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General Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rebecca Fish, Aisling Hogan, Aoife Lowery, Frank McDermott, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Yew-Wei Tan, Thomas Tsang
Another option associated with lower risks is suction-assisted lipectomy (‘liposuction’), which removes excess fat that is seen in certain patients with stage II−III lymphoedema. This is performed through minimal access stab incisions and is useful in those patients who have excess fat in the lymphoedematous limb.
Excisional surgery: When and how much it can be incorporated
Published in Byung-Boong Lee, Peter Gloviczki, Francine Blei, Jovan N. Markovic, Vascular Malformations, 2019
Justin Chin-Bong Choi, James Laredo, Byung-Boong Lee
Liposuction is another debulking technique that aims to obliterate the epifascial compartment by using a “circumferential” suction-assisted lipectomy instead of resecting the entire soft tissue, thus making it a less radical approach compared to excisional surgery. It also avoids morbidity and mortality associated excision.23–25 However, because liposuction removes only fat, it should not be performed before CDT is implemented, as it will need to transform pitting edema to nonpitting edema. Patients who benefit the most are those who develop excess fat accumulation due to secondary lymphedema of the upper limb after breast cancer treatment.23, 24 Like with excisional surgery, CDT should be continued after liposuction. Patients need to be informed that life-long, continuous use of compression garments is required postoperatively for liposuction to be efficient. Some authors advocate for preoperative assessment of patients’ readiness to comply with compression garment therapy and use this criterion to exclude patients from liposuction consideration if they do not demonstrate readiness to commit to life-long postoperative garment compression therapy (see Chapter 67 for more details).
Reconstructive Microsurgery in Head and Neck Surgery
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
John C. Watkinson, Ralph W. Gilbert
The rectus abdominus myocutaneous flap or deep inferior epigastric perforator (DIEP) flap has a number of advantages for head and neck reconstruction. The vascular anatomy of the flap is extremely consistent, making it a relatively simple flap to harvest. The ability to transfer a skin/muscle flap, a perforator-based skin flap or a myogenous flap speak to its versatility. Large areas of skin are available, with the majority of defects amenable to primary closure. The donor site is not problematic for males or females and in some patients may offer the aesthetic benefit of an abdominal lipectomy. In most situations the selection of this flap for reconstruction offers the opportunity for a two-team procedure with flap harvest occurring simultaneously with tumour ablation.
SESQ, a patient-reported outcome instrument addressing excess skin; report on the updated version and the validation process
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Christina Biörserud, Anna Elander, Monika Fagevik Olsén
In a historical perspective, abdominal lipectomy was first described and performed more than 100 years ago and it was initially used for functional repairs. In 1910, Kelly [1] reported several benefits of abdominoplasty, such as improved wellbeing, reduction of back pain, increased level of physical activity and better personal hygiene. Later, in 1967, Pitanguy began to use abdominoplasty for cosmetic purposes [2]. When the number of bariatric procedures increased in the 1960s and 1970s, post-bariatric procedures also became more common. Today, consistent studies have reported that patients experience that excess skin is most commonly located on the abdomen, upper arms, inner thighs and breasts [3–6] and that excess skin causes problems with fungal infections, eczema and lesions below the abdomen, the breasts or chest and/or in the groins, causing bad odor, itching, perspiration and problems with personal hygiene [3,7].
Liposuction for large facial involuted infantile hemangiomas in children: clinical evaluation and management strategies
Published in Journal of Dermatological Treatment, 2021
Wei Gao, Yajing Qiu, Yunbo Jin, Xiaoxi Lin
Compared to the direct open surgical resection, liposuction for large facial involuted IH is less aggressive with little violation of skin. The most common sequela of the open surgery is the scarring. Although modified surgical methods, such as the circular excision and purse string (11), are created to minimize the possible scars, there are, however, certain patients in whom the postoperative scar is still obvious and unacceptable. Thus, based on our experience and research of IH in past years (6,12–15), liposuction is a fast and definitive solution to volumetric sequelae after involution. For superficial subcutaneous lesions, the cannula could be flexibly adjusted to achieve an optimal facial symmetry. For lesions penetrating the SMAS and deeper tissue, liposuction prior to lipectomy could remove most of the superficial fibrofatty tissue, minimizing the incision of following surgical resection. Regarding the safety, we agree with Berenguer et al. (3) that the tumescent liposuction is not inferior to ultrasound-assisted liposuction. The limitation of the technique is that liposuction can only solve the problem of volumetric residue, cannot solve the poor skin texture, and telangiectasis irresponsive to laser therapy. The limitation is the lack of validation of our results through randomized control trials.
Rapidly progressive case of type I Madelung disease with bilateral parotid and minor salivary glands involvement
Published in British Journal of Biomedical Science, 2020
Two forms of Madelung disease are recognised, based on the distribution of the fat deposits. In the first type the fat deposits appears around the neck, cervical area, shoulders, upper region of the arms and chest, thus giving the patient a ‘pseudoathletic’ appearance. In the second type the adipose storage extends in the trunk, around the ribs, upper legs, giving this way the patient a generalized obese view [14]. In alcohol abuse induced disease, alcohol abstinence can prevent progression. Surgical interventions such as lipectomy or liposuction, are made in base of the superimposed clinical manifestation or aesthetically [15]. In asymptomatic patients a potential decision is watchful waiting, and in the event of a deterioration, surgical intervention [16]. The potential complication known is the increased angiogenesis and the tendency of masses to encapsulate and invade the surrounding structures. There are few data that indicate a low risk of transformations of lipomas in liposarcomas, based on a mitochondrial DNA mutation. Up to 2012, only two cases had been reported, and there are no cases in which the disease has gone into spontaneous regression [17,18].