiologic saline following infiltration into subcutaneous fat of liposuction surgery patients. Plasma lidocaine concentrations were measured repeatedly over more than 24 hours following the infiltration. Peak plasma lidocaine levels occurred 12-14 hours after beginning the infiltration. Clinical local anesthesia is apparent for up to 18 hours, obviating the need for postoperative analgesia. Dilution of lidocaine diminishes and delays the peak plasma lidocaine concentrations, thereby reducing potential toxicity. Liposuction reduces the total amount of lidocaine absorbed systemically, but does not dramatically reduce peak plasma lidocaine levels. A safe upper limit for lidocaine dosage using the tumescent technique is estimated to be 35 mg/kg. Infiltrating a large volume of dilute epinephrine assures diffusion throughout the entire targeted area while avoiding tachycardia and hypertension. The associated vasoconstriction is so complete that there is virtually no blood loss with liposuction. The tumescent technique can be used with general anesthesia or IV sedation. However, with appropriate instrumentation and surgical method, the tumescent technique permits liposuction of large volumes of fat totally by local anesthesia, without IV sedation or narcotic analgesia.     

Noncosmetic applications of liposuction

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.     

Facial liposuction and microlipoinjection

Liposuction and microlipoinjection can be used to improve the contour of the face, correct certain defects, and improve signs of aging. The technique of facial liposuction as well as that of collecting and injecting the fat used for microlipoinjection (autologous fat transplantation), is described.     

Anesthesia for liposuction in dermatologic surgery

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.     

Selection and utilization of liposuction cannulas

The liposuction surgeon can now choose from a wide variety of cannulas. However, the author has found that most procedures can be successfully performed using five or six basic types. Types of cannulas and techniques of liposuctioning are briefly described.     

The treatment of atypical lipoma with liposuction

Large lipomas may best be treated with liposuction. Once a lipoma enlarges to 4 cm or more, liposuction has several advantages over conventional surgery. A well-demarcated lipoma 15 cm in diameter and deep to muscle was treated by liposuction. Biopsy showed an atypical lipoma. Because the entire tumor was removed by liposuction, we feel that the prognosis is excellent. The cosmesis and morbidity results were far superior to those anticipated with conventional excisional surgery. Small superficial lipomas may be treated by suction lipectomy and the surrounding area can be contoured symmetrically at the same time, whereas large ones can be liposuctioned completely without extensive surgical extirpation and morbidity. Because such big lesions may represent atypical lipomas or liposarcomas, care must be taken to remove the entire tumor.     

The treatment of multiple lipomas by liposuction surgery

When lipomas reach 4 cm or more in size or are multiple, liposuction becomes an excellent alternative to excisional surgery, which is the treatment of choice for small lipomas. Two cases of multiple lipomas treated by liposuction surgery are presented.     

Refinements of the island median forehead flap for reconstruction of the medial canthal area

Extensive excision of malignant tumors in the medial portion of the eyelids involving the medial canthal tendon and orbicularis oculi muscle results in the lateral displacement of the eyelids and forward drift of the medial canthal region during the healing process if they are not repaired. We present three successful cases of reconstruction of an extensive defect in the medial portion of the eyelids by the island median forehead flap with frontal muscle and frontal galea aponeurotica to repair the medial canthal tendon and orbicularis oculi muscle. This improved technique successfully avoids lateral displacement of the eyelids and forward drift of the medial canthal region, and is a treatment choice for the extensive medial canthal defect.     

脂肪溶解液在乳腺癌腋淋巴结清除术中的应用

目的:探讨脂肪溶解液用于乳腺癌腋淋巴结清除术的可行性。方法:对30例术前扪及腋淋巴结肿大的乳腺癌患者行改良根治术,腋窝注射脂肪溶解液及脂肪抽吸后进行淋巴结清除术,术中均不用结扎血管,完整保留肋间臂神经、胸长神经及胸背神经。结果:平均完成手术时间70.3min,术中出血少,平均每例取出淋巴结16.3个,全部患者病理检查均有淋巴结转移,平均转移4.3个。所有患者术后均未出现明显的并发症,术后平均随访6个月,患者均无腋肿瘤复发、肩关节活动良好、上肢无水肿及麻痹等情况。结论:脂肪溶解液应用于腋淋巴结清除术时可使手术操作简单、省时、淋巴结清除多、神经血管损伤少及术后并发症少等优点,但对远期生存率的影响尚需进一步研究观察。     

A new, more flexible mechanism and method of liposuction

We present a new system for liposuction, formed from a blend of presently existing and simple parts. It is free of the mechanical breakdown problems and is not nearly as tiring as the recently developed "syringe-cannula-only" system. The system has other benefits that will be described. We will also discuss the full use of this simple instrument so that it may be mastered immediately by the reader. Because it is a major improvement over the "syringe-cannula-only" method, we expect this system to see vast clinical utility in the future. Now every physician who is appropriately trained can perform an efficient liposuction without expensive machinery, exhaustion, or fear of a mechanical breakdown.     

吸脂技术在腋下副乳腺手术中的应用(附12例分析)

随着人们对美的不断追求，人们在治疗疾病的同时，更加注意形体美和心理平衡方面的需求。自2006年1月至2007年10月，本院对12例17侧腋下副乳患者行腋下副乳局部麻醉，吸脂后小切口腋下副乳腺切除术，取得了满意的效果。现报告如下。     

Blunt liposuction cannula dissection with and without suction-assisted lipectomy in reconstructive surgery

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.