Influence of Tranexamic Acid in Body Contouring Surgery: Significant Changes on Complication Rates after Abdominoplasty.

BACKGROUND: Complications after abdominoplasty remain an unsolved issue in body contouring surgery. The antifibrinolytic drug tranexamic acid (TXA) has gained increasing recognition as a valuable pharmacologic agent within plastic surgery. The aim of this study was to investigate the influence of intravenously administered TXA on complications and patient safety after abdominoplasty. METHODS: Within this retrospective single-center study, patients who underwent abdominoplasty and received intravenous TXA were selected and compared to randomly selected patients who underwent abdominoplasty without administration of TXA. The patient population was divided into two study groups (TXA vs no TXA). Demographic and surgical data as well as complications were evaluated and compared. Appropriate statistical analysis was performed. RESULTS: Fifty-seven female and 3 male patients with a median age of 38 years and a mean BMI of 25.6 ± 3.3 kg/m2 were included in the study. Except smoking history, demographic data showed no statistically significant differences between both groups. The most common complication was seroma formation (n = 16; 23.9%), and its occurrence was statistically significantly lower in the TXA group (p = 0.023). Furthermore, postoperative seroma aspiration was performed in statistically significant lower numbers in the TXA group (p < 0.05). No thromboembolic events or seizures were observed. DISCUSSION: The outcomes of this study showed that the intravenous administration of TXA leads to a significant reduction of seroma formation and postoperative seroma aspiration after abdominoplasty. Simultaneously, no adverse thromboembolic events were detected. Hence we would recommend administration of TXA in body contouring surgery to decrease the incidence of seroma formation. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

High-Volume Liposuction in Lipedema Patients: Effects on Serum Vitamin D.

Background: Lipedema is a subcutaneous adipose tissue disorder characterized by increased pathological adipocytes mainly in the extremities. Vitamin D is stored in adipocytes, and serum levels inversely correlate with BMI. As adipocytes are removed during liposuction, lipedema patients might be prone to further substantial vitamin D loss while their levels are already decreased. Therefore, we examined the effect of liposuction on perioperative serum 25-hydroxyvitamin D levels. Methods: In patients undergoing lipedema liposuction, blood samples were obtained pre- and postoperatively. Statistical analyses were performed to correlate the volume of lipoaspirate, patients' BMI and number of sessions to vitamin D levels. Results: Overall, 213 patients were analyzed. Mean liposuction volume was 6615.33 ± 3884.25 mL, mean BMI was 32.18 ± 7.26 kg/m2. mean preoperative vitamin D levels were 30.1 ± 14.45 ng/mL (borderline deficient according to the endocrine society) and mean postoperative vitamin D levels were 21.91 ± 9.18 ng/mL (deficient). A significant decrease in serum vitamin D was seen in our patients (p < 0.001) of mean 7.83 ng/mL. The amount of vitamin D loss was not associated with BMI or aspiration volume in our patients (p > 0.05). Interestingly, vitamin D dynamics showed a steady drop regardless of volume aspirated or preoperative levels. Conclusions: Many lipedema patients have low vitamin D levels preoperatively. Liposuction significantly reduced these levels additionally, regardless of aspirated volume or BMI. However, vitamin D loss was constant and predictable; thus, patients at risk are easily identified. Overall, lipedema patients undergoing liposuction are prone to vitamin D deficiency, and the long-term effects in this population are currently unknown.

Gram-Positive Bacteria Increase Breast Implant-Related Complications: Prospective Analysis of 100 Revised Implants.

BACKGROUND: Breast implant-related complications can be reduced by strict antiseptic precautions during insertion, but bacteria can often be found on implant surfaces on the occasion of revision surgery. The authors prospectively analyzed the association of bacteria found on breast implant surfaces with implant-related complications in breast implant revision cases. METHODS: The authors analyzed a total of 100 breast implant revisions in 66 patients between August of 2018 and January of 2021. Capsular swabs and capsular samples were taken intraoperatively. Analyses on the occurrence of bacteria and the occurrence of implant-related complications were performed. In addition, correlations between bacteria-contaminated breast implant surfaces and implant-related complications were performed. RESULTS: Implant-related complications (perforation, rupture, capsular contraction) were observed in 42 implant sites: eight unilateral and 34 bilateral cases. In total, 16 swabs showed positive bacterial growth, 10 of which were associated with a breast implant-related complication (χ 2 = x, y, and z; P = 0.006). The most common implant-based complication at contaminated prosthetics was implant rupture. The association of contaminated breast implants and implant rupture was statistically significant. CONCLUSIONS: The authors identified a correlation between implant complications and Gram-positive bacteria found on breast implant surfaces. The most common implant-based complication seen at simultaneously positive samples was implant rupture in 50% of the authors' cases. No capsular contraction or other complications were seen. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Arthroscopy with Lipoaspirate and Plasma Infiltration Using Adipose-Derived Stem Cells Plus Platelet-Rich Plasma: Harvesting and Injection for Arthroscopic Treatment of Cartilage Defects of the Knee.

Osteoarthritis, predominantly of the knee, is a highly prevalent disease leading to pain, reduced quality of life, and significantly reduced ability to work. With autologous orthobiologic options, new regenerative treatment methods have emerged, offering an alternative to early surgical intervention. Supercharged Liparthroplasty combines arthroscopy with lipoaspirate and plasma infiltration of the joint. Lipoaspirate contains high levels of adipose-derived stem cells, which show chondroprotective and anti-inflammatory qualities. Intra-articular injection, combined with platelet-rich plasma administration for accelerated cartilage metabolism, thus provides an optional approach in osteoarthritis treatment. This article aims to provide in detail our regimen for Supercharged Liparthroplasty, including tissue harvesting and preparation of the injectables, therefore enabling physicians to adopt this point-of-care technique.