Swanson Eric
Private practice, Leawood, Kans.
Plast Reconstr Surg Glob Open. 2018 Sep 5;6(9):e1911. doi: 10.1097/GOX.0000000000001911. eCollection 2018 Sep.
Ultrasound in plastic surgery is quickly finding new applications. Ultrasound surveillance may replace ineffective individual risk stratification and chemoprophylaxis for deep venous thromboses. Abdominal penetration can be a catastrophic complication of liposuction. Preoperative screening for fascial defects may reduce risk. Limiting buttock fat injections to the subcutaneous plane is critical for patient safety, but it is difficult to know one's injection plane.
The author's use of diagnostic ultrasound was evaluated from May 2017 to May 2018. Ultrasound scans were used routinely to detect deep venous thromboses. Patients undergoing abdominal liposuction and/or abdominoplasty were scanned for possible hernias. Other common applications included the evaluation of breast implants, breast masses, and seroma management. The device was used in surgery in 3 patients to assess the plane of buttock fat injection.
One thousand ultrasound scans were performed during the 1-year study period. A distal deep venous thrombosis was detected in 2 patients. In both cases, the thrombosis resolved within 1 month, confirmed by follow-up ultrasound scans. A lateral (tangential) fat injection method was shown to safely deposit fat above the gluteus maximus fascia.
Ultrasound scans are highly accurate, noninvasive, and well-tolerated by patients. Some of these applications are likely to improve patient safety. Early detection of deep venous thromboses is possible. Unnecessary anticoagulation may be avoided. Subclinical abdominal defects may be detected. Ultrasound may be used in the office to evaluate breast implants, masses, and seromas. In surgery, this device confirms the level of buttock fat injection.
超声在整形手术中的应用正在迅速拓展。超声监测可能会取代针对深静脉血栓形成的无效个体风险分层和化学预防措施。腹部穿透可能是抽脂术的灾难性并发症。术前筛查筋膜缺损可能会降低风险。将臀部脂肪注射限制在皮下层面对于患者安全至关重要，但很难确定注射层面。
对2017年5月至2018年5月期间作者使用诊断性超声的情况进行了评估。常规使用超声扫描来检测深静脉血栓形成。对接受腹部抽脂术和/或腹壁成形术的患者进行扫描以检查是否存在可能的疝气。其他常见应用包括对乳房植入物、乳房肿块和血清肿处理的评估。该设备在3例手术中用于评估臀部脂肪注射层面。
在为期1年的研究期间共进行了1000次超声扫描。在2例患者中检测到远端深静脉血栓形成。在这两例中，血栓在1个月内消散，后续超声扫描证实了这一点。一种外侧（切线）脂肪注射方法被证明可将脂肪安全地注入臀大肌筋膜上方。
超声扫描高度准确、无创且患者耐受性良好。其中一些应用可能会提高患者安全性。可以早期检测深静脉血栓形成。可避免不必要的抗凝。可以检测到亚临床腹部缺损。超声可在门诊用于评估乳房植入物、肿块和血清肿。在手术中，该设备可确定臀部脂肪注射层面。
