Postoperative Bruising Research Articles

Tumescent Abdominoplasty

The tumescent technique makes it possible for the surgeon to perform a full abdominoplasty with suction-assisted lipoplasty (SAL) contouring without the necessity for general anesthesia. Benefits include minimal blood loss, less postoperative pain, and limited postoperative bruising. In mid-1996, the co-author performed his first full abdominoplasty under local anesthesia with i.v. sedation in his office operating facility. Since then this technique has been used routinely. Patient satisfaction and rapid return to activities of daily living are remarkable.

Tumescent Abdominoplasty

The tumescent technique makes it possible for the surgeon to perform a full abdominoplasty with suction-assisted lipoplasty (SAL) contouring without the necessity for general anesthesia, Benefits include minimal blood loss, less postoperative pain, and limited postoperative bruising. In mid-1996, the co-author performed his first full abdominoplasty under load anesthesia with IV sedation in his office operating facility. Since then this technique has been used routinely. Patient satisfaction and rapid return to activities of daily living are remarkable.

The tumescent technique facilitates hair micrografting

Micrografting for hair restoration has become increasingly popular because of the natural results it can achieve. The procedure is often performed under local anesthesia or local anesthesia with sedation. To achieve adequate anesthesia, supraorbital and supratrochlear nerve blocks are often performed as well as infiltration of the donor and recipient areas via multiple needle injections. These nerve blocks and multiple injections are associated with significant discomfort and may need to be repeated if anesthesia is inadequate. In addition, because of the rich vascularity of the scalp, donor site and recipient bed bleeding are often encountered, making the procedure more difficult and increasing postoperative bruising and morbidity. In an attempt to alleviate these difficulties and increase patient comfort, the tumescent technique was employed in 50 consecutive micrografting procedures. The ability to achieve anesthesia in the donor and recipient beds without the need for additional nerve blocks was evaluated. The ability of the tumescent technique to minimize bleeding and subsequent postoperative ecchymosis and morbidity was analyzed. The findings of this study suggest the tumescent technique is useful in facilitating hair micrografting. It consistently achieves excellent anesthesia in both donor and recipient sites without the need for multiple needle injections or nerve blocks. The duration of anesthesia is significant, allowing completion of the procedure and offering prolonged postoperative anesthesia as well. Bleeding can be minimized using the tumescent technique for both donor site harvesting and the micrografting procedure itself.

Tumescent and syringe liposculpture: A logical partnership

Liposuction has been traditionally performed under general anesthesia. Standard instrumentation for the procedure has included blunt-tipped suction cannulae connected to an electric vacuum pump by noncollapsible tubing. A subcutaneous injection of Lidocaine with Epinephrine is routinely employed to minimize blood loss during the procedure. This infiltration has been described as the "wet technique," but it is not a method to supplant general anesthesia. The tumescent technique, a method of infusing very large volumes of dilute lidocaine with epinephrine solutions, has been advocated as a satisfactory means for providing conscious anesthesia for liposuction procedures, avoiding the need for general anesthesia. The syringe technique employs blunt-tipped suction cannulae connected to a syringe. Drawing back the syringe plunger generates the negative pressures needed to remove fat during liposuction and replaces the electric vacuum pump and connecting tubing traditionally used for this procedure. This study evaluates the combined tumescent and syringe techniques for liposuction. One hundred consecutive patients were treated with the tumescent technique as the sole means of anesthesia and the syringe technique as the sole means of performing liposuction. A modified tumescent formula is presented. A comparison of liposuction aspirates using this modified tumescent technique is compared and contrasted to liposuction aspirates obtained using the "dry technique" and the "wet technique." A historical review of the syringe technique and its perceived attributes is also presented. Technical descriptions of the tumescent infusion method, tumescent fluid formulation, and suggested patient sedation and monitoring is presented. Photographic documentation of patients who underwent the combined tumescent and syringe liposculpture treating various body areas is shown. A critical analysis of the limitations of this combined technique is also described noting added time requirements, difficulties with under-correction of deformities, and need for reoperation, methods for determining the "end-point" for the procedure, as well as addressing large-volume liposuction problems. The conclusion reached by this study is that combining the tumescent technique and the syringe technique is a logical partnership. Each method complements the other, allowing liposuction to be performed with considerable advantage over traditional methods. These advantages include eliminating the need for general anesthesia, lessening blood loss and postoperative bruising, greater accuracy, precision, and overall high patient satisfaction.

Fibrinolytic drugs prevent pericardial adhesions in the rabbit

Epicardial adhesions are believed to form secondarily to impaired pericardial fibrinolytic activity. This activity was reconstituted in a rabbit pericardial adhesion model with single doses of the fibrinolytic agents tissue plasminogen activator ( t-PA), t-PA analog (Fb-Fb-CF), and streptokinase (SK), resulting in reductions in the extent and tenacity of adhesion formation. Adhesions of the median strip of the anterior cardiac surface were reduced in area from 89% ( n = 22) in controls, to 28% ( n = 5) by treatment with Fb-Fb-CF (0.94 mg), and to 49% ( n = 7) by treatment with SK (93,750 IU). A modified fabric of oxidized regenerated cellulose (mTC7) used to deliver the agent to the cardiac surface did not interfere with the activity of these agents (Fb-Fb-CF 19%, n = 14; SK 33%, n = 7). t-PA (0.94 mg) was also found to reduce adhesion formation in combination with mTC7 (4%, n = 4), although the appearance of significant postoperative bruising and bleeding resulted in a decision to terminate the treatment of further animals with t-PA with and without mTC7. Postoperative bruising, bleeding, and swelling, to a lesser extent, were associated with SK and Fb-Fb-CF. Despite the efficacy of the these fibrinolytic drugs further work is required to assess their safety before they are used clinically.

Carbon-Dioxide-Laser-Assisted Lower Facelift: A Preliminary Report

This report describes our experience over a 36-month period with 110 lower facelift surgeries using the CO2laser as the primary or only cutting and undermining instrument. Carbon dioxide laser surgery was safe and effective in these 110 cases. Using the laser provided excellent hemostasis, absence of postoperative pain, and minimal postoperative bruising and swelling. There were no complications specific to the laser. There were no operating room fires and no laser accidents to the skin, eyes, or other tissues of the patients or operative personnel. Postoperatively there were no hematomas, no infections, no unusual scarring, no flap necrosis, and no dehiscence of incision lines.

Liposuction: optimizing factors.

Two aspects of liposuction procedures are discussed as ways of improving results. First, to help with the efficiency of fat removal several technical points are considered, especially the freedom and the facility of performing the liposuction procedure with a syringe without the aid of an aspirator. Surgeons are showing a growing interest with this new method. New and practical material that allows a reduced number of necessary manipulations is described. Second, we stress the importance of drainage, especially in relation to the resumption of activity which is much quicker due to the absence of postoperative bruising. When using drainage, the final result can be obtained as early as the second or third day.

The use of sprayed fibrin glue for face lifts

The use of a fibrin and thrombin tissue glue administered in aerosol form has been evaluated in 65 patients undergoing a face lift. In 55 cases the glue was applied to the undermined areas bilaterally, and appeared to decrease postoperative oedema and bruising. In a further 10 cases the adhesive was used on one side only. In 5 of these patients there was no difference between the two sides, while in 5 cases the glued side was judged superior. With this technique drains and dressings are not necessary in the postoperative period and patients find this especially convenient.