Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_591_Библиотеки_им_академика_М_И_Перельмана
.pdf
ab
31 High-Denition Liposculpture: Critical Vision andFuture Perspective
https://t.me/medicina_free
Fig. 31.6 A 26-year-old male patient with high-denition liposculpture preoperatively (a) and 4
months postoperatively (b)
483
484
aa
bb
https://t.me/medicina_free
F. Massignan and F. Fuzinatto
1
1
Fig. 31.7 A 25-year-old female patient with previous liposuction and overweight in the preoperative period of high-denition liposculpture. Preoperative (a, a.1) and 6 months postoperatively (b, b1)
ab
31 High-Denition Liposculpture: Critical Vision andFuture Perspective
https://t.me/medicina_free
Fig. 31.8 A 36-year-old female patient with high-denition liposuction. Preoperative (a) and 1
year postoperatively (b)
485
a
b
Fig. 31.9 A 23-year-old female patient with high-denition liposuction. Preoperative (a) and 6
months postoperatively (b) in prole position
486
https://t.me/medicina_free
F. Massignan and F. Fuzinatto
a
Fig. 31.10 A 33-year-old female patient with high-denition liposuction. Preoperative (a) and 6
months postoperatively (b) showing the three dimensionality of the back
b
31 High-Denition Liposculpture: Critical Vision andFuture Perspective
https://t.me/medicina_free
487
a
Fig. 31.11 A 39-year-old female patient with high-denition liposuction. Preoperative (a) and 1
year later postoperatively (b) showing a delicate abdominal relief
b
References
Schider, F.An Atlas of Anatomy for Artists. Dover Publications 1957; NewYork, N.Y.
Massignan, F.Safety Evolution Of “Vaser” in Body Contour Surgeries. 2018.
Avelar J (1989) Regional distribution and behavior of the subcutaneous tissue concerning selection
and indication for liposuction. Aesthetic Plast Surg 3:155–165.
Pereira LH, Radwansky H. Fat grafting of the buttock and lower limbs. Aesthetic Plast Surg.
1996;20:409.
Hoyos AE, Millard JA. Vaser-assisted high denition lipoplasty. Aesthetic Surg J. 2007;27:
594-604.
Jewell, Mark L. Ultrasonic-Assisted Liposuction: Introduction and Historic Perspectives. In:
Ultrasound-Assisted Liposuction: Current Concepts and Techniques. Garcia Jr. O. (Ed).
Springer: LOCAL, ANO. 2020.
Jewell ML, Fodor PB, de Souza Pinto EB, Al Shammari MA (2002) Clinical application of
VASER-assisted lipoplasty: a pilot clinical study. Aesthet Surg J 22(2):131–146.
The Safe Evolution of Liposuction into Liposculpture https://doi.org/10.5772/intechopen.9735.
Ali Juma, Jamil Hayek and Simon Davies, 2021.
Nagy MW, Vanek PF Jr (2012) A multicenter, prospective, randomized, single- blind, controlled
clinical trial comparing VASER-assisted lipoplasty and suction- assisted lipoplasty. Plast
Reconstr Surg 129(4):681e–689e.
Bilsev Ince, Pembe Oltulu, Mehmet Emin Cem Yildirim, Majid Ismayilzade & Mehmet Dadaci
(2019) Effects of aspiration time on immediate viability of adipocyte cell in ultrasound-assisted
488
https://t.me/medicina_free
liposuction (UAL) and in traditional suction- assisted lipectomy (SAL), Journal of Plastic
Surgery and Hand Surgery, 53:1, 14–19. https://doi.org/10.1080/2000656X.2018.1515770.
Adipose Tissue Engineering from Human Adult Stem Cells: Clinical Implications in Plastic and
Reconstructive Surgery Michael S.Stosich, M.S. Jeremy J. Mao, D.D.S., Ph.D.NewYork,
N.Y.Plast. Reconstr. Surg. 119: 71, 2007.
Rohrich RJ, Beran SJ, Kenkel JM, Adams WPJ, DiSpaltro F. Extending the role of lipo-
suction in body contouring with ultrasound-assisted liposuction. Plast Reconstr Surg.
1998;101:1090–1102; discussion.
Klein JA.Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for
liposuction. J Dermatol Surg Oncol. 1990;16(3):248-263.
Cimino WW, Bond LJ.Physics of ultrasound surgery using tissue fragmentation: part I.Ultrasound
Med Biol. 1996;22:89-100.
Berkenstein MS, Grotting JC.Ultrasound-assisted lipectomy using the solid probe: a retrospective
review of 100 consecutive cases. Plast Reconstr Surg. 2000;105:2161–2174; discussion 2175.
Illouz YG.A new safe and aesthetic approach to suction abdominoplasty. Aesthetic Plast Surg.
1992;16(3):237-245.
F. Massignan and F. Fuzinatto
Chapter 32
https://t.me/medicina_free
Numerical Methodology forEvaluation
ofResults inLiposuction
RonanHortade Almeida, AndréVillaniCorreaMafra,
GnanaKeithMarquesde Araujo, andHuberthAndréVieiraZuba
Abstract Liposuction was rst described by Gerard Illouz in 1977. Its use to aspi-
rate grease in the subcutaneous lamellar layer became the standard method to treat
lipodystrophy. Illouz used the inltrative technique with a subcutaneous inltration
of solution in the subcutaneous tissues before aspiration.
Introduction
Liposuction was rst described by Gerard Illouz in 1977 (Souza Pinto etal. 2005;
Toledo and Giovannetti 2003). Its use to aspirate grease in the subcutaneous lamellar layer became the standard method to treat lipodystrophy (Toledo and Giovannetti
2003; Coleman 2000; Pollack 1999; Illouz 1998, 2006; Hunstad and Aitken 2006).
R. H. de Almeida (*) · A. V. C. Mafra
Preceptor of the Education and Training Center in Plastic Surgery, Mater Dei Hospital,
Belo Horizonte, MG, Brazil
Brazilian Society of Plastic Surgery, São Paulo, Brazil
Mater Dei Hospital, Belo Horizonte, MG, Brazil
e-mail: ronan@ronanhorta.com.br
G. K. M. de Araujo
Brazilian Society of Plastic Surgery, São Paulo, Brazil
Mater Dei Hospital, Belo Horizonte, MG, Brazil
Faculty of Medicine, UFMG, Belo Horizonte, MG, Brazil
H. A. V. Zuba
Education and Training Center in Plastic Surgery, Mater Dei Hospital,
Belo Horizonte, MG, Brazil
© The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
J. M. Avelar, R. Cavalcanti Ribeiro (eds.), Body Contouring,
https://doi.org/10.1007/978-3-031-42802-9_32
489
490
https://t.me/medicina_free
Illouz (1998) used the inltrative technique with a subcutaneous inltration of solution in the subcutaneous tissues before aspiration (Illouz 1998).
Liposuction became a consecrated method in the Brazilian plastic surgeon’s
therapeutical repertoire after the Brazilian congress in Fortaleza in 1980, when
Illouz made its rst presentation for the national community (Illouz 1998). Since
1980, some modications have been proposed. In 1982, we had the advent of supercial liposuction. At the end of the 1980s, Zocchi introduced ultrasonic liposuction
with unfavorable results, such as burning, difculty in the control of edema, seroma,
necrosis, and other complications, which discouraged the use of the new technique.
Dr. Baroudi and Dr. Fournier reported that the dry technique reduced the surgical
time and caused fewer distortions in the tissues but with a higher bleeding incidence. In the middle of the 1990s, Gross used oscillating devices to create his technique, so-called powered lipoplasty (Toledo and Giovannetti 2003).
However, the amplitude of areas to be treated sometimes makes it difcult to
evaluate the perioperative results (Chang 2004). Translating the liposuction results
into numbers yields a less-subjective demonstration.
R. H. de Almeida et al.
Anatomic andPhysiologic Considerations
Subcutaneous tissue is divided into two layers: the supercial areolar one and the
lamellar or reticular one, located deeper. The two layers are separated by the fascia
supercialis. The areolar layer contains voluminous turgid fat cells, while the lamellar one is formed by smaller, horizontally elongated cells with lower interior contents (Avelar and Illouz 1986; Duarte and Castellani 2002). The adipocytes in the
lamellar layer are mainly responsible for the hypertrophy and increase in thickness
in the fat tissue in that they are able to expand their original volume up to 100 times
(Avelar and Illouz 1986; Duarte and Castellani 2002). Areolar adipocytes exhibit
minor modications.
Subcutaneous tissue presents noticeable differences in diverse corporal areas of
obese individuals. Regions where skin is thicker and rm, such as the thorax, have
greater development of the areolar layer with a thinner lamellar layer. Thus, we
consider the cutaneous fold measure of this area a result reference for the areas
submitted to liposuction.
Methods
The initial assessments of a patient, including a solid anamnesis, an evaluation of the
patient’s objectives and expectations, and a detailed physical examination, are fundamental. Whether the patient is suitable for liposuction surgery should be evaluated,
checking comorbidities, smoking status, and nutritional status, among others. An ideal
candidate for liposuction does not smoke and has a Body Mass Index (BMI) < 30,
32 Numerical Methodology forEvaluation ofResults inLiposuction
https://t.me/medicina_free
because they would use few medications and would have few comorbidities with
good control. Patients who do not follow this pattern should receive a mistrial assessment with a risk stratication and an evaluation from the anesthesiologist to predict
whether they are an eligible patient for surgical treatment (Mendez etal. 2019).
The surgeon is responsible for realistically reporting the results according to the
patient’s body. It is also important to inform the patient about the risks and complications and to educate them to prevent confusion and misunderstandings. Thus, the
photographic record is an ally in the documentation and concrete evaluation of
results after surgery. This record claries the level of outcome and the change undergone by the patient (Mendez etal. 2019).
Physical examination is another important part in surgical planning and predicting favorable and unfavorable results. The BMI calculation should be obtained upon
examination. And having the patient stand in front of a mirror reveals six key elements: areas of concern for lipodystrophy and contour deformities, skin tone and
skin quality, asymmetries, cellulite and dimpling, myofascial support and laxity,
and zones of adherence (Mendez etal. 2019). In addition to these described above,
another element that can help predict results is measuring skinfolds, as we will discuss in this chapter.
491
Complementary Techniques toLiposuction
Several devices on the market improve the liposuction technique by helping the
surgeon perform their maneuvers or by enhancing the aesthetics of the surgical
results. Collins (Collins and Moyer 2018) describes tumescent suction-assisted
liposuction (SAL) with or without power assistance, laser-assisted liposuction
(LAL), and ultrasound-assisted liposuction (UAL) as the most popular techniques
(Collins and Moyer 2018).
The power-assisted liposuction technique provides reciprocating motion to the
cannula, facilitates the removal of adipose tissue, and reduces operator fatigue (Chia
etal. 2017). The laser-assisted liposuction technique promotes the coagulation of
small blood vessels, the rupture of adipocytes, the reorganization of the reticular
dermis, and the coagulation of collagen in fat tissues with various types of wavelengths (Chia etal. 2017). It has better results in the submental region, improving
skin retraction. Studies have suggested that it may help decrease the overall operative blood loss in high-volume liposuction. The ultrasound-assisted liposuction
technique uses sound energy at resonance with vibration. Its advantage is based on
improving fat viability and retention in autologous fat transfer (Chia etal. 2017).
There is evidence of benets in the treatment of the dense glandular tissue in gynecomastia. Besides that, seroma rates are higher, and the benets did not improve
patient satisfaction, swelling, or bruising. Compared with the SAL technique, the
results are controversial in terms of outcomes and long-term complications (Collins
and Moyer 2018). Radiofrequency-assisted liposuction allows for the use of energy
in the subcutaneous tissues without compromising the skin, aiding in tissue
492
https://t.me/medicina_free
contraction. Studies have shown good results, with linear tissue contraction in the
postoperative period (Chia etal. 2017). Finally, water-assisted liposuction uses pulsating solution jets with simultaneous aspiration. One study has shown better weight
retention, less apoptosis, and greater angiogenesis (Chia etal. 2017).
The use of energy devices improves efciency; however, they come with various
complications, such as thermal injury, seroma, deformities, irregularities, and contractures. These may be associated with excessive use and the inexperience of the
surgeon (Collins and Moyer 2018).
R. H. de Almeida et al.
Method fortheThickness oftheCutaneous Fold
Using an adipometer or bidigital maneuver with a ruler, we measure the thickness
of the cutaneous fold in the medium-axillary line between the nineth and tenth ribs
(Fig.32.1). We measure the areas to be treated by using the same methodology, and
we show the differences to the patient. Anatomical guidance points for measuring
the treatment areas are the linea alba above the umbilical of the superior abdomen,
an imaginary line over the rectus abdominis muscles for the inferior abdomen, the
iliac crests and their tubercles for the anks, and the infrascapular area perpendicular to the latissimus dorsi muscle bers for the dorsum. Another preoperative aspect
observed is the presence of corporal contour asymmetries in the quantitative demonstration to the patient. We write down all the collected values in the patient’s
record for posterior comparison and then photograph the patient.
The patient is submitted to the preoperative delimitation of the area to be treated
and is directed to liposuction via the humid or inltrative technique with an inltration of 0.9% sodium chloride solution and adrenaline at a concentration of
1/500,000, under peridural anesthesia and venous sedation performed by an
anesthesiologist.
During the surgical procedure, the to-be-treated areas are repeatedly measured to
determine via liposuction the dimensions of its cutaneous folds to the one collected
in the thoracic region of reference. The ending of the surgery is determined by the
equivalence of the values. This technique avoids both underaspiration and
Соседние файлы в папке Библиотека им академика М.И. Перельмана