Laser-Assisted Liposuction in Face and Body Contouring

Laser liposuction was developed as minimally invasive liposuction technique where energy breaks adipocytes (comparing with traditional liposuction where disruption is manual). After its implementation in the early 1990s, various academic reports were published that showed superiority of the laser assisted liposuction over standard tumescent technique. After tissue damage with photo-optical thermal energy, histological changes result in adipocyte disruption, blood vessel coagulation and neocollagenesis. The clinical manifestation of the latter is significant skin tightening and faster and more comfortable recovery. The diameter of the laser fiber is very small. Therefore, it is possible to reach adipose tissue entrapped in fibrotic areas and also superficially under the skin. The lysis of the given adipose tissue enables the subsequent suction with microcannulas. That explains the widespread use of the laser-assisted liposuction in the face and neck. Due to the significant skin tightening, the procedure can be done solely for rejuvenation purposes and is called endolight lifting. The possibility to reach fat in the fibrotic areas makes laser-assisted lipolysis/liposuction ideal procedure for contouring irregularities from previous body contouring procedures.

Surgical Outcome in Tumescent and Non-Tumescent Method of Harvesting Split Skin Graft - An Observational Study at KR Hospital, Mysuru

BACKGROUND The study was started with the aim to determine take up rate in tumescent technique compared to non-tumescent technique for harvesting split skin graft. Tumescent technique has been practiced for over forty years especially in liposuction. Tumescent anaesthesia is a combination of crystalloid, lignocaine, adrenaline and sodium bicarbonate. Using tumescent local anaesthesia for harvesting a split thickness skin graft is not in much practise. This study was designed to provide strong evidence of this technique. METHODS This was an observational study. Two treatment groups of patients, tumescent (group A, N = 21) and non-tumescent technique (group B, N =21), who fulfilled the inclusion criteria were randomly assigned. Tumescent technique involved administration of Klein’s formula. No prior administration of agent was performed in non-tumescent technique. The recipient site was opened in both groups on the fifth day after surgery and take rate assessed. RESULTS The difference in take up rate between the two groups was found to be statistically significant. Compared to the patients in group B, patients who underwent tumescent technique (group A) had higher take up rate (> 12 %, P = 0.005). We did not find any statistically significant difference in donor site percentage healing between the tumescent and non-tumescent groups, P = 0.379. CONCLUSIONS Tumescent technique gives better take up results and is more effective than nontumescent technique in harvesting split skin graft. The subdermal injection creates a smooth, dense surface which assists donor harvesting. This can be implemented preoperatively in split-thickness skin grafting. KEYWORDS Split Skin Graft, Take Up Rate, Harvesting, Tumescent, Non-Tumescent, Local Anaesthesia

Tumescent non-tumescent technique for split thickness skin graft harvesting

Background: Split-thickness skin graft failures can be attributed to flaws in the recipient bed which has to be well prepared. Tissues with limited blood supply such as bone, tendons, cartilage or sites with necrotic tissue or infection do not accept skin grafts. Adrenaline is used to harvest skin grafts due to its vasoconstriction effect which limits blood loss. The aim of our study was to determine skin graft take after tumescent technique compared to a non-tumescent technique for harvesting.Methods: Two treatment groups of patients who fulfilled the inclusion criteria were randomly assigned. Forty patients underwent split-thickness skin graft harvesting with tumescent technique and forty patients underwent non-tumescent split-thickness skin graft harvesting. The recipient site was opened in both groups on the fifth day after surgery and take rate assessed. The donor site was assessed on day ten and if not healed, followed up for three weeks.Results: There was a statistically significant association between skin graft take rate and skin grafting technique (p=0.011). The mean graft take rate was 2.5% higher in the tumescent group compared to the non-tumescent group (96.3% compared to 94%). On day 10, there was no difference in percentage healing of donor sites between the tumescent and non-tumescent groups, p=0.562.Conclusions: Tumescent technique significantly reduced intraoperative blood loss. It is safe, inexpensive and easy to use. The subdermal adrenaline/saline injection creates a smooth, dense surface which assists debridement and donor harvesting.