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Bekeny JC, Huffman SS, Thomas C, Tumminello M, Kata A, Parikh R, Tom LK, Kleiber GM. Small Intestinal Perforation after 360-Degree Liposuction: A Case Report. Aesthetic Plast Surg 2024; 48:946-952. [PMID: 37653177 DOI: 10.1007/s00266-023-03567-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/26/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE As one of the most commonly performed cosmetic procedures, liposuction is relatively safe. Bowel injury following liposuction is a rare but devastating complication, which necessitates hospital admission and surgical intervention. The authors highlight a case report describing the presentation, diagnosis, and management of a patient with bowel injury following liposuction. CASE A 58-year-old woman presented with abdominal pain, erythema, and discharge three days after 360-degree abdominal liposuction with concomitant fat grafting to bilateral buttocks at an outpatient surgery center. Bowel perforation was suspected after CT-scan revealed extraluminal gas in the abdomen and communication that traversed the peritoneum. Exploratory laparotomy was performed which demonstrated at least one site of distinct perforation of the small bowel and an area omentum noted to be inflamed, thickened and with a purulent rind. The patient underwent 20-cm small bowel resection and partial omentectomy temporarily closed with negative pressure wound therapy. After subsequent abdominal wall debridements the patient received ventral hernia repair with bridging mesh and abdominal closure. CONCLUSIONS While safe, elective cosmetic procedures are not without risk of serious and even fatal complications. Providers must be familiar with the presentation of bowel injury following abdominal liposuction to prevent delays in appropriate surgical and medical care. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Jenna C Bekeny
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington, NW, 20007, USA
| | - Samuel S Huffman
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington, NW, 20007, USA
- Georgetown University School of Medicine, Washington, DC, USA
| | - Chris Thomas
- Georgetown University School of Medicine, Washington, DC, USA
| | - Mariana Tumminello
- Department of General Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Anna Kata
- Department of General Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Rajiv Parikh
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington, NW, 20007, USA
| | - Laura K Tom
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington, NW, 20007, USA
| | - Grant M Kleiber
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington, NW, 20007, USA.
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Khalaf MH, Sameer M, Khan MB, Ahmed A. Abdominal Visceral Injury, a Devastating Consequence of Abdominal Liposuction: A Case Report and Literature Review. Cureus 2023; 15:e34378. [PMID: 36874694 PMCID: PMC9977203 DOI: 10.7759/cureus.34378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2023] [Indexed: 01/31/2023] Open
Abstract
Abdominal liposuction is a commonly performed cosmetic procedure. However, as with any procedure, it can be associated with complications. One of the life-threatening complications of this procedure is visceral injury and bowel perforation. This complication is very rare, nevertheless general, and acute care surgeons must be aware of its possibility, its management, and its possible sequelae. We report a case of a 37-year-old female who underwent abdominal liposuction which was complicated by bowel perforation and was transferred to our facility for further care. She underwent an exploratory laparotomy in which multiple perforations were repaired. The patient then underwent multiple surgeries including stoma creation and had a long postoperative course. A literature review reveals the devastating sequelae of reported similar visceral and bowel injuries. The patient eventually did well and her stoma was reversed. This patient population will require close intensive care unit observation and a low threshold of suspicion for missed injuries during initial exploration. Further down the line, they will need psychosocial support and the mental health implications of this outcome must be cared for. The long-term aesthetic outcome is yet to be addressed.
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Affiliation(s)
| | | | | | - Aryan Ahmed
- Acute Care Surgery, Hamad Medical Corporation, Doha, QAT
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Pneumothorax, Pneumomediastinum, and Pneumoperitoneum After Combined Abdominoplasty and Liposuction: Rare Adverse Events. Ann Plast Surg 2022; 89:258-260. [PMID: 35993682 DOI: 10.1097/sap.0000000000003200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Liposuction is a relatively safe surgical procedure, with most complications being minor in nature. However, there are a few life-threatening complications that should not be underestimated. We present a case of a patient who developed bilateral pneumothoraces, pneumomediastinum, and pneumoperitoneum after combined liposuction and abdominoplasty. Although this presentation is rare, clinicians should keep a high index of suspicion in patients presenting with shortness of breath, chest pain, and/or abdominal pain after liposuction.
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Perforation of Abdominal Viscera Following Liposuction: A Systemic Literature Review. Aesthetic Plast Surg 2022; 46:774-785. [PMID: 34462799 DOI: 10.1007/s00266-021-02532-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Liposuction is among the most popular esthetic procedures worldwide. With growing demand and popularity, reports of serious complications accumulate. Despite being a rare complication of the procedure, visceral perforation is associated with morbidity and severe debilitation. METHODS The authors conducted a literature search for reported cases of perforation of abdominal viscera following liposuction procedures in the electronic databases of PubMed, Scopus and Cochrane Library databases. RESULTS The authors found 22 publications; 19 cases case reports and three studies, reporting a total of 49 cases of visceral perforation following abdominal liposuction procedures. Average age of patients was 50 years (range 24-72). Twenty-seven patients (73%) were female, and 10 were male (27%). Forty (81%) patients underwent isolated liposuction, and nine (19%) had multiple procedures carried out in a single surgery. Twenty patients (42%) had undergone previous abdominal surgery, 13 (27%) suffered abdominal wall weakness or deformities, and 7 (14%) suffered from obesity. 25 (52%) ileal perforations occurred, 6 jejunal (12.5%), 5 colic (10%) and 2 (4%) each of splenic and hepatic. Seven patients (14%) died during their hospitalization, 20 (41%) were discharged with no sequelae complications, and 22 (45%) developed complications after discharge. CONCLUSIONS Liposuction is a popular esthetic procedure that underwent numerous changes over the past century since its introduction. Despite its widely accepted reputation of a safe procedure with minimal complications, a growing number of reports on visceral perforation following liposuction have emerged. Scrupulous pre-operative evaluation and high index of suspicion are crucial for avoiding complications and unfavorable outcomes. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Montrief T, Bornstein K, Ramzy M, Koyfman A, Long BJ. Plastic Surgery Complications: A Review for Emergency Clinicians. West J Emerg Med 2020; 21:179-189. [PMID: 33207164 PMCID: PMC7673892 DOI: 10.5811/westjem.2020.6.46415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/11/2020] [Indexed: 12/04/2022] Open
Abstract
The number of aesthetic surgical procedures performed in the United States is increasing rapidly. Over 1.5 million surgical procedures and over three million nonsurgical procedures were performed in 2015 alone. Of these, the most common procedures included surgeries of the breast and abdominal wall, specifically implants, liposuction, and subcutaneous injections. Emergency clinicians may be tasked with the management of postoperative complications of cosmetic surgeries including postoperative infections, thromboembolic events, skin necrosis, hemorrhage, pulmonary edema, fat embolism syndrome, bowel cavity perforation, intra-abdominal injury, local seroma formation, and local anesthetic systemic toxicity. This review provides several guiding principles for management of acute complications. Understanding these complications and approach to their management is essential to optimizing patient care.
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Affiliation(s)
- Tim Montrief
- University of Miami Miller School of Medicine, Department of Emergency Medicine, Miami, Florida
| | - Kasha Bornstein
- University of Miami Miller School of Medicine, Miami, Florida
| | - Mark Ramzy
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, Dallas, Texas
| | - Brit J Long
- Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
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Spreading Awareness: Bowel Perforation with Liposuction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2715. [PMID: 32537364 PMCID: PMC7253287 DOI: 10.1097/gox.0000000000002715] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/28/2020] [Indexed: 11/26/2022]
Abstract
Complications with liposuction are not uncommon; some of these are very serious and can be life-threatening. In this case report, we represent a case of bowel perforation with liposuction.
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Gardener C, Pandis L, Grigatti M, Vindigni V, Bassetto F, Brambullo T. Bowel perforation after liposuction in abdominal contouring surgery: Case report. Int J Surg Case Rep 2020; 72:5-9. [PMID: 32506029 PMCID: PMC7276379 DOI: 10.1016/j.ijscr.2020.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/03/2020] [Accepted: 05/03/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Liposuction is one of the most performed procedures in aesthetic plastic surgery worldwide, and its spectrum of applications covers almost all body areas. Systemic or visceral complications following liposuction are rare, but unfortunately, they can be very serious. PRESENTATION OF CASE We discuss the case of a 69 y.o. woman who underwent abdominal contouring surgery consisting in flank pseudohernia correction, liposuction and short scar abdominoplasty, which was complicated by intestinal perforation. Bowel perforation was suspected on the 3rd day following surgery after a CT-scan and was treated with exploration through a median laparotomy, resection of the perforated bowel and subsequent ileo-ileal anastomosis. The 10 cm-long resected segment of the small intestine presented multiple 2 mm-large holes at the microscopic examination. DISCUSSION We assume that patient position on the operating table and abdominal wall laxity during surgery as well as the timing of each specific procedure played an important role in the occurrence of bowel perforation. CONCLUSION To our knowledge, this is the first case report of an accidental visceral perforation during a combined procedure of flank bulging correction and abdominal liposuction. Overall the increased risk of combined procedures in plastic surgery is linked to increased operative time. In the current case timing of surgery sequence more than operative time itself was relevant in increasing anterior abdominal wall pressure and thus setting the patient at a higher risk of bowel perforation.
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Affiliation(s)
- Caterina Gardener
- Clinic of Plastic and Reconstructive Surgery, Neuroscience Department, University of Padua, Italy.
| | - Laura Pandis
- Clinic of Plastic and Reconstructive Surgery, Neuroscience Department, University of Padua, Italy
| | - Martina Grigatti
- Clinic of Plastic and Reconstructive Surgery, Neuroscience Department, University of Padua, Italy
| | - Vincenzo Vindigni
- Clinic of Plastic and Reconstructive Surgery, Neuroscience Department, University of Padua, Italy
| | - Franco Bassetto
- Clinic of Plastic and Reconstructive Surgery, Neuroscience Department, University of Padua, Italy
| | - Tito Brambullo
- Clinic of Plastic and Reconstructive Surgery, Neuroscience Department, University of Padua, Italy
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Marques Álvarez L, Rodríguez-García R, Palomo Antequera C, Escudero Augusto D, González-Pinto I. Intestinal perforation after liposuction. Cir Esp 2019; 97:536-538. [PMID: 30683272 DOI: 10.1016/j.ciresp.2018.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 11/27/2018] [Accepted: 12/15/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Lara Marques Álvarez
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Raquel Rodríguez-García
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
| | - Carmen Palomo Antequera
- Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Dolores Escudero Augusto
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Ignacio González-Pinto
- Servicio de Cirugía General, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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Ezzeddine H, Husari A, Nassar H, Kanso M, Nounou GE, Khalife M, Faraj W. Life Threatening Complications Post-Liposuction. Aesthetic Plast Surg 2018; 42:384-387. [PMID: 29387943 DOI: 10.1007/s00266-017-1058-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 12/06/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Liposuction is one of the most commonly performed aesthetic procedures. It is performed worldwide as an outpatient procedure. However, the complications are underestimated and underreported by caregivers. We present a case of delayed diagnosis of bilothorax secondary to liver and gallbladder injury after tumescent liposuction. METHODS A 26-year-old female patient was transferred to our emergency department from an aesthetic clinic with worsening dyspnea, tachypnea and fatigue. She had undergone extensive liposuction of the thighs, buttocks, back and abdomen 5 days prior to presentation. RESULTS A chest X-ray showed significant right-sided pleural effusion. Thoracentesis was performed and drained bilious fluid. CT scan of the abdomen revealed pleural, liver and gall bladder injury. An exploratory laparoscopy confirmed the findings, the collections were drained; cholecystectomy and intraoperative cholangiogram were performed. The patient did very well postoperatively and was discharged home in 2 days. CONCLUSION Even though liposuction is considered a simple office-based procedure, its complications can be fatal. The lack of strict laws that exclusively place this procedure in the hands of medical professionals allow these procedures to still be done by less experienced hands and in outpatient-based settings. Our case serves to highlight yet another unique but potentially fatal complication of liposuction. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Hiba Ezzeddine
- Department of General Surgery, Liver Transplantation and Hepatopancreaticobiliary Unit, American University of Beirut Medical center, Beirut, Lebanon
| | - Ahmad Husari
- Department of Internal Medicine, Respiratory Diseases and Sleep Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hussein Nassar
- Department of General Surgery, Liver Transplantation and Hepatopancreaticobiliary Unit, American University of Beirut Medical center, Beirut, Lebanon
| | - Mariam Kanso
- Department of General Surgery, Liver Transplantation and Hepatopancreaticobiliary Unit, American University of Beirut Medical center, Beirut, Lebanon
| | - Ghina El Nounou
- Department of General Surgery, Liver Transplantation and Hepatopancreaticobiliary Unit, American University of Beirut Medical center, Beirut, Lebanon
| | - Mohamad Khalife
- Department of General Surgery, Liver Transplantation and Hepatopancreaticobiliary Unit, American University of Beirut Medical center, Beirut, Lebanon
| | - Walid Faraj
- Department of General Surgery, Liver Transplantation and Hepatopancreaticobiliary Unit, American University of Beirut Medical center, Beirut, Lebanon.
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Cárdenas-Camarena L, Andrés Gerardo LP, Durán H, Bayter-Marin JE. Strategies for Reducing Fatal Complications in Liposuction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1539. [PMID: 29184746 PMCID: PMC5682182 DOI: 10.1097/gox.0000000000001539] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 08/29/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Liposuction has become one of the most common cosmetic surgical procedures, and severe complications secondary to this procedure have also increased significantly. That is why we carry out a research work to know the most frequent severe complications reported in the scientific literature to indicate criteria for prevention. METHODS English-language scientific publications about liposuction and its complications were analyzed using the PubMed.gov, from the beginning of PubMed's history through June 10, 2017. Five terms were used to define liposuction and its complications: "liposuction," "liposuction AND complications," liposuction AND major complications," "liposuction AND complications AND death," and "liposuction AND death." The quantities of results for the 5 phrases were analyzed, along with their contents. RESULTS One thousand sixty-three results were obtained from 1973 through June 10, 2017 for the phrase "Liposuction and Complications" in humans; for "Liposuction and Major Complications," 153 articles were found; for "Liposuction and Deaths," 89 articles were found; and 42 articles were obtained with the terms "Liposuction and Major Complications and Deaths." After final depuration, all those that were not specific to severe liposuction complications were eliminated, leaving a total of 39 articles that were included in our study. Five problems proved to be the most serious complications when performing liposuction: Thromboembolic disease, fat embolism, pulmonary edema, lidocaine intoxication, and intraabdominal visceral lesion. CONCLUSIONS The 5 most important complications that can cause death in liposuction are easily preventable using simple measures and proper safety protocols that are described in this work.
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Affiliation(s)
- Lázaro Cárdenas-Camarena
- From the INNOVARE, Specialized Plastic Surgery, Division of Plastic Surgery at the Jalisco Institute of Reconstructive Surgery “Dr. José Guerrerosantos,” Zapopan, Jalisco, México; Private Practice, Monterrey, México; Private Practice, Mérida, Yuc, México; and Private Practice, Medical Director of Clínica “EL Pinar” in Bucaramanga, Colombia
| | - Lozano-Peña Andrés Gerardo
- From the INNOVARE, Specialized Plastic Surgery, Division of Plastic Surgery at the Jalisco Institute of Reconstructive Surgery “Dr. José Guerrerosantos,” Zapopan, Jalisco, México; Private Practice, Monterrey, México; Private Practice, Mérida, Yuc, México; and Private Practice, Medical Director of Clínica “EL Pinar” in Bucaramanga, Colombia
| | - Héctor Durán
- From the INNOVARE, Specialized Plastic Surgery, Division of Plastic Surgery at the Jalisco Institute of Reconstructive Surgery “Dr. José Guerrerosantos,” Zapopan, Jalisco, México; Private Practice, Monterrey, México; Private Practice, Mérida, Yuc, México; and Private Practice, Medical Director of Clínica “EL Pinar” in Bucaramanga, Colombia
| | - Jorge Enrique Bayter-Marin
- From the INNOVARE, Specialized Plastic Surgery, Division of Plastic Surgery at the Jalisco Institute of Reconstructive Surgery “Dr. José Guerrerosantos,” Zapopan, Jalisco, México; Private Practice, Monterrey, México; Private Practice, Mérida, Yuc, México; and Private Practice, Medical Director of Clínica “EL Pinar” in Bucaramanga, Colombia
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Abstract
A joint Ad Hoc Committee of the American Society of Liposuction Surgery (ASLS) and the American Academy of Cosmetic Surgery (AACS) was formed to create the following guidelines for liposuction surgery. The members of this committee include: Robert Alexander, M.D., D.M.D.; Guillermo Castillo, M.D.; Robert Jackson, M.D.; Jeffrey Klein, M.D.; Melvin Shiffman, M.D.; and Howard Tobin, M.D. These guidelines were presented to and passed by the ASLS and AACS Board of Trustees on October 16, 1997.
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12
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Perforation of viscera, a dramatic complication of liposuction: a review of 19 cases evaluated by experts in France between 2000 and 2012. Plast Reconstr Surg 2015; 135:743-750. [PMID: 25719693 DOI: 10.1097/prs.0000000000001030] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Perforation of one or several intraperitoneal organs during a liposuction procedure is an exceptional but underestimated complication. Knowledge of this complication is essential because of frequent delay in diagnosis and possible dramatic consequences. METHODS Nineteen cases were evaluated by experts and are presented in a retrospective analysis. Sixteen women and three men, aged 24 to 72 years, were operated on in France between July of 2001 and January of 2012. Abdominal liposuction (200 to 2400 ml) was performed in combination or not with an abdominoplasty. RESULTS Uncommon pain and an intestinal obstruction were present in all of the patients. The peritonitis was never frank, replaced frequently by infraclinic peritonitis with septic and/or hypovolemic shock. Diagnosis, performed by abdominal scan between days 1 and 7, revealed intraperitoneal gas or liquid. Perforation, unique or multiple, because of the intraperitoneal passage of the cannula, often in the umbilical region and promoted by the presence of a hernia, involved the following organs: ileum (14 cases), jejunum (two cases), spleen (two cases), transverse colon (one case), cecum (one case), and sigmoid (one case). Death occurred in three cases, between days 2 and 11. Eleven patients had temporary ileostomy or colostomy. Associated complications were abdominal wall cellulitis, necrotizing fasciitis, thrombophlebitis, lung collection, and late subobstructive syndrome. CONCLUSIONS Visceral perforation during liposuction, a severe and sometimes fatal complication with late and difficult diagnosis, is not often reported. Careful technique, particularly if an umbilical approach is used, should avoid this dramatic complication. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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13
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Dellière V, Bertheuil N, Harnois Y, Thiénot S, Gérard M, Robert M, Watier E. Multiple bowel perforation and necrotising fasciitis secondary to abdominal liposuction in a patient with bilateral lumbar hernia. Indian J Plast Surg 2015; 47:436-40. [PMID: 25593436 PMCID: PMC4292128 DOI: 10.4103/0970-0358.146650] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
We present a rare complication of abdominal liposuction: bowel perforation and necrotizing fasciitis. Because of bilateral lumbar hernia, a 56-year-old woman had caecum and descending colon perforation during lipoplasty. She had septic shock syndrome at her admission. The authors treated this complex wound with several debridement, omental flap, NPWT and split-thickness skin graft. The incidence of abdominal wall perforation with visceral injury is 14 in 100,000 liposuctions performed. There are only 12 cases of bowel perforation in literature but this complication is probably underestimated. Prompt surgical debridement is absolutely mandatory in this life threatening scenario. Lumbar hernia is very rare and should be ruled out before every abdominal liposuction clinically or with imaging modalities.
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Affiliation(s)
- Vincent Dellière
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes, France
| | - N Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes, France
| | - Y Harnois
- Department of General Surgery, Rennes University Hospital, Rennes, France
| | - S Thiénot
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes, France
| | - M Gérard
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes, France
| | - M Robert
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes, France
| | - E Watier
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes, France
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14
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Abstract
Liposuction is the most frequent aesthetic procedure worldwide for adipose tissue reduction and treatment of lipedema. It is being employed with increasing frequency. In 2010, in the USA more than 200.000 liposuctions were performed. Apart from aesthetic indications, liposuction also is suitable for treatment of benign adipose tissue diseases. This intervention is not a simple procedure but requires extensive knowledge and experience to prevent irreversible medical or aesthetic complications. Severe complications including necrotizing fasciitis, toxic shock syndrome, hemorrhage, perforation of inner organs und pulmonary embolism - some even with lethal outcome - occasionally have been reported. These complications were mostly due to inadequate hygiene measures, inappropriate patient selection, use of excessive local anesthesia during mega-liposuction (tumescent technique) and inadequate post-operative surveillance. The complication rate usually reflects a lack of medical experience as well as technical inadequacies.
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Affiliation(s)
- G Sattler
- Rosenpark Klinik, Heidelberger Landstraße 18-20, 64297 Darmstadt.
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15
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Damkat-Thomas L, Hodgins N, Khan K. Laparoscopy complicating abdominal wall plastic surgery. J Plast Reconstr Aesthet Surg 2013; 66:e81-3. [PMID: 23312236 DOI: 10.1016/j.bjps.2012.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 12/18/2012] [Indexed: 11/30/2022]
Abstract
Abdominoplasty is often requested by patients following massive weight loss or multi-gravida. We report the cases of three patients who had incidental asymptomatic hernias diagnosed intra-operatively during abdominoplasty. All patients had previously undergone laparoscopic procedures and two had subsequent massive weight loss. Routine pre-operative clinical examination may not identify a small trocar related hernia. Prior knowledge of such hernias would aid in operative planning and reduce the risk of potential complications.
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Affiliation(s)
- Lindsay Damkat-Thomas
- Northern Ireland Plastic and Maxillofacial Service, Ulster Hospital, Upper Newtownards Road, Belfast, Northern Ireland, United Kingdom.
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16
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Di Candia M, Malata CM. Aesthetic and functional abdominal wall reconstruction after multiple bowel perforations secondary to liposuction. Aesthetic Plast Surg 2011; 35:274-7. [PMID: 21046103 DOI: 10.1007/s00266-010-9591-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 08/19/2010] [Indexed: 10/18/2022]
Abstract
This report describes a case of aesthetic and functional abdominal wall reconstruction performed to salvage a deformed, scarred, and herniated anterior abdomen after severe peritonitis and partial rectus muscle necrosis secondary to multiple bowel perforations sustained during liposuction performed in a cosmetic clinic. The diagnosis of intestinal perforation was missed intraoperatively and in the immediate postoperative period. The patient was admitted 4 days after the surgery to the intensive therapy unit in septicemic shock. After resuscitation and stabilization, she was treated by debridement of the abdominal wall, bowel resection, and temporary jejunostomy and colostomy (reversed 10 months later). She was referred 18 months after liposuction to the Plastic Surgery Service with a large central midline abdominal incisional hernia presenting with thinned out skin (14 × 11 cm) overlying adherent bowel. A components separation technique was successfully used to reconstruct the abdominal wall, with no recurrent herniation 2 years later. Survivors of bowel perforations sustained during abdominal liposuction may later present with challenging aesthetic and functional problems, as described in this report. These long-term sequelae have not been addressed hitherto in the literature.
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18
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Efficacy of tumescent local anesthesia with variable lidocaine concentration in 3430 consecutive cases of liposuction. J Am Acad Dermatol 2010; 62:988-94. [DOI: 10.1016/j.jaad.2009.09.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 08/25/2009] [Accepted: 09/03/2009] [Indexed: 11/30/2022]
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19
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20
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HABBEMA LOUIS. Safety of Liposuction Using Exclusively Tumescent Local Anesthesia in 3,240 Consecutive Cases. Dermatol Surg 2009; 35:1728-35. [DOI: 10.1111/j.1524-4725.2009.01284.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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21
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Kattapuram TM, Avery LL. Ureteral tear at the ureteropelvic junction: a complication of liposuction. Emerg Radiol 2009; 17:79-82. [PMID: 19259711 DOI: 10.1007/s10140-009-0797-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Accepted: 01/20/2009] [Indexed: 10/21/2022]
Abstract
We report the case of a 47-year-old woman who presented to the emergency room with gross hematuria during liposuction of the abdomen. Computed tomography (CT) using hematuria protocol demonstrated extravasation of contrast at the right ureteropelvic junction and a small urinoma in the right perinephric space. The diagnosis of ureteral tear at the ureteropelvic junction (UPJ) was confirmed. A ureteral stent was placed at surgery. Visceral injuries and other complications associated with liposuction have been described. However, this is the first reported case of a ureteral tear related to liposuction.
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Affiliation(s)
- Taj M Kattapuram
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
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22
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Harnett P, Koak Y, Baker D. Splenic trauma during abdominal wall liposuction: a case report. J R Soc Med 2008; 101:201-3. [PMID: 18387911 DOI: 10.1258/jrsm.2008.081010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A 35-year-old woman collapsed 18 hours after undergoing abdominal wall liposuction. Abdominal CT scan revealed a punctured spleen. She underwent an emergency splenectomy and made an uneventful recovery.
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Affiliation(s)
- Paul Harnett
- Department of Surgery, Royal Free and University College Medical School, Royal Free Hospital Pond Street, London NW3 1PL, UK.
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23
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Mallappa M, Rangaswamy M, Badiuddin MF. Small intestinal perforation and peritonitis after liposuction. Aesthetic Plast Surg 2007; 31:589-92. [PMID: 17659408 DOI: 10.1007/s00266-007-0050-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Accepted: 03/01/2007] [Indexed: 10/23/2022]
Abstract
A case of small intestinal perforation and peritonitis after tumescent liposuction performed in an ambulatory setting elsewhere is presented. Only four other cases were reported earlier. In all cases, the diagnosis had been missed initially. Unique problems in diagnosis, preventive steps, and risk reduction are discussed.
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Affiliation(s)
- Mahesh Mallappa
- Department of Surgery, Welcare Hospital, Al Garhoud Area, Dubai, United Arab Emirates.
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Sharma D, Dalencourt G, Bitterly T, Benotti PN. Small intestinal perforation and necrotizing fasciitis after abdominal liposuction. Aesthetic Plast Surg 2006; 30:712-6. [PMID: 17093873 DOI: 10.1007/s00266-006-0078-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Liposuction, the most common aesthetic procedure performed in the United States, is not without risk, but the overall complication rate in the literature varies from less than 1% to 9.3%. A 55-year-old woman who had undergone abdominal liposuction with bilateral breast augmentation was hospitalized in a state of profound septic shock. A diagnosis of necrotizing fasciitis was made on the basis of findings that included abdominal skin discoloration, subcutaneous emphysema, and air in the subcutaneous plane seen on abdominal computed tomography (CT) scan. During the operative procedure for abdominal wall debridement, extensive necrosis of abdominal wall fascia with leakage of bilious fluid from defects in the rectus sheath was found. Subsequent peritoneal cavity exploration showed two perforations in the mid ileum with gross peritoneal cavity contamination.
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Affiliation(s)
- Devesh Sharma
- Department of General Surgery, Geisinger Medical Center, 100 North Academy Avenue, Danville, PA, 17822, USA.
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25
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Dessy LA, Mazzocchi M, Fioramonti P, Scuderi N. Conservative management of local Mycobacterium chelonae infection after combined liposuction and lipofilling. Aesthetic Plast Surg 2006; 30:717-22. [PMID: 17093877 DOI: 10.1007/s00266-006-0031-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A case of Mycobacterium chelonae infection in the buttock after combined liposuction and lipoinjection is presented. The real possibility of contamination from operating room equipment was the potential etiologic factor of this infection. The clinical presentation of the disease was typical. The difficulty confirming the diagnosis was solved by specific culturing techniques. Successful treatment with limited debridement and irrigation combined with prolonged specific antibiotic therapy effected a long-term cure.
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Affiliation(s)
- Luca A Dessy
- Department of Plastic Surgery, University "La Sapienza" of Rome, Rome, Italy.
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26
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Ultrasound-Assisted Abdominoplasty: Combining Modalities in a Safe and Effective Technique; David L. Abramson, M.D. Plast Reconstr Surg 2003. [DOI: 10.1097/01.prs.0000072256.21401.b1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Abstract
Intensivists frequently collaborate with plastic and reconstructive surgeons in treating patients with major wounds, following significant reconstructive procedures, and following free-tissue transfers. Pressure ulcers are a significant source of morbidity and mortality in the intensive care unit; prevention, early recognition, and multidisciplinary treatment are critical components for successful management. Necrotizing fasciitis is an aggressive, soft-tissue infection that requires rapid diagnosis, early surgical intervention frequent operative debridements, and soft-tissue reconstruction Catastrophic abdominal injuries and infections can be treated with an open abdominal approach and require the expertise of a plastic surgeon to reconstruct the abdominal wall. The success of free-tissue transfers and complex reconstructive procedures requires a thorough understanding of the factors that improve flap survival.
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Affiliation(s)
- Gerard J Fulda
- Department of Surgery, Christiana Care Health Services, 4755 Ogletown-Stanton Road, Newark, DE 19718, USA.
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28
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Meyers H, Brown-Elliott BA, Moore D, Curry J, Truong C, Zhang Y, Wallace Jr RJ. An outbreak of Mycobacterium chelonae infection following liposuction. Clin Infect Dis 2002; 34:1500-7. [PMID: 12015697 DOI: 10.1086/340399] [Citation(s) in RCA: 147] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2001] [Revised: 01/16/2002] [Indexed: 11/03/2022] Open
Abstract
Among 82 patients who underwent liposuction performed by a single practitioner in a 6-month period, 34 (41%) developed cutaneous abscesses. An organism identified as Mycobacterium chelonae by polymerase chain reaction restriction-enzyme analysis was recovered from cultures of samples from 12 of those patients. DNA large restriction-fragment pattern analysis by pulsed-field gel electrophoresis demonstrated that a strain of M. chelonae recovered from biofilm in the piped-water system in one of the physician's offices differed by only 2 restriction fragments from the 12 patient isolates, which differed from each other by 0 or 1 restriction fragment. A detailed retrospective cohort study that included interviews with former employees and statistical analysis of risk factors indicated that inadequate sterilization and rinsing of surgical equipment with tap water were likely sources of mycobacterial contamination. This is the first reported outbreak of nosocomial infection due to M. chelonae in which a source has been identified and the first to occur in association with liposuction in patients in the United States.
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Affiliation(s)
- Hildy Meyers
- County of Orange Health Care Agency/Public Health, Santa Ana, CA, 92706, USA.
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29
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Brown SL, Bacsanyi JT, Purvis-Wynn SL. Fatal and serious complications associated with cosmetic suction lipectomy. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2002. [DOI: 10.1177/229255030201000204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Liposuction is the most commonly performed cosmetic surgery procedure in the United States. The medical devices and drugs used in the performance of liposuction are regulated by the Food and Drug Administration. Serious liposuction-related complications, including death, are reported in the literature. A review of reported complications and causes of deaths related to liposuction is presented. Prospective studies examining potential risk factors for complications, such as amount of fatty tissue removed and extent of body surface area affected, concomitant surgeries, method of anesthesia, impact of physician training and site of surgery, are needed to clarify the risks involved in liposuction. Studies are required to establish the risk-benefit profile of this procedure to allow patients and physicians to be adequately informed. Adverse events have been under-reported to the Food and Drug Administration despite numerous reports in the medical literature of serious complications associated with the use of medical devices in the performance of liposuction.
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Affiliation(s)
- S Lori Brown
- Office of Surveillance and Biometrics, Center for Devices and Radiological Health
| | - Janos T Bacsanyi
- Office of Post-Marketing Drug Risk Assessment, Center for Drug Evaluation and Research, United States Food and Drug Administration, Rockville, Maryland, USA
| | - Sherry L Purvis-Wynn
- Office of Surveillance and Biometrics, Center for Devices and Radiological Health
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30
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Coleman WP, Hanke CW, Glogau RG. Does the specialty of the physician affect fatality rates in liposuction? A comparison of specialty specific data. Dermatol Surg 2000; 26:611-5. [PMID: 10886265 DOI: 10.1046/j.1524-4725.2000.00084.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- W P Coleman
- Department of Dermatology, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Talmor M, FAhey TJ, Wise J, Hoffman LA, Barie PS. Large-volume liposuction complicated by retroperitoneal hemorrhage: management principles and implications for the quality improvement process. Plast Reconstr Surg 2000; 105:2244-8; discussion 2249-50. [PMID: 10839425 DOI: 10.1097/00006534-200005000-00053] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Large-volume liposuction can be associated rarely with major medical complications and death. The case of exsanguinating retroperitoneal hemorrhage that led to cardiopulmonary arrest in an obese 47-year-old woman who underwent large-volume liposuction is described. Extensive liposuction is not a minor procedure. Performance in an ambulatory setting should be monitored carefully, if it is performed at all. Reporting of adverse events associated with outpatient procedures performed by plastic surgeons should be mandated. Hemodynamic instability in the early postoperative period in an otherwise healthy patient may be due to fluid overload, lidocaine toxicity, or to hemorrhagic shock and must be recognized and treated aggressively. Guidelines for the safe practice of large-volume liposuction need to be established.
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Affiliation(s)
- M Talmor
- Department of Surgery, New York Presbyterian Hospital-Cornell Medical Center, NY 10021, USA.
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33
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Abstract
As one of the most frequent regions treated by liposuction in both men and women, the abdomen presents unique learning opportunities for the liposuction surgeon. Because of anatomic variation, the upper abdomen is more fibrous than the lower abdomen, requiring a slightly different approach to achieve optimal fat removal. The periumbilical area also provides unique challenges for the operator and care must be taken to avoid leaving a ring of residual fat. Potentially excellent skin retraction in the area, combined with relatively aggressive fat removal can lead to dramatic results including, in some cases, significant contraction of a long-standing panniculus. In this article, the basic techniques and potential pitfalls of abdominal liposuction are presented in detail.
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Affiliation(s)
- S V Pollack
- Department of Medicine (Dermatology), University of Toronto, Ontario, Canada
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34
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35
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Daane SP, Rockwell WB. Analysis of methods for reporting severe and mortal lipoplasty complications. Aesthetic Plast Surg 1999; 23:303-6. [PMID: 10541841 DOI: 10.1007/s002669900289] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
During the past 2 years, media attention has focused on catastrophic outcomes associated with liposuction. A critical review of the lipoplasty literature was undertaken to determine the incidence of severe and mortal complications. Reported lipoplasty complications and patient outcome studies published in the English literature through January 1, 1999, were reviewed. From these and from ASPRS questionnaire surveys of experienced, board-certified plastic surgeons, it is apparent that (1) plastic surgeons do not often voluntarily report severe and mortal complications (either as case reports or in self-reported series), and (2) while survey studies provide the most accurate estimate of complications due to lipoplasty, they are subject to an underreporting bias because they exclude complications occurring in the hands of residents and junior attendings. The mortality from lipoplasty procedures is higher than the 0.003 to 0.02% reported in the literature and may be as high as 0.1%.
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