Liposuction  Uses , Contraindications And Complications

Suction-induced lipectomy or lipoplasty. Surgical aspiration of fat using metal cannulas to remove adipose tissue in specific anatomical locations. The 1970s saw the introduction of modern liposuction.

Adipose tissue is divided into compartments by fibrous septa. The superficial fat layer has more fibrous septa and is densely packed. Reduced quantity of fibrous septa, loosely organized in the deep fat layer. The superficial fascia system, known as Scarpa's fascia in the trunk or SMAS in the face, divides the deep layer from the superficial layer. The apical layer encircles the lymphatics, blood, sweat glands, and hair follicles. It never targets this area.

Pre-Procedure Evaluation

The distribution of fat is either gynoid (mostly in the lower body) or android (in the central belly or above the trunk). Hernias and scars require extremely careful attention.  DVT/PE risk using various ratings.

Selecting the right patient is crucial. Normal body shapes should be deviated from. The patient's BMI should be 30% of the optimal BMI, and they should not be obese.  Skin laxity should be minimal.

Contraindications

A four-week smoking cessation period is required. One should take uncontrolled diabetic mellitus into account. Body dysmorphic disorder, which is a skewed perception of one's own appearance in the absence of any obvious abnormalities.

Uses

Male gynecomastia
• It helps to lessen fat deposits that are localized, such as buffalo hump.
• It is used on the lower face and trunk for abnormal fat buildup.
• It is applied to augment the breasts' adipose tissue.
• It is utilized in the treatment of lipodystrophy syndrome in HIV-positive individuals as a result of protease inhibitor use.

It is used to harvest fat for autologous grafting.
Wetting solution, cannula, and negative suction are the three essential parts. Prior to liposuction, the wetting solution penetrates the subcutaneous tissue. Lidocaine, epinephrine, and regular saline are the ingredients of the fluid.

Various methods can be used to moisten liquids. The degree of infiltration into tissues and the resulting blood loss expressed as a percentage of aspirate fluid are the basis for different procedures. Super wet (infiltrating the wetting solution in a 1:1 ratio), Wet (it's also not recommended), and Dry (without utilizing any wetting solution). Less blood loss—between 1 and 4%.

The most favored method is the tumuscent kind, with a blood loss of less than 1% of the entire aspirated volume. Perhaps a blunt-tipped cannula is required. They lessen blood loss and avoid punctures into the pleura, peritoneum, or deep neck areas. Both big and small cannulas are employed.

With small cannulas, there is less chance of contour abnormalities. Fatty avulsion and stromal disruption are more common with larger cannulas. A hand syringe or suction machine or devices are used for negative suction. Steer clear of high-pressure equipment while removing little amounts of fat. Autologous fat grafting is to be performed using harvested fat.

Also Read: Laser Resurfacing And Lipotransfer

Principle 

Prior to surgery, mark the regions while standing. Cannulas with negative suction: these allow fat to enter the suction system by separating fat cells from fibrous septa. A deep fat layer is the target layer.

The zones of adherence, which include the inferolateral iliotibial tract, distal post thigh, lateral gluteal depression, and gluteal crease, are places where subcutaneous tissue is strongly adherent to the deep fascia of underlying muscles. These areas should never be targeted. 

Fluid management 

• Lipoaspirate <4L – Maintenance fluids 
• Lipoaspirate >4L- Additional fluid 
• 0.25 ml of fluid for every 1 ml of lipoaspirate 

Related: Reconstructive Techniques – Skin Anatomy And Skin Grafts

Other Techniques

Dependent on suction Simplest of all is liposuction. PAL, or power-assisted liposuction, uses a cannula with a motor that oscillates between 4000 and 6000 cycles per minute to separate fat cells. Operator tiredness is reduced by it.

There are two types of liposuctions: laser/RFA and ultrasound assisted. They enhance the reticular dermis and aid in rupturing adipocytes. They like tightening and retracting the skin.

Also Read: Skin Carcinoma – Basal And Squamous Cell  Carcinoma

Complications

• Large volume liposuctions- significant blood loss, fluid shifts, and hemodynamic instability. 
• Contour irregularities.
• Post-operative bruising
• Seroma
• Hematoma
• Lidocaine toxicity
• Fluid overload
• Hypothermia

Precautions- Warm blankets, ambient temperature

Also Read: Vascular Anomalies - Hemangiomas and Malformations

Lethal Complications

There may be a perforation of the abdominal viscera; necrotizing fasciitis or sepsis; pulmonary or fat embolism.

Hope you found this blog helpful for your NEET SS Surgery Skin and Subcutaneous preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.