9807-213 Kenkel
Kenkel JM, Robinson JB Jr, Beran SJ, Tan J, Howard BK, Zocchi ML, Rohrich RJ.
The tissue effects of ultrasound-assisted lipoplasty.
Plast Reconstr Surg. 1998 Jul;102(1):213-20. PMID: 9655430
Comment in:
Plast Reconstr Surg. 1998 Jul;102(1):280; author reply 280-1.
Department of Plastic and Reconstructive Surgery at the University of Texas
Southwestern Medical Center, Dallas 75235-9132, USA.
The objective of our study was to investigate the effects of ultrasonic energy
on tissues, using a porcine model, performed under various instrumental and
procedural parameters. Domestic pigs were anesthetized and prepared for surgery.
An incision was made on the side of the hip randomly assigned to the right or
left side. Tumescence solution was infiltrated via a blunt tip, small diameter
cannula, followed by performance of standard liposuction. On the contralateral
side, a similar incision was made. For ultrasonic liposuction experiments
without the sheath, a percutaneous introducer was inserted into the incision,
which was protected at the entry site from contact with the cannula. Tumescence
solution was infiltrated via a blunt tip, small diameter cannula, and then the
site was treated with ultrasonic energy at maximum output from the machine with
liposuction concurrent through the hollow cannula. The experiments with the
sheath did not require a pretreatment with tumescence solution but consisted of
tumescence solution pumped through the sheath at a low infusion rate, with
concurrent treatment utilizing ultrasonically assisted liposuction through the
central lumen of the cannula. In all cases, the lipoaspirate was preserved for
biochemical analysis. After treatment, the pigs were euthanized, and samples for
histopathology were taken. The pigs were then perfused with a radio-opaque
solution through the left ventricle following preperfusion with saline. The
groups were ultrasound-assisted liposuction with sheath (n = 3),
ultrasound-assisted without sheath (n = 4), and tumescence alone (n = 1), with
standard liposuction performed on the contralateral side for all
ultrasound-assisted liposuction animals. The lipoaspirates from the
ultrasonically assisted liposuction with the sheath showed significantly less
blood loss (measured as hemoglobin in the aspirate) than standard liposuction (p
= 0.012) at comparable levels of fat (measured as triglycerides in the
aspirate). The lipoaspirates from ultrasound-assisted liposuction without the
sheath showed blood loss comparable to that experienced with standard
liposuction. The ratio of hemoglobin to triglyceride was lowest in the
ultrasound-assisted group with (p = 0.01) and without (p = 0.06) the sheath when
compared to traditional liposuction. In both of these treated groups, the
radiograms of the perfused areas showed significantly less vascular disruption
when compared with suction-assisted liposuction. Histopathologic examination of
specimens taken from various treated areas showed substantial tissue damage
comparable in ultrasound- and suction-assisted liposuction treated groups. This
preliminary experimental study showed that ultrasound-assisted lipoplasty is
comparable to traditional suction-assisted lipoplasty. Treatment with ultrasound
provided more significant hemoglobin/triglyceride ratios, indicative of more
lipid aspirated per hemoglobin lost, and better preservation of vascular tissues
as demonstrated by our perfusion studies. Treatment with the sheath showed a
significantly lower hemoglobin release with a diminished volume infused into the
subcutaneous space during the procedure.
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