| PRS 0402-718-Hoffmann
Hoffmann JN, Fertmann JP, Baumeister RG, Putz R, Frick A.
Tumescent and dry liposuction of lower extremities: differences in lymph vessel injury.
Plast Reconstr Surg. 2004 Feb;113(2):718-24; discussion 725-6. PMID: 14758241
Department of Surgery, Klinikum Grosshadern, Munchen, Germany.
johannes.hoffmann@gch.med.uni-muenchen.de
Lipectomy is a standard procedure in plastic surgery. Until now, however, there
was no definite information about the influence of different liposuction
techniques (tumescent versus dry liposuction) on the integrity of lymph
collectors during this procedure. To study the effect of these liposuction
techniques on the incidence of lymph vessel injury, postmortem lymphatic
preparations were done in nine human cadavers (18 lower extremities).
Conventional liposuction with a blunt 4-mm cannula in the dry technique (n = 29
regions) was compared with the tumescent technique (n = 26). Liposuction was
performed in parallel to the superficial lymph vessels (longitudinal suction) or
transversally in an 80-degree to 90-degree angle to the extremity (vertical
suction). Careful surgical preparation of different regions followed. A specific
macroscopic lymph vessel injury score was applied to differentiate three degrees
of lymph vessel lesions according to the extravasation of patent blue. In all
lower extremities, postmortem lymph flow occurred as indicated by patent blue
staining of the lymph vessels. Injection of fluid that is obligatory during
tumescent suction did not result in grade 2 injury. On the contrary, tumescent
suction overall produced significantly fewer lymph vessel lesions when compared
with the dry technique (p < 0.05). Longitudinal liposuction produced
significantly less injury when compared with vertical suction (p < 0.05).
Tumescent suction and dry suction were equally effective in removing adipose
aspirates, as verified by circumference measurements. In addition, tumescent
liposuction is unlikely to cause major lesions of epifascial lymph vessels
during suction procedures vertical to the extremity axis. Therefore, in this
respect, this technique is superior to dry suction.
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