Complications of liposuction

With the right approach, liposuction is one of the safest operations, after which the percentage of complications is minimal. At the same time, liposuction is unquestionably the most dangerous of all aesthetic operations, as the development of infectious complications presents a real danger to the life of the patient.

All complications of liposuction can be divided into general and local, and local, in turn, to aesthetic and medical.

General complications. Common complications that can develop after liposuction include anemia, fat embolism and thromboembolism.

Postoperative anemia develops after massive intraoperative blood loss, usually associated with reduced sensitivity of the patient's tissues to adrenaline or an excessively extensive operation.

As a preventive measure in the planning of extensive operations, preoperative blood exfusion is used, which allows, after its return at the end of the intervention, to refuse from transfusion of donor blood.

Fat embolism is a very rare complication of liposuction, it occurs, as a rule, when combined with open intervention (for example, with the plastic of the anterior abdominal wall). Symptoms of fat embolism occur within the next 24 hours after the operation, and sometimes within 2-3 days (tachycardia, fever, increasing respiratory failure, skin manifestations, etc.).

Despite the extreme rarity of the development of common complications, each surgical clinic should have a set of medications to provide emergency medical care in these conditions, along with instructions to the doctor on duty. If necessary, this saves you hours and minutes, on which the effectiveness of the entire treatment may depend.

Local complications may include wound suppuration, hematoma formation, seroma, persistent edema of the shins and feet, impaired skin sensitivity in the areas of liposuction, phlebitis of superficial veins, and even the development of necrosis of the skin and subcutaneous fat.

Infectious complications. The wound remaining after liposuction has the following specific features:

• During the intervention, the subcutaneous and deep layers of fatty tissue are damaged in large areas (width and depth);
• in contrast to a typical (cut) surgical wound, fatty tissue undergoes significant mechanical damage;
• the damaged area is located at a distance from the cutaneous wound, which has a minimum size, and therefore the outflow of wound contents through the wound is practically impossible.

In these conditions, the developing infectious process, as a rule, acquires a "malignant" character and proceeds according to the type of anaerobic (nonclostridial) infection. Typical features of this flow are a sudden onset, rapid (sometimes lightning-fast) spread, rapid deterioration of the general condition of the patient due to pronounced toxemia.

As measures to prevent infectious complications, we can distinguish the following:

• patients who are planning liposuction should be carefully selected on the basis of a sufficiently deep preoperative examination;
• Liposuction is performed only in practically healthy people with normal laboratory and other studies;
• in women, the operation is performed only in the interval between menstruations;
• immediately before surgery, the patient must take a shower;
• in the course of operations, it is necessary to strictly follow the rules of aseptic and antiseptic;
• in extensive operations, the prophylactic use of antibiotics, which are administered an hour before the intervention, is necessary.

A very important factor contributing to the development of infection is the formation of skin and fat accumulation along the edge of the skin cut. It arises as a result of repeated movements of the cannula with a too narrow incision and is defined as a well-marked corolla of the dark tissue, which must be excised at the end of the operation.

With the developing infectious process, only the initiated complex therapy can give the desired effect in a timely manner. Otherwise, the lethal outcome becomes a real possibility.

On more than 800 liposuction operations performed at the Center for Plastic and Reconstructive Surgery, infectious complications were noted in two observations.

Both patients were young (23 and 24 years old) with local forms of fat deposits. One of them performed liposuction on the anterior and posterior surfaces of the tibia with a total extraction of about 800 ml of fat. The other performed liposuction of the inner thighs and knee joints with a similar volume of removed fat. In both cases, the inflammation developed as an anaerobic non-clostridial infection with unexpressed clinical manifestations in the first 2 days after the operation. Previously, there was a rapid development of severe general intoxication with an increase in symptoms and a significant expansion of the cellulite zone.

Treatment included early and complete dissection and drainage of inflammatory foci, the use of the most potent broad-spectrum antibiotics at maximum doses, adequate infusion therapy, plasma exchange, oxygenobarotherapy. As a result, the inflammatory processes could be stopped within a week. Cosmetic defects were relatively small.

Edema of the shin and foot can occur with extensive treatment of the hips along their inner surface and at the level of the knee joint. Disorders of the lymphatic drainage pathway are manifested by the appearance of edema at the level of the lower third of the shin, ankle and foot; as a rule, they pass within 1-2 months.

The formation of gray and necrosis of the skin is a rare complication when properly performed. They can occur when the operation is performed aggressively, using a cannula of an excessively large diameter with a relatively small thickness of the fat layer, and also in the absence of sufficient compression of therapeutic linen. Treatment with sulfur involves puncture evacuation of serous fluid and the wearing of tights of sufficient density.

Disturbances in skin sensitivity in the liposuction zone result from traumatization of nerve fibers and manifest as a hypoesthesia that can be combined with areas of hyperesthesia. Disrupted sensitivity is gradually restored.

Change in skin color and scars. As a result of the deposition of hemosiderin in very rare cases, pigmentation of the skin in the treated area develops, which takes only a few months.

[1], [2], [3], [4], [5], [6]