The tumescent technique for liposuction is well established. In this method as originally formulated by Klein, large volumes of dilute lidocaine anesthetic are infiltrated into the subcutaneous tissue and the fat aspirated is by a small cannula. The procedure can be performed without further anesthetic or with supplemental analgesia as required, or with the patient fully anesthetized at the discretion of the cosmetic surgeon. Mortality, while extremely rare, has been related to lidocaine toxicity especially when lidocaine is combined with other anesthetic or systemic medications and pulmonary embolism. However fatal and near fatal morbidity have resulted from necrotizing fasciitis and cases involving intestinal perforation. Overall the paucity of major complications such as infection in abdominal liposuction with the tumescent technique is well documented. Guidelines of care for liposuction have been well established by various specialties although specifics on preoperative use of antibiotics are lacking. Most cosmetic surgeons utilize broad-spectrum antibiotics preoperatively; however, the antibacterial effect of lidocaine may be important in infection prevention .Because of the potential for infection by exposed bowel in the colostomy patient, it is unusual for cosmetic surgeons to attempt cosmetic liposuction in those patients. The concern would be bacterial seeding of extensive areas of fat through the abdomen and flanks leading to severe infection.
The cosmetic surgeon has performed two liposuctions on a 50- year-old 66-kg woman with a 5-year history of a left abdominal colostomy due to traumatic cauda equina syndrome, who was in otherwise excellent health. The first lipectomy was of the flanks, saddlebags, and knees. The patient was given 1 g cefazolin preoperatively and the colostomy site was covered with two layers of 3M Steri-Drape. The second layer of draping extended beyond the margins of the first layer. The ports were on the upper lateral buttocks and knees, and 2,300 ml of fat was removed. The procedure was completed without complications and recovery was uneventful. Several months later, an abdominal lipectomy for cosmetic purposes was performed as described in the following. Again, a preoperative broadspectrum antibiotic was utilized, and the stoma was double-draped using a wide border with adhesive surgical draping with the second layer of draping extending beyond the first layer.
Liposuction was performed under local anesthesia. The patient had very minimal fat in the abdomen and no complaints of stool leakage. The procedure was planned to effect a smooth transition to the area of the stoma. She was meticulously scrubbed with Betadine from the neck to the knees. The stoma and bag were covered with 3M Steri-Drape no. 1010, which is a plastic drape that adheres tightly to skin. A larger Steri-Drape was then applied over the first. Gloves were then changed by all personnel. Cefazolin (1 g) was given intravenously. Mild additional sedation and analgesia were accomplished with diazapam sublingual, a narcotic, and antihistamine intramuscularly. Small stab incisions were made in the right inguinal fold and right upper abdomen (her stoma was on the left). Klein formulation (50 ml of 1% lidocaine, 12.5ml of 8.4% sodium bicarbonate, 1ml of 1:1,000 epinephrine in 1 l of normal saline) was infused with a total of 1 l. Because of patient anxiety, the immediate area of the stoma was not addressed. Conservative-tip cannulas (3- and 4-mm diameter) were utilized and 250–ml of fat was obtained.
A volume of 250 ml of additional serosanguinous fluid was obtained. The postoperative course was uneventful. Although photographs were not dramatic, the patient was pleased with the result. The cosmetic surgeon utilized the tumescent technique, which allows the procedure to be completed under local anesthetic and takes advantage of the known antibacterial effect of lidocaine. The technique is to double-drape with adhesive surgical draping extending widely beyond the stoma edge, with the second drape overlapping and extending beyond the first drape. Both bag and stoma are covered. However, the patient did not have a leakage problem compared with other reported patients.
Our website is not responsible for the information contained by this article. Webworldarticles.com is a free articles resource thus practically any visitor can submit an article. However if you notice any copyrighted material, please contact us and we will remove the article(s) in discussion right away.
This article was sent to us by:
Helen D. Evans at
01282010
1. Pamper Your Skin and It Pampers You
All articles in this directory are property of their respective authors. Additionally, read our Privacy Policy
© 2010 WebWorldarticles.com - All Rights Reserved. Partners: Gunblade Saga