Tumescent Solution Research Articles

Lipoaspiration and Processing to Create Microfragmented Adipose Tissue

Background: Orthobiologics are increasingly used to treat musculoskeletal (MSK) conditions. Adipose may be a useful source of autologous cells for orthobiologic interventions. The lipoaspiration and processing techniques necessary to obtain these cells are not traditionally taught in most orthopedic training programs. Therefore, the goal of this video is to review the technique for adipose harvest and preparation to create microfragmented adipose tissue (MFAT). Indications: Currently, all MFAT applications are off-label. In practice, this is most commonly used for osteoarthritis and tendon disease. Technique Description: After local anesthesia is administered, a 17-gauge trochar is inserted into the subcutaneous adipose, and tumescent solution is injected. After a 5-minute waiting period, a separate 17-gauge harvest trochar is attached to the Autopose double-syringe (Arthrex; Naples, Florida) and is inserted into the subcutaneous adipose. Lipoaspiration is performed by moving the harvest device back and forth in a fan-like pattern. After 20 mL of lipoaspirate has been harvested from the first site, the lipoaspiration process is repeated on the contralateral side. After 40 mL of lipoaspirate has been harvested, the device is removed and decanted for 3 to 5 minutes. Then, 10 mL of sterile saline solution is injected into the device using the Luer lock attachment. This rinse process is repeated a second time. Once the excess fluid has been removed, the device is capped, and the outer syringe is slowly pushed down to move the tissue through the resizing filter. The inner syringe is removed and contains the final MFAT product. Discussion/Conclusion: Lipoaspirate is a simple technique that can be performed in the clinic or operating room to create MFAT. This provides a unique population of autologous cells that may be beneficial for treating MSK pathology.

COMPARISON BETWEEN ADRENALINE AND WITHOUT ADRENALINE SOLUTION ON BLEEDING CONTROL OF SKIN GRAFT DONOR SITE: A RANDOMIZED CONTROLLED TRIAL

OBJECTIVE: To compare the bleeding control of skin graft donor site between normal saline soaked gauze with adrenaline and conventional technique having no adrenaline. METHODS: This open-label randomized control trial was conducted at Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan from October 2020 to March 2021. Seventy-five patients were randomized to interventional (n=36, 48%) and control group (n=39, 52%) through sealed envelopes. Diluted solution was prepared by adding 30cc of Ringer’s lactate and 10cc of lignocaine 2%, with 1cc of adrenaline of 1:200000 with 200 ml of normal saline solution. Solution for control group was containing only normal saline. Following the skin harvesting at donor site, a gauze piece soaked with tumescent solution was applied at the donor site wound. Bleeding severity and epithelialization were assessed. Data was recorded in a pre-designed performa and analyzed through SPSS version-25. RESULTS: There was no significant differences in baseline characteristics like age (p=0.823), gender (p=0.984) and nature of injury (p=0.936) among two groups. Severe, moderate and mild bleeding was noted in 20/39 (51.3%), 15/39 (38.5%) and 4/39 (10.3%) cases in control group as compared to 0/36 (0%); 2/36 (5.6%) and 25/36 (69.4%) cases in interventional group respectively (**<0.001). No bleeding was noted in 9/36 (25%) cases of interventional group. Complete epithelialization was observed in 24/36 (66.7%) & 17/39 (43.6%) cases in adrenaline and control groups respectively (p=0.045). CONCLUSION: Application of adrenaline was more effective in bleeding control and early epithelialization at donor site following the skin harvesting as compared to conventional technique.

The Notable Articles Project

Editors’ note: This is the second issue to include the Notable Articles Project. In this column, an important Forum article from the past is republished along with commentary from a respected expert. Abbasi Solution is a modification of our standard tumescent solution that includes steroid to

Effects of Heated Tumescence Solution in Bitches after Unilateral Mastectomy

Background: Mammary tumors, for which mastectomy is the main treatment, are the most common neoplasms in bitches. Mastectomy is painful and, in order to reduce the pain stimulus in the transoperative period, tumescent local anesthesia is associated with general inhalation anesthesia. However, despite the numerous benefits of tumescence, intraoperative hypothermia is the most common complication. In Medicine, especially in plastic and dermatological surgery, it is common to use a heated tumescence solution to prevent intraoperative hypothermia; however, in Veterinary medicine, no previous study has examined the advantages and disadvantages of using heated tumescence solution. Thus, this study aimed to investigate the transanesthetic cardiorespiratory effects of heated tumescence solution in bitches submitted to radical unilateral mastectomy.Materials, Methods & Results: Eight animals were treated with 0.1% lidocaine solution, warmed to 37-42°C, using a Klein’s cannula for administration. Chlorpromazine (0.3 mg/kg) and meperidine (3 mg/kg) were used as pre-anesthetic medication intramuscularly, and induction was performed with intravenous propofol and maintenance with isoflurane. The data collection times were as follows: 15 min after starting isoflurane administration (M1), 5 min after tumescence (M2), after beginning of surgical incision (M3), during breast pullout (M4), after clamping of the superficial caudal epigastric vein, and artery (M5), after the beginning of the approximation of the subcutaneous tissue (M6), after the beginning of the intradermal suture (M7), and at the end of the surgical procedure (Mfinal). The heart (HR) and respiratory (ƒ) rates, mean arterial pressure (MAP), end-tidal CO2 concentration (EtCO2), expired isoflurane concentration (EtISO), and rectal temperature (RT) were measured. The HR, ƒ, and EtCO2levels did not differ statistically. The mean EtISO presented in M2 (1.16 ± 0.41) was significantly lower than that in M3 (1.39 ± 0.40) and M4 (1.49 ± 0.49).Discussion: In the HR analysis, it was found that during all evaluation moments, the means remained within the reference range for the species. Moreover, the values during the breast pullout (M4) did not exceed 20% of those presented minutes before the beginning of the surgery (M2), which was indicative of analgesic rescue, suggesting that the animals did not experience pain. Hypoventilation resulted in an increase in EtCO2 values. Thus, it can be said that in this study, there was no respiratory depression during the transoperative period, as the values of the variables ƒ and EtCO2 were within the reference for the species. With regard to the EtISO variable, there was no reduction in the MAC of isoflurane with the use of heated tumescence solution, as reported by some authors (EtISO 0.8%). However, the EtISO values presented here are close to those found in the literature during breast pullout (EtISO between 1.3% and 1.52%), with the use of refrigerated tumescence solution. In addition, the values shown in M4 are within the equivalent of 1 MAC (1.41%) of isoflurane, proving that heated tumescent local anesthesia is a safe technique and an excellent adjunct to inhalation anesthesia, as it provides intraoperative analgesia. Therefore, heated tumescence solution is safe and an excellent adjuvant in general inhalational anesthesia for radical unilateral mastectomy as it did not increase inhaled anesthetic consumption during surgery.Keywords: tumescent local anesthesia, lidocaine, dogs, inhalation anesthesia, mammary tumors.

A randomized controlled trial: Comparison of one-per-mil tumescent technique and tourniquet in surgery for burn hand contracture in creating clear operative field and assessment of functional outcome

BackgroundThis study aims to compare the use of one-per-mil tumescent solution (a mixture of epinephrine and 0.2% lidocaine in a ratio of 1:1,000,000 in normal saline solution) and tourniquet to create clear operative fields and to evaluate the functional outcomes after post burn hand contracture surgery. MethodsThe subjects of this randomized controlled trial were divided into one-permil tumescent technique and tourniquet group for a similar surgical procedure. Three independent assessors evaluated the clarity of the operative fields through recorded videos for the first 15 min and the first 10-minute of each hour of the surgery. Functional outcome was evaluated at least three months postoperatively using total active and passive motion (TAM and TPM) of each digit. Malondialdehyde (MDA) and tumor necrosis factor alpha (TNF-α) were tested during baseline (5 min before the procedures), ischemia phase, and reperfusion phase (a phase when the blood flow returned to the tissue). Results35 subjects were included in this study: 17 in the tumescent group and 18 in the tourniquet group. We found a significant difference in the clarity of operative field between tumescent and tourniquet groups, 5 vs 35 bloodless operative fields, respectively (p < 0.05). TAM and TPM of each digit before surgery and 3 months postoperatively showed no significant difference between both groups (p > 0.05). Furthermore, we found no difference in MDA and TNF-α levels between both groups at their respective phases. ConclusionsThe use of one-per-mil tumescent technique does not replace tourniquet use to create bloodless operative fields in burned hand contracture surgery. However, the postoperative functional results were similar in both groups showing that tumescent technique can be used as an alternative to tourniquet without compromising outcomes. The MDA and TNF-α examinations do not provide conclusive outcomes regarding ischemia and reperfusion injury.

Surgical management of gynecomastia by four-plane tumescent subcutaneous mastectomy (TSM)

Introduction: Gynecomastia or the enlargement of breast tissue in men is one of the most common problems. Surgical management includes surgical excision or liposuction or both based on the grade. Surgical excision by Subcutaneous mastectomy(SM) is the criterion standard for the management of gynecomastia with only glandular hypertrophy without skin excess. We have evaluated the ease, safety and pitfalls of SM with tumescent technique. Aims and objectives: To describe our technique of tumescent subcutaneous mastectomy (TSM), its operative ease, post-operative analgesia, and complications. Patients and methods: The study was conducted in the department of plastic surgery of a tertiary care hospital from 2018 August to 2021 July. 53 SM without liposuction were included in the study. Operative procedure: Infiltration solution consisted of Ringer Lactate - 500ml + 2% Lignocaine (12.5ml) + 1:1000 Adrenaline (0.5ml) + 0.5% Bupivacaine (12.5ml). 200-250 ml of tumescent solution was used per side using four-plane technique (Sub glandular, glandular, supra glandular and subdermal). SM was done using a standard technique. Operative time, ease of surgery, duration of post-operative analgesia and post-operative complications were recorded on a preformed questionnaire. Results: 80% operating surgeons reported very good visualization of tissue planes and 79.2% reported dissection was very easy. 85% of the excisions were performed using 2 or less gauze pieces. Post-operative analgesia was achieved for 4-6 hours in more than 75%. Complications like seroma (7.5%), epidermal loss (3.8%), contour abnormality (1.9%) and nipple flattening (3.8%) were noted. Discussion: The effects of tumescent components like hydro-dissection, vasoconstriction and analgesia added to the benefits of this technique. The complications noted were like or less compared to standard SM. Conclusion: TSM being safe and easy, with an additional benefit of post-operative analgesia, is a worthy option in the management of gynecomastia with glandular hypertrophy without skin excess.

Multiple Symmetric Lipomatosis: Lipectomy for Madelung Collar.

Multiple symmetric lipomatosis (MSL) is a rare disease associated with metabolic disorders and alcoholism. In this report, we describe the clinical outcome and surgical protocol for eight men with Madelung collar who underwent treatment in a craniofacial and plastic surgery facility in Hanoi, Vietnam, between May 2018 and December 2020. We discuss the patients' clinical symptoms, subclinical signs, epidemiology, magnetic resonance imaging, computerized tomography, surgical protocol, complications, and postoperative indicators that we collected and evaluated. Each patient underwent surgery in two stages (i.e., in supine and prone positions). We injected a tumescent solution 10 min before the incision. Two surgeons performed each operation simultaneously. After surgery, we followed the patients for 6-27 months. All of the patients had a history of long-time alcohol abuse and had associated comorbidities that included liver disease, blood disorders, restricted neck movement, and orthopnea. We did not have to open the trachea or transfuse blood during any of the surgical procedures. Postoperatively, all patients were satisfied with their functional results and aesthetic appearance. One patient experienced a recurrence of his MSL. We believe our surgical protocol provides optimal results for patients with MSL and Madelung collar.

The Effects of Using Tranexamic Acid in Tumescent Solution During Rhytidectomy Surgery

Introduction: Tranexamic acid (TXA) is a common adjunct to assist in hemostasis in a wide variety of applications. Although TXA has gained more popularity in facial cosmetic surgery, there are limited studies evaluating the effects of TXA in rhytidectomy patients, especially when used in tumescent solution. Purpose: The purpose of this study was to evaluate the effects of TXA on surgical time, postoperative ecchymosis, and need for aspiration when used in tumescent solution during cervicofacial rhytidectomy procedures. Materials and Methods: The authors designed a retrospective cohort study from an eligible population of all patients treated with cervicofacial rhytidectomy using tumescent solution at Williamson Cosmetic Center in Baton Rouge, LA, from January 1, 2019, to December 31, 2019. The outcome variables were surgical time, need for postoperative aspiration, and the duration of bruising postoperatively. The primary predictor variable was the use of TXA in the tumescent solution. Statistical analysis was performed using t tests and chi-square analyses. Results: Overall, 70 patients were included in the study with a mean age of 61.4 ± 7.2 years and 90% were female. Forty-five patients were in the TXA group and 25 in the non-TXA group. The use of TXA in tumescent solution was statistically significant for reducing ecchymosis ( p &lt; .001). The majority of patients in the TXA group (60%) had bruising cleared by day 7, whereas the majority of patients in the non-TXA group (52%) had bruising cleared by day 28. There was a statically significant reduction in frequency of postoperative aspiration in the TXA group (8.9% in TXA group vs 40.0% in the non-TXA group, P = .002). The study did not demonstrate a significant difference in surgical time between the two groups. Discussion: Although there is a lack of recognition of the potential benefits of TXA, there has been an increased off-label use by numerous surgical specialties. Routes of administration include topical, oral, intravenous, local infiltrative, and by tumescent anesthesia. Improvements in intraoperative hemostasis and postoperative ecchymosis are some of the main benefits of TXA. Conclusions: Utilizing TXA in tumescent solution in patients undergoing cervicofacial rhytidectomy procedures is associated with an improvement in postoperative ecchymosis duration and a decreased need for postoperative aspiration compared with the non-TXA group.

Tumescent Anesthesia: A Brief History Regarding the Evolution of Tumescent Solution.

Tumescent anesthesia, initially developed as a safer and more effective alternative to general anesthesia in performing liposuction, is used extensively today for a wide array of surgical procedures performed by various specialties. The make-up of the tumescent solution is variable, and it has evolved significantly over the past 40+ years. Even prior to Jefferey Klein&rsquo;s tumescent solution recorded in his article from 1987, &ldquo;The Tumescent Technique for Lipo-Suction Surgery,&rdquo; there were significant contributions paving the way to modern formulations.1 In this article, we attempt to provide the most comprehensive history and timeline documenting the evolution of tumescent solution to date. J Drugs Dermatol. 2021;20(12):1283-1287. doi:10.36849/JDD.6212.

Evaluation of Flush Endovenous Laser Ablation of the Great Saphenous Vein up to the Saphenofemoral Junction

Background: Varicose vein disease is one of the most common health problems faced by vascular surgeons worldwide affecting up to 23% of the adult population. The majority of patients with primary varicose veins have great saphenous vein (GSV) insufficiency. Objective: To determine the feasibility and safety of flush Endovenous laser ablation (EVLA) of the patients with Great saphenous vein (GSV) up to the saphenofemoral junction. Patients and Methods: A prospective study was conducted in the Vascular Surgery Department, Faculty of Medicine, Zagazig University from January to June 2021 including 18 cases. All patients were subjected to detailed history taking, clinical examination, the clinical severity of venous disease was established using CEAP [Clinical, etiological, anatomical & pathological] and VCSS, the effect of disease-specific quality of life was determined using the CIVIQ, Laboratory Investigations and duplex ultrasonography performed for all patients. Results: The operative time ranged from 20 minutes to 40 minutes, with a mean of 30 minutes. Regarding hospital stay, all patients were discharged on the same day of the intervention. Return to normal activity ranged from 7 to 9 days, with a mean of 7.33 +/- 1.46. as regard complications; only Ecchymosis in 2 limbs (7%), Temporary numbness at the leg in 3 limbs (11%), and incomplete occlusion in one patient (4 %). Conclusion: The use of a high wavelength (1470nm) with a modified fiber tip with tumescent solution has a crucial role in achieving the best results and minimizing the adverse effects. This allows homogenous destruction of the vein wall exclusively.

No Tourniquet Technique of Surgery for Macrodactyly

The tourniquet technique in limb surgery has traditionally been performed to produce bloodless operative fields. Nevertheless, there are limitations derived from the tourniquet itself; either the complications that may occur because of the ischemic effects, or the constraint of time because of the ischemic time. As no surgeon expects dreadful adverse events in their practices, an alternative technique may fill up the demand. The implementation of epinephrine, which was previously believed to be dangerous, has been performed in end-artery organs such as toes and fingers. In this article, the authors apply the tumescent technique with the use of 1:1,000,000 epinephrine or shortly termed as one-per-mil solution, without using the pneumatic tourniquet. The technique presents relatively clear operative fields, yet safe. Although the risk of bleeding is higher because of the enlarged vascular caliber and all structures around the affected digits, the technique facilitates clear visualization of important structures. In addition, the long action of the one-per-mil tumescent solution notably provides a much longer surgery duration, which facilitates complex surgery for macrodactyly. Level of Evidence: Treatment level of evidence IV—case series. See Instructions for Authors for a complete description of levels of evidence.

Efficacy and Safety of Tranexamic Acid for the Control of Surgical Bleeding in Patients Under Liposuction.

Liposuction remains one of the most frequently performed cosmetic surgical procedures and its popularity is increasing every year. However, since its inception, justified concerns regarding patient safety have placed limits on the volume of fat that can be aspirated, influenced by hemodynamic fluctuations and blood loss during liposuction. Tranexamic acid (TXA) is an antifibrinolytic agent that competitively inhibits the conversion of plasminogen to plasmin, thus preventing the binding and degradation of fibrin. Despite the existence of evidence of the effectiveness of TXA in orthopedic and cardiac surgeries, there is little evidence of its use in liposuction. The objective of this study was to evaluate the efficacy and safety of tranexamic acid in the control of surgical bleeding in patients undergoing liposuction, through a prospective, open, randomized and controlled clinical trial. Two groups of 25 participants each were formed to whom the application of TXA in a tumescent solution prior to liposuction or liposuction with the traditional technique was randomly assigned. The results showed a decrease in blood loss reflected by the differences in the final hematocrit values, as well as decrease in the same per aspirated volume (p = 0.003). No adverse events were found related with the TXA application and no blood transfusions were required in this group, in contrast to the control group where the need for blood transfusion was present in 20% of the intervened participants. LEVEL OF EVIDENCE II: 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.

Epinephrine one-per-mil tumescent solution in hand surgery: Review of experimental and clinical studies

One-per-mil epinephrine solution (1:1,000,000) injected as a tumescent has been used in several hand and upper-limb surgery cases as a substitute for tourniquet. However, reviews of its effectiveness are still lacking. A comprehensive review was conducted based on PubMed, Scopus, Science Direct, Cochrane Library, and Semantic Scholar database search of relevant studies using the keyword “one-per-mil.” Studies not using the exact one-per-mil tumescent solution formula were excluded. The review of clinical studies was conducted according to PRISMA guidelines. Epinephrine and the hydrostatic vasocompressive effect created bloodless operative fields, with 100% experimental flap survival after ischemic insult. The technique was effective in creating bloodless operative fields in 36.3% of varied hand and upper-limb surgery cases and in fully awake surgery. Current studies show that one-per-mil tumescent solution is safe and effective, enabling use of tourniquet to be avoided.

Management of skin graft donor site in pediatric patients with tumescent technique and AQUACEL® Ag foam dressing

Split thickness skin graft donor sites are challenging to manage in children because of patient fear and anxiety. Therefore, strategies that minimize the frequency of dressing change are beneficial. This paper describes a technique to simplify wound care for split thickness skin graft donor sites. A tumescent solution of saline containing 0.25% bupivacaine with epinephrine is infiltrated into the graft donor site. Skin grafts are harvested with an electric dermatome. The donor sites are dressed with AQUACEL® Ag Foam, which is a sodium carboxymethylcellulose hydrofiber dressing that contains silver ions. A total of 17 split thickness skin grafts were performed with this technique. Patient age ranged from 2.4 year to 16.9 years (average 12 years). The AQUACEL® Ag Foam dressings were removed at an average of 23 days (range 11 to 31 days) at which time complete donor site epithelialization was seen in 13/17 (76.5%) patients. The remaining 4 patients had < 5% of the donor site that had not epithelialized; these went on to heal uneventfully with a brief period of petrolatum gauze dressing changes. Two patients had foul smelling discharge under the dressing that resolved promptly with dressing removal. The above technique allows the primary dressing to stay in place long enough for epithelialization to take place. The obviation of dressing changes in the early post-operative period results in patient comfort and care giver convenience.

Post-operative follow-up of 150 patients with sentinel lymph node biopsy under tumescence local anesthesia.

Sentinel lymph node biopsy (SLNB) is useful for staging of patients with melanoma. Although SLNB is mostly performed under general anesthesia (GA), tumescence local anesthesia (TLA) can also be used. However, less data are available regarding feasibility of SLNB under TLA. Here we present a post-operative follow-up of 150 patients. We prospectively analyzed data from 150 patients with primary cutaneous malignant melanoma. We assessed pain, post-operative complications and patients' satisfaction after SLNB under TLA. 32% of the patients reported post-operative pain within the first 48h after SLNB. Seroma was the most frequent complication, as 29 seromas after SLNB were observed. Wound infection was observed in 3.3% of the patients. 98.7% of the patients were satisfied with SLNB under TLA. SLNB under TLA is a safe and feasible option and should be considered for patients with melanoma. Especially with multimorbid or elderly patients, the risks of GA can be avoided.

Tumescent local anesthesia as an alternative to general anesthesia in release of post-burn neck contracture and skin graft harvesting: A comparative study

Background: Anesthetic management of severe post burn neck contracture is difficult, demanding due to fixed flexion deformity of neck, incomplete oral occlusion and insufficient mouth opening leading to difficulty in intubation. Patients undergoing contracture release, skin graft harvest under general anesthesia (GA) were compared with patients undergoing the same surgery under tumescent local anesthesia (TLA) technique.&#x0D; Methodology: Twenty-one patients with post burn neck contracture undergoing contracture release with split skin grafting under GA were compared with twenty-one patients undergoing the same surgery under TLA. Post-operative pain and satisfaction were assessed using 10 cm VAS (Visual Analogue Scale).&#x0D; Results: Demographic profile was comparable in both groups. Changes in intra-operative vital parameters remained insignificant. The average volume of tumescent solution used was 254.76 + 49.05ml. Blood loss was significantly decreased, postoperative pain relief was more than sixteen hours in thirteen patients and extended beyond twenty-four hours in six patients in the TLA group. Time for the first rescue analgesia was significantly lesser in the GA group and the average dose of injection tramadol used in the GA group was significantly higher within the first 24 h. Overall satisfaction in the TLA group was significantly higher than in the GA group.&#x0D; Conclusion: TLA can be used as sole technique for release of post burn neck contracture and harvest of split skin grafts with less blood loss and significantly better postoperative pain relief avoiding complications of general anesthesia.&#x0D; Key words: Tumescent local anesthesia; Post burn neck contracture; Skin graft harvest; General anesthesia&#x0D; Citation: Prasad MK, Jain P, Varshney RK, Khare A, Jheetay GS. Tumescent local anesthesia as an alternative to general anesthesia in the release of post-burn neck contracture and skin graft harvesting: A comparative study. Anaesth. Pain intensive care 2021;25(1):34–39.&#x0D; DOI: 10.35975/apic.v25i1.1434&#x0D; Received: 18 February 2020, Reviewed: 16 March 2020, Accepted: 30 April 2020

Effect of Subcutaneous Adrenaline/Saline/Lidocaine Injection on Split-Thickness Skin Graft Donor Site Wound Healing.

Subcutaneous injection of tumescent solution, which contains local anesthetic, adrenaline, and saline, before split-thickness skin graft harvesting, shows a significant hemostatic effect. This method can reduce the initial bleeding from the donor site. The aim of this study is to assess the benefits of controlling the bleeding from donor sites by tumescent injection. A randomized, controlled trial was performed to compare the wound healing of split-thickness skin graft donor sites treated with or without tumescent injection. This randomized, controlled trial examined donor site healing days as the main measure of outcome. postoperative pain, donor site ulceration, and scar quality were evaluated as secondary outcome measures. Patients planned for split-thickness skin graft harvest were randomly assigned to receive either pre-harvest subcutaneous injection of local anesthetic, adrenaline, and saline solution (tumescent solution) (Group 1) or post-harvest application of adrenaline solution-soaked gauze to the skin graft donor sites (Group 2). Donor sites were treated with calcium alginate dressings after graft harvesting. On the 10th postoperative day, the dressings were removed and donor site healing were measured. Follow-up evaluation of scar quality was performed 6 months after surgery. Postoperative pain was evaluated on the 1st day after operating. Forty-five patients (26 males; average age 61.8 years) completed the late follow-up evaluation (6 months postoperatively), with 26 patients in group 1 and 19 in group 2. There were no significant differences between the two groups in any of the outcome measures. Tumescent technique provides sufficient hemostasis in split skin graft donor sites, especially the initial bleeding just after graft harvesting, without any negative effects. Larger series should be studied to evaluate the effect in donor site wound healing.

Comparative evaluation about the efficacy of the use of variable concentrations of Epinephrine in Tumescent solution for control of bleeding in patients with abdominal liposuction

Objectives: The use of epinephrine for controlling the blood loss has gained out in many dermatological surgeries; however, its use in liposuction has not been studied. In this regard, we aimed to figure out the effectiveness of using epinephrine in tumescent solution during liposuctions surgery.&#x0D; Methods: In this study we present a prospective, double-blind, nonrandomized study evaluating the effects of adding epinephrine to tumescent solution intra-operative in patients undergoing liposuction. Thirty-six patients including 6 males and 29 females undergoing liposuction were divided into two groups. In case group we use 1-1.4 mg/L epinephrine (based on the location of surgery) in tumescent solution; and control group did not receive epinephrine. Lab data such as hemoglobin and hematocrit as well as clinical data including blood pressure and heart rate were recorded before, after 1h and 6h of liposuction.&#x0D; Results: In this study, we observed that both case and control group faced a significant dropped in their hemoglobin and hematocrit; however, the decrement was significant lower in case group. In addition, both groups had a stable hemostasis after 1h and 6h of surgery. In this regard, we did not observe any significant difference between heart rate and blood pressure of two groups.&#x0D; Conclusion: The results of this study suggest that using epinephrine as vasoconstriction agent in tumescent solution might decrease the rate of bleeding and increase the chance of stable hemostasis both during and after abdominal liposuction.

Shear Force Processing of Lipoaspirates for Stem Cell Enrichment Does Not Affect Secretome of Human Cells Detected by Mass Spectrometry In Vitro.

Lipofilling is one of the most often performed surgical procedures in plastic and reconstructive surgery. Lipoaspirates provide a ready source of stem cells and secreted factors that contribute to neoangiogenesis and fat graft survival. However, the regulations about the enrichment of these beneficial cells and factors are ambiguous. In this study, the authors tested whether a combination of centrifugation and homogenization allowed the enrichment of viable stem cells in lipoaspirates through the selective removal of tumescent solution, blood, and released lipids without significantly affecting the cell secretome. Human lipoaspirate was harvested from six different patients using water jet-assisted liposuction. Lipoaspirate was homogenized by first centrifugation (3584 rpm for 2 minutes), shear strain (10 times intersyringe processing), and second centrifugation (3584 rpm for 2 minutes). Stem cell enrichment was shown by cell counting after stem cell isolation. Lipoaspirate from different processing steps (unprocessed, after first centrifugation, after homogenization, after second centrifugation) was incubated in serum-free cell culture medium for mass spectrometric analysis of secreted proteins. Lipoaspirate homogenization leads to a significant 2.6 ± 1.75-fold enrichment attributable to volume reduction without reducing the viability of the stem cells. Protein composition of the secretome did not change significantly after tissue homogenization. Considering the enrichment effects, there were no significant differences in the protein concentration of the 83 proteins found in all processing steps. Stem cells can be enriched mechanically without significantly affecting the composition of secreted proteins. Shear-assisted enrichment of lipoaspirate constitutes no substantial manipulation of the cells' secretome.

Iatrogenic sciatic nerve injury during liposuction and fat tissue grafting: a preventable surgical complication with devastating patient outcomes

BackgroundLiposuction and autologous fat transplantation represent widely used techniques in plastic surgery to correct or enhance contour irregularities in the face and body. While these techniques are assumed to be safe, liposuction and fat grafting impose a hidden risk for serious preventable surgical complications and adverse patient outcomes. We hereby report two cases of iatrogenic sciatic nerve injury and provide recommendations on how to prevent this serious surgical complication.Case presentationWe present two cases of sciatic nerve injury - one related to liposuction and the other related to gluteal lipo-augmentation. The first case is a 20-year-old female who presented to our institution with right leg weakness one week after undergoing scar revision and fat grafting in the left peri-oral region to correct peri-oral cicatricial banding and tissue atrophy. Fat was harvested from the medial thigh using a 3-mm cannula with low-pressure manual suction, utilizing minimal tumescent solution. Nerve conduction velocity and electromyography testing suggested a right-sided sciatic nerve lesion as a result of direct trauma. The patient was observed for a period of 4 months during which time she underwent physical therapy. At four months post-operatively, she had recovered completely. The second case is that of a 39-year-old female who presented to our institution with left-sided weakness of foot eversion and dorsiflexion five days after she had undergone liposuction of the thighs, flanks, and abdomen in addition to gluteal lipo-augmentation at an outside facility. The patient had undergone super wet liposuction in the areas of the abdomen, flanks and thighs. 200 mL of collected fat was then transplanted into each buttock at multiple levels. Post-operative computed tomography and electroneurography revealed acute left sided sciatic injury consistent with direct trauma to or compression of the sciatic nerve. The patient underwent an extensive regimen of physical therapy. Three months post-operatively, the patient had regained some motor function, but was lost to follow-up thereafter.ConclusionThe sciatic nerve is relatively superficial and vulnerable to injury in the upper thigh and lower buttock regions. Therefore, extreme care should be taken when working in these areas to avoid direct or indirect injury to the sciatic nerve by compression or traction.