INTRODUCTION :The incidence of venous thrombosis in plastic surgery is 1.2 % and 0.8 % for pulmonary embolus in patients undergoing an abdominoplasty. When this operation is combined with other procedures the incidence can increase up to 6.6 percent. PURPOSE To present our clinical results with a postoperative management designed for the prevention of thromboembolism in high-risk aesthetic surgery patients undergoing abdominoplasty and large volume liposuction. MATERIALS & METHODS 410 female patients have been followed over the past three years after undergoing an abdominoplasty and large volume liposuction. These consecutive cases fell into the categories of high risk and highest risk patients. They were evaluated according to the American Society of Anesthesiologists classification. The preoperative evaluation was performed by a board certified anesthesiologist following the risk assessment management as reported by the Division of Plastic Surgery at Georgetown Medical Center. All patients underwent general anesthesia in a fully accredited outpatient surgical facility, and were discharged at 23 hrs post op. Follow-up care was delivered at home by a registered nurse and 1 week later at the surgeon's office. The surgical protocol included: Upper and lower Bair Huggers to maintain a core temperature of 36 o C throughout the procedure. Intermittent compression garments were applied to the legs once the patient was fully anesthetized. A Foley catheter was placed to monitor input and output. Antibiotic therapy included Gentamicin and Cefazolin until patient was discharged home. A subcutaneous injection of a low molecular weight heparin Enoxeparin (Levonox) 30 mgs one hour after surgery and every 12 hours for 72 hours. Suction assisted lipectomy was performed with the traditional Illouz method. Super wet tumescent infiltration was carried out as described by Hunstad. Triamcinolone 10 mg per liter of solution was added to the tumescent solution. Five millimeter cannulas were used for lipectomy and 3-4 mm basket cannulas for liposculpturing. A precise record of the aspirate was recorded. The incisions were left open for drainage. The abdominoplasty technique was performed as described by Lockwood. Two Jackson-Pratt drains were left at 2 cm. below the incision site. Postoperative care included: Continuous antibiotic coverage for 5 days. Compression garments were worn for 4 weeks. Regional infusion Marcaine pain pumps were used for 72 hours. Patients have been carefully monitored for signs and symptoms of VT,DVT and PE following the clinical criteria reported by Most et al. Parameters have included age, pre operative weight, body mass index, ASA classification, procedures performed, number of body surface areas treated, length of surgery, volume of fat and fluids extracted , previous medication treatment, use of estrogens, past medical history including risk factors. RESULTS: No patient has developed DVT or PE following this postoperative management. The majority of patients were between 25-39 years old. The average volume of suction aspirate removed was 6.7 liters. Aspirate volumes varied from 0.7 liters to 14.35 liters. We found that 59.2% of our patients had a higher BMI than 30, with 1.7 percent being extremely obese .The average BMI was 27.45 and the mean preoperative weight was 72.4 kg. The average length of surgery was 2 hours and 24 minutes.

CONCLUSION We feel very optimistic to report a 0% incidence of VT, DVT & PE events with this postoperative management that includes the prophylactic use of a low molecular weight heparin for patients undergoing abdominoplasty and large volume liposuction. This protocol is now part of our postoperative regimen in aesthetic surgery high risk cases.

View Synopsis (.doc format, 374.0 kb)