Increased intraabdominal pressure in abdominoplasty: delineation of risk factors.
*Pressure; Abdominal Cavity/*physiopathology; Abdominal Wall/physiopathology/*surgery; Adult; Body Mass Index; Female; Humans; Linear Models; Lipectomy/*adverse effects; Middle Aged; Morbid/*surgery; Nonparametric; Obesity; Pilot Projects; Postoperative Complications; Probability; Prognosis; Prospective Studies; Rectus Abdominis/surgery; Risk Assessment; Statistics; Treatment Outcome
BACKGROUND: Abdominoplasty is associated with a 1.1 percent risk of deep venous thrombosis. This has been attributed to rectus plication causing intraabdominal hypertension, known to effect decreased venous return, venous stasis, and thus thrombosis. The authors conducted a pilot study to determine which components of the abdominoplasty procedure (i.e., general anesthesia, flexion of the bed, plication, and/or binder placement) may elevate intraabdominal pressures and whether this was clinically relevant. METHODS: Twelve abdominoplasty and 10 breast reduction (control) patients were enrolled prospectively. Intraabdominal pressure was transduced through the bladder before plication in the supine and flexed positions, after plication in both positions, after skin closure in the flexed position, and on postoperative day 1 with and without a binder in the flexed position. RESULTS: All intraabdominal pressures measured were clinically insignificant (\textless20 mm Hg). A statistically significant increase was found from flexion of the bed (mean difference, 3.80 +/- 2.0, p \textless 0.001, in the control group; and 4.39 +/- 1.68, p \textless 0.001, in the study group); rectus plication (mean difference, 2.78 +/- 2.11, p = 0.001, in the supine position; and 2.03 +/- 2.48, p = 0.016, in the flexed position); and binder placement (2.63 mm Hg for no binder versus 4.5 mm Hg with binder, p = 0.004). Both groups also showed an increase from preoperative to skin closure (mean difference, 2.03 +/- 6.7, p = 0.035, for the control group; and 2.83 +/- 3.97, p = 0.031, for the study group), suggesting general anesthesia as a risk factor. CONCLUSIONS: This study confirms the effect of rectus plication on increasing intraabdominal pressures but also implicates bed position, binder placement, and general anesthetic as risk factors. A larger study is needed to clarify the role of these variables in elevating intraabdominal pressure during abdominoplasty.
Huang Georgeanna J; Bajaj Anureet K; Gupta Subhas; Petersen Floyd; Miles Duncan A G
Plastic and reconstructive surgery
2007
2007-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/01.prs.0000254529.51696.43" target="_blank" rel="noreferrer noopener">10.1097/01.prs.0000254529.51696.43</a>
Fat embolism after liposuction in Klippel-Trenaunay syndrome.
Adult/etiology; Embolism; Fat/*etiology; Female; Humans; Hypertrophy; Klippel-Trenaunay-Weber Syndrome/*surgery; Lipectomy/*adverse effects; Lower Extremity/blood supply/surgery; Postoperative Complications; Respiratory Distress Syndrome; Vascular Malformations/surgery; Young Adult
Fat embolism syndrome (FES) is a rare but potentially fatal postoperative complication from liposuction. We present the case of a 24-year-old woman with Klippel-Trenaunay syndrome who developed FES as a complication of lower extremity liposuction. There may be an increased risk of FES in patients with vascular malformations undergoing liposuction.
Zeidman Michael; Durand Paul; Kundu Neilendu; Doumit Gaby
The Journal of craniofacial surgery
2013
2013-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/SCS.0b013e3182953a63" target="_blank" rel="noreferrer noopener">10.1097/SCS.0b013e3182953a63</a>