Ablaza V J, Gingrass M K, Perry L C, Fisher J, Maxwell G P
Institute for Aesthetic and Reconstructive Surgery, Baptist Hospital, Nashville, Tenn, USA.
Plast Reconstr Surg. 1998 Aug;102(2):534-42. doi: 10.1097/00006534-199808000-00039.
Removing excess subcutaneous fat with the assistance of ultrasonic energy has recently become a technique of interest in the United States after nearly a decade of use in Europe. There are a number of reported advantages of ultrasound-assisted lipoplasty over traditional liposuction, and there are also some theoretical concerns. Ultrasound-assisted lipoplasty involves the conversion of electrical energy to mechanical energy and transfer to the tissues through acoustic pressure waves, with the formation of heat as a by-product. Heat generated in this process dissipates through the body's own cooling mechanisms and conduction to the surrounding tissues, and it does not contribute to the clinical treatment of the adipose tissue. Reports of "burns" and ischemic skin injuries in the literature, and concerns for potential heat-related problems, prompted us to investigate whether significant temperature elevations occur in the clinical setting. Subcutaneous tissue temperature determinations during ultrasound-assisted lipoplasty were begun in February of 1996, and data were collected from 55 patients who had the procedure performed during a 6-month period. Intraoperatively, temperature measurements were made with a data-logging instrument and a needle microprobe inserted into the subcutaneous tissues. Temperatures were taken in the area of liposuction before the infusion of tumescent fluid, after tumescent fluid infusion, and at 5-minute intervals until the end of the procedure. The patient's core body temperature remained stable during the procedure within a narrow range (35.7 degrees C to 36.3 degrees C). There was a gradual increase in the temperature of the subcutaneous tissues over time during the application of ultrasonic energy; however, average subcutaneous temperatures remained below the core temperature (p < 0.05) at all time intervals. Room-temperature tumescent fluid further enhanced the thermal safety zone without lowering core body temperature. There were no temperature related complications in our study population and no untoward effects of performing temperature measurements. We conclude that there is no clinically significant elevation of subcutaneous temperatures during ultrasound-assisted lipoplasty. Reported ischemic skin complications are more likely the result of injury to the subdermal plexus rather than a temperature-induced thermal injury. Although heat is a natural by-product of the energy transfer involved in ultrasound-assisted lipoplasty, the risk of thermal injury is negligible when the procedure is performed by experienced operators. Complete understanding of the technique along with strict adherence to basic principles of flap vascularity will ensure safe and effective performance of ultrasound-assisted lipoplasty.
在欧洲应用了近十年后，借助超声能量去除多余皮下脂肪的技术最近在美国引起了关注。与传统抽脂术相比，超声辅助抽脂术有许多已报道的优点，但也存在一些理论上的担忧。超声辅助抽脂术涉及将电能转换为机械能，并通过声压波传递到组织，同时产生热量作为副产品。在此过程中产生的热量通过人体自身的冷却机制以及传导到周围组织而消散，它对脂肪组织的临床治疗并无作用。文献中关于“烧伤”和缺血性皮肤损伤的报道，以及对潜在热相关问题的担忧，促使我们研究在临床环境中是否会出现显著的温度升高。1996年2月开始在超声辅助抽脂术中测定皮下组织温度，并收集了在6个月期间接受该手术的55例患者的数据。术中，使用数据记录仪器和插入皮下组织的针状微探头进行温度测量。在注入肿胀液前、注入肿胀液后以及每隔5分钟直至手术结束时，在抽脂区域测量温度。手术过程中患者的核心体温在狭窄范围内保持稳定（35.7摄氏度至36.3摄氏度）。在施加超声能量期间，皮下组织的温度随时间逐渐升高；然而，在所有时间间隔内，皮下平均温度均低于核心体温（p < 0.05）。室温肿胀液进一步增强了热安全区，而不会降低核心体温。在我们的研究人群中没有与温度相关的并发症，并且进行温度测量也没有不良影响。我们得出结论，在超声辅助抽脂术中皮下温度没有临床意义上的显著升高。报道的缺血性皮肤并发症更可能是真皮层下丛状血管损伤的结果，而不是温度诱导的热损伤。尽管热量是超声辅助抽脂术能量传递的自然副产品，但当由经验丰富的操作人员进行该手术时，热损伤的风险可以忽略不计。对该技术的全面理解以及严格遵守皮瓣血管的基本原则将确保超声辅助抽脂术安全有效地进行。
