The tissue effects of ultrasound-assisted lipoplasty.
The objective of our study was to investigate the effects of ultrasonic energy on tissues, using a porcine model, performed under various instrumental and procedural parameters. Domestic pigs were anesthetized and prepared for surgery. An incision was made on the side of the hip randomly assigned to the right or left side. Tumescence solution was infiltrated via a blunt tip, small diameter cannula, followed by performance of standard liposuction. On the contralateral side, a similar incision was made. For ultrasonic liposuction experiments without the sheath, a percutaneous introducer was inserted into the incision, which was protected at the entry site from contact with the cannula. Tumescence solution was infiltrated via a blunt tip, small diameter cannula, and then the site was treated with ultrasonic energy at maximum output from the machine with liposuction concurrent through the hollow cannula. The experiments with the sheath did not require a pretreatment with tumescence solution but consisted of tumescence solution pumped through the sheath at a low infusion rate, with concurrent treatment utilizing ultrasonically assisted liposuction through the central lumen of the cannula. In all cases, the lipoaspirate was preserved for biochemical analysis. After treatment, the pigs were euthanized, and samples for histopathology were taken. The pigs were then perfused with a radio-opaque solution through the left ventricle following preperfusion with saline. The groups were ultrasound-assisted liposuction with sheath (n = 3), ultrasound-assisted without sheath (n = 4), and tumescence alone (n = 1), with standard liposuction performed on the contralateral side for all ultrasound-assisted liposuction animals. The lipoaspirates from the ultrasonically assisted liposuction with the sheath showed significantly less blood loss (measured as hemoglobin in the aspirate) than standard liposuction (p = 0.012) at comparable levels of fat (measured as triglycerides in the aspirate). The lipoaspirates from ultrasound-assisted liposuction without the sheath showed blood loss comparable to that experienced with standard liposuction. The ratio of hemoglobin to triglyceride was lowest in the ultrasound-assisted group with (p = 0.01) and without (p = 0.06) the sheath when compared to traditional liposuction. In both of these treated groups, the radiograms of the perfused areas showed significantly less vascular disruption when compared with suction-assisted liposuction. Histopathologic examination of specimens taken from various treated areas showed substantial tissue damage comparable in ultrasound- and suction-assisted liposuction treated groups. This preliminary experimental study showed that ultrasound-assisted lipoplasty is comparable to traditional suction-assisted lipoplasty. Treatment with ultrasound provided more significant hemoglobin/triglyceride ratios, indicative of more lipid aspirated per hemoglobin lost, and better preservation of vascular tissues as demonstrated by our perfusion studies. Treatment with the sheath showed a significantly lower hemoglobin release with a diminished volume infused into the subcutaneous space during the procedure.
Kenkel
J M
JM
Department of Plastic and Reconstructive Surgery at the University of Texas Southwestern Medical Center, Dallas 75235-9132, USA.
Robinson
J B
JB
Beran
S J
SJ
Tan
J
J
Howard
B K
BK
Zocchi
M L
ML
Rohrich
R J
RJ
D000110:Acetylcholinesterase / Q000032:analysis; D000273:Adipose Tissue / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D000818:Animals; D016063:Blood Loss, Surgical; D002404:Catheterization / Q000295:instrumentation; D003287:Contrast Media; D004195:Disease Models, Animal; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006615:Hip / Q000601:surgery; D015187:Lipectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008297:Male; D009211:Myoglobin / Q000032:analysis; D010544:Peroxidases / Q000032:analysis; D011859:Radiography; D011897:Random Allocation; D013396:Suction; D013552:Swine; D007507:Therapeutic Irrigation; D014280:Triglycerides / Q000032:analysis; D014464:Ultrasonic Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods
D003287:Contrast Media; D006454:Hemoglobins; D009211:Myoglobin; D014280:Triglycerides; D010544:Peroxidases; D000110:Acetylcholinesterase