Baylor College of Medicine, Houston, TX.
University of Texas MD Anderson Cancer Center, Houston, TX.
Aesthet Surg J. 2020 Jun 15;40(7):753-758. doi: 10.1093/asj/sjaa029.
Pneumothorax is a rare complication of liposuction resulting from injury to the lung parenchyma.
This study aimed to determine the incidence of pneumothorax complicating liposuction, describe an archetypal presentation, identify risk factors, and propose options for risk reduction.
In a retrospective chart review, liposuction procedures performed over a 16-year period by 8 surgeons in 1 practice were screened for pneumothorax. Cases featuring pneumothorax were analyzed to ascertain risk factors, presentation, and pathogenesis.
Among the 16,215 liposuction procedures performed during the study period, 7 pneumothoraxes were identified (0.0432%). Six (85.7%) were female. Three (42.9%) had previous liposuction. Six cases (85.7%) included liposuction of the axillary region. All cases featured depression of intra/postoperative oxygen saturations as the initial sign. Three (42.9%) were identified intraoperatively. All patients were transferred to a hospital for imaging. Five (71.4%) underwent chest tube placement. Two (28.6%) were treated with observation alone. Pneumothoraxes were left-sided in 4 cases (57.1%), and right-sided in 3 cases (42.9%). In early cases, 1.5-mm infiltration cannulas were used; in 2016 cannula size was changed to 3-4 mm for infiltration and 4-5 mm for liposuction.
Possible risk factors for pneumothorax include liposuction of the axilla, use of flexible infiltration cannulas, and scarring from previous liposuction. We recommend including pneumothorax as a potential complication during informed consent, performing infiltration with a stiff >3.5-mm cannula, minimizing positive-pressure ventilation, emphasized awareness of cannula tip location in all patients but particularly in patients with previous liposuction or scar tissue, and increased caution when operating in the axillary area.
气胸是脂肪抽吸术罕见的并发症，是由于肺实质损伤引起的。
本研究旨在确定脂肪抽吸术并发气胸的发生率，描述典型表现，确定危险因素，并提出降低风险的方案。
在一项回顾性病历审查中，筛查了 8 位医生在 16 年时间内在同一家机构进行的脂肪抽吸术，以确定是否发生气胸。对出现气胸的病例进行分析，以确定危险因素、表现和发病机制。
在研究期间进行的 16215 例脂肪抽吸术中，发现了 7 例气胸（0.0432%）。其中 6 例（85.7%）为女性。其中 3 例（42.9%）曾行过脂肪抽吸术。6 例（85.7%）的病例包含腋窝区域的脂肪抽吸术。所有病例的初始表现均为术后氧饱和度降低。其中 3 例（42.9%）在术中发现。所有患者均转至医院进行影像学检查。其中 5 例（71.4%）进行了胸腔引流管放置。2 例（28.6%）仅接受观察治疗。其中 4 例（57.1%）为左侧气胸，3 例（42.9%）为右侧气胸。在早期病例中，使用了 1.5mm 的浸润套管；2016 年，套管尺寸改为 3-4mm 用于浸润，4-5mm 用于脂肪抽吸。
气胸的可能危险因素包括腋窝脂肪抽吸术、使用灵活的浸润套管以及既往脂肪抽吸术引起的疤痕。我们建议在知情同意书中将气胸列为潜在并发症，使用 >3.5mm 的刚性浸润套管进行浸润，尽量减少正压通气，在所有患者中强调套管尖端位置的意识，特别是在有既往脂肪抽吸术或疤痕组织的患者中，在腋窝区域操作时应更加小心。
