Dhami Lakshyajit D
Laser, Aesthetic and Plastic Surgeon, Vasudhan Arjin Cosmetic and Laser Surgery, Mumbai, India.
Indian J Plast Surg. 2008 Oct;41(Suppl):S27-40.
Advent of the tumescent technique in 1987 has allowed for safe contouring in ambulatory single session liposuction under regional or general anaesthesia. Safety and aesthetic issues define MegaLiposuction to be in Volume in litres of more than 10% of Body weight in Kgs. 870 cases of liposuction were performed between September 2000 and August 2008. In (65%) cases, the total volume of aspirate was greater then 5 liters. (Range: 5 to 25 liters). In 24% cases, the large volume liposuction was combined with a limited or a total block lipectomy. Regional anaesthesia with conscious sedation was preferred except where liposuction was for above the subcostal region (the Upper Trunk, Lateral Chest, Back, Gynaecomastia, Breast, Arms and Face) or when the patient so desired. Tumescent infiltration with Lactated ringer, adrenalin, triamcinalone and hyalase was made in all cases. This approach has clinically shown less tissue edema in the post operative period than when the conventional physiological saline was being used in place of Ringer Lactate. The amount injected varied from 1,000 ml to 12,500 ml depending on the size, site and area. Local anesthetic was included only to the terminal portion of the tumescent mixture while infiltrating the sub-costal regions, or when above costal region was combined with below costal region being anaesthetized with Spinal Anaesthesia. The aspirate was restricted to the unstained white / yellow fat and the amount of fat aspirated did not have any bearing to the amount of solution infiltrated. There was no major complication. Blood transfusion was given only on one occasion when the patient had been on aspirin and had also received Low Molecular weight Heparin intra-operative. The hospital stay ranged from 8 to 24 hours for liposuction as well as for liposuction with a lipectomy. Serous discharge from access sites, sero-sanguinous fluid accumulation requiring drainage were necessitated in less than 10% cases. Minor re-contouring touch ups were requested in 5% cases. Early ambulation was encouraged for mobilization of third space fluid shifts to expedite recovery and to prevent deep vein thrombosis. More than 10% patients were operated on for Liposuction of other areas, after a gap of 7 days to 6 months. Meticulous perioperative monitoring of systemic functions ensures safety in tumescent megaliposuction for the obese and rewarding results can be achieved in a single sitting.
1987年肿胀技术的出现使得在区域麻醉或全身麻醉下的门诊单次吸脂手术中进行安全塑形成为可能。安全性和美学问题将大容量吸脂定义为吸出量（以升为单位）超过体重（以千克为单位）的10%。2000年9月至2008年8月期间共进行了870例吸脂手术。在65%的病例中，吸出物总量超过5升（范围：5至25升）。在24%的病例中，大容量吸脂与有限或全腹壁切除术相结合。除了吸脂部位在肋下区域以上（上躯干、侧胸、背部、男性乳房发育症、乳房、手臂和面部）或患者有此要求外，首选区域麻醉加清醒镇静。所有病例均采用含乳酸林格液、肾上腺素、曲安奈德和透明质酸酶的肿胀液浸润。与使用传统生理盐水代替乳酸林格液相比，这种方法在临床上显示术后组织水肿更少。注入量根据部位大小和面积从1000毫升到12500毫升不等。在浸润肋下区域时，或当肋上区域与肋下区域联合使用脊髓麻醉进行麻醉时，局部麻醉剂仅包含在肿胀液的末端部分。吸出物仅限于未染色的白色/黄色脂肪，吸出的脂肪量与浸润的溶液量无关。未发生重大并发症。仅在1例患者术中使用阿司匹林且同时接受低分子肝素治疗时进行了输血。吸脂手术以及吸脂加腹壁切除术的住院时间为8至24小时。不到10%的病例出现切口部位浆液性渗出、需要引流的血清血性液体积聚。5%的病例要求进行小范围的再次塑形微调。鼓励早期活动以促进第三间隙液体转移，加快恢复并预防深静脉血栓形成。超过10%的患者在间隔7天至6个月后接受了其他部位吸脂手术。对全身功能进行细致的围手术期监测可确保肥胖患者肿胀大容量吸脂的安全性，并且单次手术即可取得满意效果。
