The application of suction-assisted lipectomy for the problem of axillary hyperhidrosis.
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OBJECTIVE: To investigate the effectiveness of liposuction as treatment in troublesome colostomies and urinary stomas in selected patients. DESIGN: Open clinical study. SETTING: University hospital, Norway. SUBJECTS: 8 consecutive patients with colostomies (n = 2) or urinary stomas (n = 6) who required treatment with liposuction above or around the stoma, mainly for leakage. INTERVENTIONS: Syringe-assisted liposuction under local anaesthesia. MAIN OUTCOME MEASURES: Change in stoma function, particularly reduction in the incidence of leakage, and by the patients' satisfaction graded according to a four point scale. RESULTS: All patients noted considerable improvements in stoma function, or abdominal contour, or both. CONCLUSION: Troublesome colostomies and urinary stomas can in selected patients be successfully treated with liposuction above or around the stoma.
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The practice of massive liposuction for the treatment of patients with large lipodystrophies has already been reported. The safety of this technique lies in proper fluid and blood replacement. Blood conservation techniques are therefore needed to avoid or minimize homologous transfusion. The use of a combination of predeposited autologous blood and acute intraoperative normovolemic hemodilution in the management of 150 patients requiring massive liposuction is reported. Since it is possible to anticipate the amount of blood loss in liposuction, a formula is proposed to monitor the hematocrit of the patient during the procedure and therefore predict the need for homologous transfusion. The technique reported enabled us to aspirate up to 11 liters in a single stage. Homologous transfusion was either avoided or markedly reduced. The degree of patient satisfaction was high, with no mortality or morbidity reported.
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A new method of excision of submental skin and fat with modified Z-incision affords easy excision, wide exposure, and simple closure. Thirty-two patients over an 18-year period have had satisfactory results with inconspicuous scars. Modification of platysma muscles and subplatysmal fat excision are facilitated by the wide exposure. Use of this method has been limited to those cases in which a large submental fold is present in a patient who declines to have a regular rhytidectomy or in cases of residual submental redundancy after a complete rhytidectomy. Occasionally, a rhytidectomy is not sufficient.
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Lokalized fat can be removed for pathologic but also for purely aesthetic reasons. Lipexhaeresia is a method that enables one to do this without leaving any significant scars. Certain principles of approach must be observed if aesthetically satisfactory results are to be obtained. Experience shows that there are no limits as to indication. Combination with dermolipectomy in the area of the buttocks increases the range of application.
Indications and operative techniques for dermolipectomies in the abdominal and lumbar region are discussed including resections of excess skin after weight reduction, intestinal bypass, and pregnancy. Dangers and complications are discussed.
In 1981, we started performing minor suction curettage with the elements available at that time. In the course of surgical practice, we have modified the suction system and devised a new pattern of suction cannulas adapted for this kind of operation, with all possible variants. During this period, we have treated 150 patients, ranging in age from 17 to 63 years. In the light of present knowledge, we consider it time to provide a systematization of this technique.
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This paper describes the removal of fat from several areas of the face and neck. Defatting is recommended whenever an excess is unaesthetic. The areas to be treated are most frequently submental and submandibular, but also chin, lower check and Bichat fat pads may have to be removed. A special type of rhytidectomy with upward pulling and direct crow's foot excision is often performed in conjunction with the defatting.
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