In 1921, a French surgeon carried out curettage on the knee area of one of o his patients in order to achieve an improvement in the shape. This procedure was later combined with suction, until in the end curettage was abandoned. Prof. Fournier introduced the cross technique in 1987, achieving impressive results with regard to the evenness of the skin.
The shape and size of the cannulas used for liposuction have continued to change and develop. The pioneers of liposuction were Ilouz, Fournier, and Klein. An ultrasound-assisted method was first introduced in 1982. Another technique that protects the tissue by using vibrating cannulas was introduced by an American, W.P. Coleman, in 2000.
As this book is intended to impart basic knowledge, the tumescence technique demonstrated in the accompanying video is manual liposuc-tion, as this is most suitable for learning the new technique of liposuc-tion from the beginning. Admittedly, this technique is time-consuming, but it achieves good results and can be learned reliably.
Of all the additional instruments used at the Bodenseeklinik, the best when it comes to large areas of liposuction has proved to be the MicroAire (MicroAire Surgical Instruments, Charlottesville, VA, see figure on p. 162) system (tissue-sparing; suction without much bleeding; comfortable for the surgeon to operate; almost pain-free suction; timesaving). The size of cannulas varies between 2 and 4 mm; at the beginning of suction 3 mm cannulas should be used (extremities, saddle area). In very corpulent patients, 4 mm cannulas can be used in the abdominal area. For delicate modeling in the neck, buttock, knee, and ankle areas, 2 mm cannulas are sufficient.
The protective technique of tumescent liposuction has considerably reduced the high risks of dry suction under general anesthetic (thrombosis, blood loss, embolism, infection, scarring, skin unevenness, hematoma). If the tumescence solution containing local anesthetic as well as vasoconstricters is injected beforehand general anesthesia is not necessary. The patient receives only sedation and intraoperative monitoring (IV access, pulse, blood pressure, O2 saturation, and ECG monitoring). Adding adrenaline to the solution as a vasoconstricter reduces the risk of the patient losing a large amount of blood and prevents large hematomas from developing.
In addition, the incidence of complications can be drastically reduced by perioperative thrombosis and embolism prophylaxis [single-shot cefaclor 2 g, Mono Embolex IM (low molecular weight heparin) before, during, and after the operation]. In a study carried out by the American Society of Dermatologic Surgery there were no cases of embolism, thrombosis, or infection in 15,336 patients treated with tumescent liposuction.
Problems can result, however, from the use of too much tumescence solution, which can place considerable strain on the circulation. The decisive factor is the tumescence solution used.
The first tumescent local anesthesia with lidocaine was described and documented by Klein as a local anesthetic solution. Mang's solution uses prilocaine as a local anesthetic in an even smaller dose (the smallest dose allowing almost painless suction was determined in a clinical study), as it exhibits the least toxicity. The prilocaine plasma levels were considerably below those for lidocaine.
Mang's solution used for tumescent local anesthesia Compound Quantity
Prilocaine 1% 150 ml 25 ml
Epinephrine 3 mg 0.5 mg
NaHCO3 8.4% 30 mEq 5 mEq
Triamcinolone acetonide 30 mg 5 mg
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