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1.
Aesthet Surg J ; 43(6): 675-682, 2023 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-36495200

RESUMO

Superficial gluteal lipofilling is a fat grafting procedure performed to correct a trochanteric depression and buttock deflation. Brazilian butt lift (BBL) is a gluteal lipofilling procedure traditionally associated with exaggerated appearance and intramuscular fat transfer. The risk of mortality from fat embolism in BBL was previously reported as being 1:2500. The actual risk was later estimated to be nearer 1:15,000, which is similar to the mortality risk in abdominoplasty. There is increasing evidence regarding the safety of subcutaneous gluteal lipofilling. This has principally been related to new technologies, surgical techniques, and training being developed to avoid intramuscular injection of fat. The efficacy and benefits of intraoperative ultrasound for guiding the subcutaneous placement of fat and avoiding inadvertent deep lipofilling have been demonstrated. Other serious risks and complications must be considered in addition to mortality. These include hypothermia, sepsis, skin necrosis, and poor aesthetic results, as well as the much-publicized risk of fat embolism. Complications are better controlled and managed in strictly regulated healthcare settings. Patients seeking surgery at unregulated facilities or via medical tourism are deemed to be at higher risk of being exposed to these serious complications and/or inadequate subsequent management.


Assuntos
Embolia Gordurosa , Procedimentos de Cirurgia Plástica , Embolia Pulmonar , Cirurgiões , Humanos , Procedimentos de Cirurgia Plástica/efeitos adversos , Embolia Gordurosa/etiologia , Embolia Gordurosa/prevenção & controle , Nádegas/cirurgia , Estética , Tecido Adiposo/transplante
2.
Aesthet Surg J ; 41(Suppl 1): S25-S30, 2021 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-34002766

RESUMO

Autologous fat grafting for buttock augmentation is one of the fastest growing plastic surgery procedures, but has also received significant publicity for the relatively high mortality rate secondary to fat emboli. The literature has grown exponentially in the past 5 years on this subject, helping to clarify our knowledge and providing recommendations to minimize risks, including avoiding intramuscular injections, placing the patient in the jackknife position, and utilizing larger-bore cannulas. Since the application of these recommendations, the rate of pulmonary fat embolism has decreased from 0.097% to 0.04%, with a current mortality of 1 in 14,921, making it statistically safer than abdominoplasty. Despite the evolution in our knowledge, techniques, and outcomes, it remains of utmost importance to properly select and educate patients about the safety of fat grafting for buttock augmentation. Level of Evidence: 4.


Assuntos
Embolia Gordurosa , Procedimentos de Cirurgia Plástica , Tecido Adiposo , Autoenxertos , Nádegas/cirurgia , Embolia Gordurosa/etiologia , Embolia Gordurosa/prevenção & controle , Humanos , Transplante Autólogo
3.
Aesthetic Plast Surg ; 45(2): 718-729, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33403423

RESUMO

INTRODUCTION: Complications of fat grafting by means of injection may lead to unwanted passage of substrate into vessel lumens resulting in catastrophic complications. Likewise, a similar trend of complications is observed with non-autologous fillers regardless of an almost generalized use of blunt cannulas, the latter being implicated in the majority of serious vascular complications of hyaluronic acid injection. This report is the product of investigation to review all cases that underwent an original technique of fat injection: "The smart fat injection" during the cannula's brisk withdrawal technique. The aim of this research was to document the safety of this technique by searching if fat embolism had occurred and if yes, its incidence in this group of fat injection surgeries. METHOD: This retrospective review included 3039 patients who underwent the smart fat injection at the facial or corporeal level between 2001 and 2019. The study focused on the search for complications linked to fat yet also cruorical embolism, as the latter may resemble the clinical symptoms of fat embolism. RESULTS: The assessment of the 3039 patients who underwent the smart fat injection during cannula's brisk withdrawal, resulted in none presenting clinically detectable fat or a cruorical embolism. CONCLUSION: This report documents the safety of the smart fat injection developed over a period of 22 years. It further explains the rationale of the technique for avoiding fat embolism while simultaneously enhancing fat take. This technique should not be implemented without appropriate in vitro training. LEVEL OF EVIDENCE V: 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 Table of Contents or online Instructions to Authors www.springer.com/00266 .


Assuntos
Cânula , Embolia Gordurosa , Tecido Adiposo , Embolia Gordurosa/etiologia , Embolia Gordurosa/prevenção & controle , Humanos , Injeções , Estudos Retrospectivos , Resultado do Tratamento
4.
Aesthet Surg J ; 40(1): 78-89, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31152663

RESUMO

BACKGROUND: Microscopic fat embolism syndrome (micro-FES) has been recently identified as a potentially fatal complication following gluteal augmentation utilizing autologous fat grafts; safety recommendations advocating for subcutaneous lipo-injections may be insufficient for its prevention. OBJECTIVES: The authors of this systematic review evaluated the potential role of corticosteroid prophylaxis for the prevention of micro-FES in gluteal augmentation procedures. METHODS: The authors performed a systematic search employing the National Library of Medicine (PubMed), Medline, and Embase databases. Search terms were those pertaining to studies reporting the efficacy of prophylactic corticosteroid administration on micro-FES incidence in a high-risk surrogate population. RESULTS: Thirteen articles met the inclusion criteria for review, comprising 2 studies reporting on the efficacy of a single intravenous (IV) corticosteroid dose for the prophylaxis of micro-FES, 9 studies reporting on multiple prophylactic IV doses, and 2 additional studies reporting on the efficacy of inhaled corticosteroids in this context. All studies were identified from the orthopedic literature given that none were available directly from within plastic surgery. The prophylactic efficacy of multiple IV doses of methylprednisolone, or a single larger dose, was established, whereas the efficacy of inhaled corticosteroids remains elusive. CONCLUSIONS: A single perioperative IV dose of methylprednisolone may be most appropriate for utilization by plastic surgeons; the safety and implication of this therapy on wound healing and fat graft survival are discussed. Further studies directly evaluating the efficacy of corticosteroid prophylaxis in the gluteal augmentation population are indicated. Finally, recommendations pertaining to the prevention, timely recognition, and effective management of micro-FES are discussed.


Assuntos
Contorno Corporal , Embolia Gordurosa , Cirurgia Plástica , Corticosteroides/efeitos adversos , Embolia Gordurosa/etiologia , Embolia Gordurosa/prevenção & controle , Humanos
5.
Gen Thorac Cardiovasc Surg ; 68(4): 363-369, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31720984

RESUMO

OBJECTIVE: In lung transplantation, unexpected pulmonary emboli, including thrombi and fat, have been observed with high probability and are associated with potential primary graft dysfunction. We evaluated a new perfusion method using warm retrograde flushing that removes more fat than conventional cold retrograde flushing. METHODS: We developed a novel porcine donor model for pulmonary fat embolism by administering autologous fat in the left pulmonary artery. The left pulmonary artery and the left superior and inferior pulmonary veins were cannulated for flushing and collecting these solutions. After flushing, the left lung was reperfused under observation for 3 h. Two groups underwent warm and cold additional retrograde flush (WS; warm solution group, CS; cold solution group). RESULTS: The fat removal rate in the antegrade flush was equal in both groups (3.0 ± 0.6% vs 3.0 ± 0.4%, p = 0.46); however, the rate was significantly greater in the WS group in retrograde flush (25.2 ± 3.2% vs 8.0 ± 1.4%, p = 0.01). Histology with Oil Red O staining and its software analysis showed more residual fat in the CS group (0.12 ± 0.01% vs 0.38 ± 0.07%, p = 0.01). There was no significant difference in the pulmonary function and hemodynamics during the 3-h period after reperfusion. CONCLUSION: Warm retrograde perfusion can remove more fat from lung grafts with fat embolism in a porcine donor model.


Assuntos
Transplante de Pulmão , Pulmão/fisiopatologia , Pulmão/cirurgia , Preservação de Órgãos/métodos , Perfusão , Tecido Adiposo/patologia , Animais , Modelos Animais de Doenças , Embolia Gordurosa/prevenção & controle , Hemodinâmica , Complacência Pulmonar , Disfunção Primária do Enxerto/prevenção & controle , Artéria Pulmonar/cirurgia , Embolia Pulmonar/prevenção & controle , Reperfusão/métodos , Sus scrofa , Suínos , Temperatura
6.
Aesthet Surg J ; 40(10): 1098-1107, 2020 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-31606739

RESUMO

Macroscopic fat embolism (MAFE) has grabbed the attention of the plastic surgery community in recent years because of its high mortality rate. Many articles on preventing MAFE during gluteal fat grafting are available in the literature. However, total prevention is difficult: a number of factors, both technical and human, mean that MAFE remains a potential complication. This review was written with the main goal of providing a treatment plan. MAFE shares many similar pathophysiologic and hemodynamic features with massive thrombotic pulmonary embolism (PE), especially the associated cardiopulmonary decompensation. Lessons learned from PE management were used to devise a management algorithm for MAFE. The use of extracorporeal membrane oxygenation and its potential application as a main modality of treatment for MAFE was explored. The lack of evidence in the literature for the treatment of MAFE, and its high mortality, lent urgency to the need to write an article on the management aspect in the form of a narrative review, to ensure that every plastic surgeon practicing gluteal fat grafting is knowledgeable about the treatment aspect of this deadly complication.


Assuntos
Embolia Gordurosa , Oxigenação por Membrana Extracorpórea , Embolia Pulmonar , Cirurgiões , Cirurgia Plástica , Embolia Gordurosa/diagnóstico , Embolia Gordurosa/etiologia , Embolia Gordurosa/prevenção & controle , Humanos , Embolia Pulmonar/etiologia , Embolia Pulmonar/terapia
7.
Khirurgiia (Mosk) ; (12): 84-90, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825347

RESUMO

AIM: To assess the effect of the modified infusion therapy regimen on the frequency of development of laboratory and clinical manifestations of fat embolism syndrome in patients after hip replacement. MATERIAL AND METHODS: The study was conducted in 80 patients (70 men and 10 women) who were admitted for planned revision hip arthroplasty. The criteria for not inclusion in the study were the presence of a traumatic brain injury, episodes of acute disturbance of blood supply (stroke) and diabetes mellitus in history. 40 patients of the main group during the operation were administered Gelofuzin and Sterofundin isotonic, and in the first day after the operation Remaxol and Sterofundin isotonic. Using the copy-steam method, a control group (n=40) out of 197 patients was selected by gender and age. In the control group, infusion therapy was carried out using a 0.9% NaCl solution. All patients underwent assessment of fat globulemia, water-electrolyte balance, acid-base status and oxygenation index - before surgery; 2, 24, 48, and 72 hours after the operation, on the third day, mental disorders were assessed using the Addenburg scale (ACE-R) for evaluating cognitive functions. RESULTS: All patients underwent hip joint endoprosthetics. In the group receiving the modified infusion therapy regimen, the results were significantly better, there were no statistically significant changes in the level of electrolytes (p=0.14), episodes of a decrease in the oxygenation index and cognitive dysfunction. In contrast to patients in the control group, where the level of chlorine and sodium was significantly higher, the number of fat globules with a diameter of more than 8 µm, as well as in two patients, the development of postoperative delirium with a decrease in the oxygenation index below 300 was observed. The causal relationship between the number of fat globules with a diameter of more than 8 microns and clinical manifestations of cerebral and pulmonary forms of fat embolism (r-Pirsen = -0.87 and -0.80, respectively). There were no statistically significant changes in platelet count, potassium concentration with indicators of fat globulemia and a scale of cognitive impairment. CONCLUSION: A high correlation of fatty globulemia with the development of respiratory and pulmonary dysfunction after hip replacement was determined. The inclusion of Gelofuzin, Sterofundin isotonic and Remaxol in intensive therapy provides a pronounced emulsifying effect on fat globules appearing in the bloodstream in the first hours after hip replacement, and effective prevention of potentially dangerous fat embolism.


Assuntos
Artroplastia de Quadril/efeitos adversos , Embolia Gordurosa/prevenção & controle , Gelatina/administração & dosagem , Fármacos Hematológicos/administração & dosagem , Succinatos/administração & dosagem , Embolia Gordurosa/etiologia , Feminino , Humanos , Infusões Intravenosas , Masculino , Compostos Orgânicos/administração & dosagem , Reoperação
8.
Plast Reconstr Surg ; 144(2): 385-388, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31348347

RESUMO

Gluteal fat grafting has been highlighted as a significant safety issue in plastic surgery, with a mortality rate as high as one in 3000 cases. Injury to the gluteal veins resulting in fat emboli has been identified as the cause of these mortalities. The gluteal veins lie deep to the gluteal musculature in the buttocks, and it has been suggested that avoiding intramuscular injection of fat may prevent these complications. The authors present a novel injection cannula design that uses impedance sensing to determine the location of the cannula tip. Specifically, the system can determine when the tip of the cannula leaves the subcutaneous plane and enters muscle. The use of this system may prevent inadvertent injury to the gluteal veins and subsequent embolic complications. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, V.


Assuntos
Cânula , Gordura Subcutânea/transplante , Animais , Nádegas/irrigação sanguínea , Impedância Elétrica , Embolia Gordurosa/prevenção & controle , Desenho de Equipamento , Injeções Subcutâneas , Sus scrofa , Suínos , Veias
9.
Plast Reconstr Surg ; 143(6): 1625-1632, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31136476

RESUMO

Given the widespread utility and therapeutic potential of autogenous fat grafting, plastic surgeons should be familiar with its safety profile and associated adverse events. This article provides a critical review of the literature and delineates risk factors associated with various complications when grafting to the breast and gluteal regions. The majority of adverse events are related to fat necrosis and require minimal diagnostic or therapeutic intervention. Larger graft volumes, as in cosmetic augmentation, are associated with higher incidences of fatty necrosis. The oncologic safety of fat grafting is supported by multiple clinical studies with thousands of breast cancer patients, albeit predominantly retrospective in nature. Although less frequent, serious complications include fat emboli during gluteal augmentation. Identification of associated risk factors and implementation of proper surgical techniques may minimize the occurrence of life-threatening complications.


Assuntos
Tecido Adiposo/transplante , Nádegas/cirurgia , Embolia Gordurosa/prevenção & controle , Mamoplastia/métodos , Cirurgia Plástica/métodos , Adulto , Contorno Corporal/efeitos adversos , Contorno Corporal/métodos , Neoplasias da Mama/cirurgia , Embolia Gordurosa/mortalidade , Estética , Feminino , Humanos , Mastectomia/métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Medição de Risco , Cirurgia Plástica/efeitos adversos , Taxa de Sobrevida , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Resultado do Tratamento
10.
J Invest Surg ; 32(3): 228-231, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29286843

RESUMO

INTRODUCTION: Liposuction is one of the most popular plastic surgery procedures. As in any surgery, there are risks and complications, especially when combined with fat injection. Case reports of fat embolism have been reported. A possible explanation is the puncture and tearing of gluteal vessels during the procedure, especially when a deep injection is planned. OBJECTIVE: To identify the places where fat can be located after injection during a fat graft in the gluteus. METHODS: An experimental study was done in which colorant was injected in four directions using four different quadrants of the gluteus. We Injected 10 cc six times following clock hands until 60 cc were injected, and the cutaneous flap and the muscles were then elevated. Our main purpose was to describe where the colorant went and if it was in contact with the vessels (superior and inferior gluteal vessels). In total, four gluteus muscles were injected and dissected. RESULTS: Injection in the lower lateral quadrant was mainly into the muscle, and colorant was observed in the hypogastric vessels. The injection in the upper quadrants stayed mainly in the subcutaneous tissue. CONCLUSIONS: During surgery, it is important to identify the location of the perforators and to avoid a deep injection, especially from the lower lateral quadrant to the superior medial quadrant (Q4 to Q1), as the probability of puncturing and injecting fat into the main vessels from this direction is higher.


Assuntos
Tecido Adiposo/transplante , Contorno Corporal/efeitos adversos , Embolia Gordurosa/prevenção & controle , Lipectomia/efeitos adversos , Contorno Corporal/métodos , Nádegas/irrigação sanguínea , Nádegas/cirurgia , Cadáver , Corantes/administração & dosagem , Dissecação , Humanos , Injeções Subcutâneas/efeitos adversos , Injeções Subcutâneas/métodos , Lipectomia/métodos
11.
Aesthet Surg J ; 39(2): 174-184, 2019 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-30247585

RESUMO

Background: Fat grafting for gluteal augmentation is one of the most popular aesthetic surgery procedures. It has an associated mortality to fat embolism of 0.2%. Objectives: The authors of this study sought to describe which technique for synthetic graft application was least likely to cause a fat embolism. Methods: Ten fresh bodies were obtained and 4 groups arranged with 5 buttocks each randomly assigned. Group 1 was infiltrated through the upper medial intergluteal sulcus (upper medial intergluteal sulcus) with an angulation of -30°, -10°, and 0°. Group 2 was infiltrated through the middle lower gluteal sulcus with an angulation of -30°, 0°, and +15°. Group 3 was infiltrated through a peritrochanteric (PT) access at the level of the femur head at 0° and +10° and in the middle of the buttock at the level of the posterior superior iliac crest at -30° toward the trochanter (lateral direction). Group 4 was infiltrated in the same manner as group 1 without -30°. A complication occurred when the graft was in contact with the vascular or nervous bundle, within the gluteus medius muscle, or both. Results: Group 1 had 3 buttocks with a complication (UMIGS -30°). Group 2 had complications in all the injection techniques. Group 3 had 5 buttocks with a complication (PT at 0°). Group 4 had no complications. Conclusions: The injection of the fat graft through the UMIGS at 0° and 10° angles, and through the middle of the buttock at the level of posterior superior iliac crest a -30° angle, reaches the surface needed for gluteal augmentation. The group 2 techniques should be avoided because they have a high risk of complication.


Assuntos
Contorno Corporal/efeitos adversos , Embolia Gordurosa/prevenção & controle , Traumatismos dos Nervos Periféricos/prevenção & controle , Gordura Subcutânea/transplante , Adolescente , Adulto , Contorno Corporal/métodos , Nádegas/irrigação sanguínea , Nádegas/inervação , Cadáver , Cânula/efeitos adversos , Corantes/administração & dosagem , Embolia Gordurosa/etiologia , Feminino , Humanos , Ílio/anatomia & histologia , Injeções Intramusculares/efeitos adversos , Injeções Intramusculares/instrumentação , Injeções Intramusculares/métodos , Masculino , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/etiologia , Adulto Jovem
12.
Plast Reconstr Surg ; 141(5): 639e-649e, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29465484

RESUMO

BACKGROUND: Despite rapid growth, gluteal fat transplantation is an operation in search of science and a teachable technique. Long operating times, tedious syringe transfers, inability to shape the recipient site, and the risk of fat embolism all headline as impediments to clinical adoption of the procedure. Expansion vibration lipofilling is a syringe-free surgical strategy that is a logical extension of Separation, Aspiration, and Fat Equalization (SAFELipo). In expansion vibration lipofilling, there is simultaneous disruption of recipient-site connective tissue, internal expansion using exploded-tip cannulas, and backfilling of these spaces with roller pump-propelled fat. METHODS: Two thousand four hundred nineteen consecutive cases of expansion vibration lipofilling fat transplantation to the buttocks were reviewed. Average follow-up was 12 months. The technique of expansion vibration lipofilling is dependent on the use of larger caliber cannulas attached to a roller pump and to an oscillatory power-assisted liposuction device, which is less labor-intensive, potentially allowing for better knowledge of cannula-tip location at all times during the procedure. RESULTS: Operating times averaged 1 hour 40 minutes. The average volume of fat inserted was 1003 cc. Complications included donor-site seroma, infection, and one pulmonary embolism treated with anticoagulation. There were no cases of fat embolism or death. CONCLUSIONS: Expansion vibration lipofilling is a new method for large-volume fat transplantation. Avoidance of fatal fat emboli demands a surgeon's complete knowledge of cannula tip location at all times during the procedure. Syringe-free, larger caliber, and less flexible cannulas, combined with techniques requiring less operator upper extremity effort resulting in less fatigue, may contribute to avoidance of this dreadful complication. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Tecido Adiposo/transplante , Lipectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Curetagem a Vácuo/métodos , Vibração , Adolescente , Adulto , Idoso , Nádegas/cirurgia , Embolia Gordurosa/epidemiologia , Embolia Gordurosa/etiologia , Embolia Gordurosa/prevenção & controle , Feminino , Humanos , Lipectomia/efeitos adversos , Lipectomia/instrumentação , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/etiologia , Embolia Pulmonar/terapia , Seroma/epidemiologia , Seroma/etiologia , Transplante Autólogo/efeitos adversos , Transplante Autólogo/instrumentação , Transplante Autólogo/métodos , Curetagem a Vácuo/efeitos adversos , Curetagem a Vácuo/instrumentação , Adulto Jovem
13.
J Invest Surg ; 31(4): 292-297, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28485991

RESUMO

INTRODUCTION: Liposuction is a popular surgical procedure. As in any surgery, there are risks and complications, especially when combined with fat injection. Case reports of fat embolism have described a possible explanation as the puncture and tear of gluteal vessels during the procedure, especially when a deep injection is planned. METHODS: A total of 10 dissections were performed in five fresh cadavers. Each buttocks was divided into four quadrants. We focused on the location where the gluteal vessels enter the muscle and the diameter of the vessels. Colorant at two different angles was injected (30° and 45°). We evaluated the relation of the colorant with the main vessels. RESULTS: We found two perforators per quadrant. The thickness of the gluteal muscle was 2.84 ± 1.54 cm. The area under the muscle where the superior gluteal vessels traverse the muscle was located 6.4 ± 1.54 cm from the intergluteal crease and 5.8 ± 1.13 cm from the superior border of the muscle. The inferior gluteal vessels were located 8.3 ± 1.39 cm from the intergluteal crease and 10 ± 2.24 cm from the superior border of the muscle. When we compared the fat injected at a 30° angle, the colorant stayed in the muscle. Using a 45° angle, the colorant was in contact with the superior gluteal artery and the sciatic nerve. No puncture or tear was observed in the vessels or the nerve. CONCLUSIONS: The location where the vessels come in contact with the muscle, which can be considered for fat injection, were located in quadrants 1 and 3. A 30° angle allows for an injection into the muscle without passing into deeper structures, unlike a 45° injection angle.


Assuntos
Tecido Adiposo/transplante , Contorno Corporal/efeitos adversos , Nádegas/cirurgia , Embolia Gordurosa/prevenção & controle , Lipectomia/efeitos adversos , Adulto , Artérias , Contorno Corporal/métodos , Nádegas/irrigação sanguínea , Cadáver , Corantes/administração & dosagem , Embolia Gordurosa/etiologia , Feminino , Humanos , Injeções Intradérmicas/efeitos adversos , Injeções Intradérmicas/métodos , Lipectomia/métodos , Masculino , México , Pessoa de Meia-Idade , Nervo Isquiático , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Adulto Jovem
15.
Injury ; 48 Suppl 1: S3-S6, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28449860

RESUMO

Fat embolism is common in patients with major fractures, but leads to devastating consequences, named fat embolism syndrome (FES) in some. Despite advances in treatment strategies regarding the timing of definitive fixation of major fractures, FES still occurs in patients. In this overview, current literature is reviewed and optimal treatment strategies for patients with multiple traumatic injuries, including major fractures, are discussed. Considering the multifactorial etiology of FES, including mechanical and biochemical pathways, FES cannot be prevented in all patients. However, screening for symptoms of FES should be standard in the pre-operative work-up of these patients, prior to definitive fixation of major fractures.


Assuntos
Embolia Gordurosa/prevenção & controle , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas/métodos , Traumatismo Múltiplo/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Fraturas da Tíbia/cirurgia , Protocolos Clínicos , Embolia Gordurosa/complicações , Embolia Gordurosa/fisiopatologia , Fraturas do Fêmur/fisiopatologia , Fixação Intramedular de Fraturas/efeitos adversos , Humanos , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/fisiopatologia , Segurança do Paciente , Complicações Pós-Operatórias/fisiopatologia , Guias de Prática Clínica como Assunto , Síndrome , Fraturas da Tíbia/fisiopatologia , Fatores de Tempo
16.
J Trauma Acute Care Surg ; 82(2): 338-344, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28107310

RESUMO

BACKGROUND: Fat embolism (FE) and the consequent FE syndrome occurring after trauma or surgery can lead to serious pulmonary injury, including ARDS and death. Current treatment of FE syndrome is limited to supportive therapy. We have shown in a rat model that the renin angiotensin system plays a significant role in the pathophysiology of FE because drugs interfering with the renin angiotensin system, captopril and losartan reduce the histopathologic pulmonary damage. The purpose of the current study was to determine if inhibition of renin by aliskiren, an FDA-approved drug for treating hypertension, would produce effective protection in the same model. METHODS: The FE model used intravenous injection of the neutral fat triolein in unanesthetized rats. Intraperitoneal injections of saline or aliskiren at either 50 or 100 mg/kg were performed 1 hour after FE induction via triolein. Rats were euthanized at 48 hours, and various histologic stains were used to examine the lungs. RESULTS: (1) Fibrosis: rats treated with triolein showed significant fibrotic changes with increased collagen and myofibroblast activation (p < 0.0001 for both trichrome and α-smooth muscle actin staining). Aliskiren blocked this inflammatory and profibrotic process to a level indistinguishable from the controls (p < 0.0001 for both trichrome and α-smooth muscle actin staining). (2) Fat: rats treated with triolein showed a statistically significant increase in fat (p = 0.0006). Subsequent aliskiren administration at both doses reduced the size, distribution, and amount of fat droplets (low dose, p = 0.0095; high dose, p = 0.0028). (3) Vessel patency: the low dose of aliskiren blocked the reduction of lumen patency observed after triolein administration (p = 0.0058). CONCLUSIONS: Aliskiren protected the lungs of rats from gross and histopathologic FE-induced pulmonary damage at 48 hours. Clinical implications include the use of aliskiren both prophylactically (before certain orthopedic procedures) and therapeutically (after severe trauma) to prevent the consequent severe pulmonary pathologic sequelae.


Assuntos
Amidas/farmacologia , Embolia Gordurosa/prevenção & controle , Fumaratos/farmacologia , Animais , Modelos Animais de Doenças , Masculino , Ratos , Ratos Sprague-Dawley , Reprodutibilidade dos Testes , Trioleína/farmacologia
17.
Eur J Trauma Emerg Surg ; 43(3): 313-318, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26781645

RESUMO

BACKGROUND: Many studies have established intravenous corticosteroid as an effective prophylactic therapy in fat embolism syndrome (FES). However, its use is limited among surgeons because of systemic side effects. Inhalational steroids have least systemic effects and are widely used for several chest conditions (i.e., asthma), but their effectiveness in FES has not been established. QUESTION/PURPOSE: This study was sought to evaluate the (1) efficacy and (2) safety of inhalational Ciclesonide (CIC) in prevention of FES and treatment of hypoxemia in isolated skeletal trauma victims. METHODS: A nonrandomized prospective control trial was designed in which all patients between 18 and 40 years with isolated skeletal injury who presented within 8 h of injury were allocated to either Trial group or control group. Trial group patients received 640 mcg of inhalational CIC with a metered-dose inhaler at the time of admission, and at 24 h. Control group patients did not receive any prophylactic therapy. Both groups were evaluated for development of FES (Gurd's criteria) and hypoxemia (PaO2 <70 mmHg) for 72 h. The complications related to CIC administration were evaluated in trial group patients during their hospital stay. RESULTS: Of 35 patients in each group, two patients in Trial group and nine patients in control group developed FES (P = 0.022). Eight patients in Trial group had hypoxemia at the time of admission, six of them improved and one additional patient developed hypoxemia after inhalational CIC administration. In control group, ten patients had hypoxia at the time of admission, only one of them improved and remaining nine patients had persistent hypoxemia even after 72 h. Additionally, three patients developed hypoxemia. A significant improvement in hypoxemia and a significant decrease in the incidence of FES were observed in Trial group (P < 0.05) compared to control group. None of the patients presented with any complications or adverse effects of steroid in Trial group. CONCLUSION: Inhalational CIC is a safe and effective therapy for prevention of FES and also an effective drug for treatment of hypoxemia in orthopedic trauma victims. LEVEL OF EVIDENCE: Level III, therapeutic study.


Assuntos
Embolia Gordurosa/complicações , Embolia Gordurosa/prevenção & controle , Glucocorticoides/uso terapêutico , Hipóxia/prevenção & controle , Traumatismo Múltiplo/complicações , Pregnenodionas/uso terapêutico , Administração por Inalação , Adolescente , Adulto , Feminino , Glucocorticoides/administração & dosagem , Humanos , Hipóxia/complicações , Escala de Gravidade do Ferimento , Masculino , Pregnenodionas/administração & dosagem , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
18.
Surg Technol Int ; 29: 287-294, 2016 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-27728952

RESUMO

The reamer-irrigator-aspirator (RIA) system has been recently developed to decrease the incidence of osseous thermal necrosis and fat embolism associated with intramedullary reaming of long bones in trauma cases. This is achieved by continuous irrigation and suction. Recently, the use of RIA has been expanded to harvest bone graft and debride the medullary canal of long bones in cases of osteomyelitis and intramedullary tumors. Additionally, the collection system of this device has been utilized for its ability to capture bone graft and marrow aspirate. The purpose of this study is to report a comprehensive literature review on the: 1) use of RIA for canal reaming prior to intramedullary nailing; 2) use of RIA for the treatment of intramedullary osteomyelitis of long bones; 3) use of RIA for bone graft harvesting; 4) osteogenic potential of the RIA aspirate; and 5) future applications of the RIA system.


Assuntos
Embolia Gordurosa/prevenção & controle , Fixação Intramedular de Fraturas/efeitos adversos , Irrigação Terapêutica , Transplante Ósseo , Humanos , Sucção
19.
J Bone Joint Surg Am ; 98(8): 658-64, 2016 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-27098324

RESUMO

BACKGROUND: Approximately 2 million patients in the United States annually undergo total joint arthroplasty with reaming and placement of intramedullary nails, resulting in extravasation of bone marrow and fat into the circulatory system and potentially causing fat embolism syndrome. Acute and chronic changes in mental status documented after these procedures may be related to embolic events. The Reamer/Irrigator/Aspirator (RIA) device has been shown to decrease intramedullary pressure during reaming. We hypothesized that the use of the RIA in a canine model would reduce the number of microemboli detected in the carotid artery and brain compared with nailing either with or without reaming. METHODS: Twenty-four large canines underwent unreamed nailing (UR), sequentially reamed nailing (SR), or RIA-reamed nailing (RIA) of bilateral femora (eight dogs per group). During reaming and nailing, the number and size of microemboli transiting the carotid artery were recorded. After euthanasia, the brain was harvested for immunostaining and measurement of microinfarction volumes. RESULTS: Total embolic load passing through the carotid artery was 0.049 cc (UR), 0.045 cc (SR), and 0.013 cc (RIA). The number and size of microemboli in the UR and SR groups were similar; however, the RIA group had significantly fewer larger-sized (>200-µm) emboli (p = 0.03). Pathologic examination of the brain confirmed particulate emboli, and histologic analyses demonstrated upregulation of stress-related proteins in all groups, with fewer emboli and less evidence of stress for RIA reaming. CONCLUSIONS: RIA reaming decreased microemboli compared with traditional reaming and unreamed nailing, suggesting that intramedullary pressure and heat are important variables. The documented embolic events and brain stress may help to explain subtle neurobehavioral symptoms commonly seen in patients after undergoing long-bone reaming procedures. CLINICAL RELEVANCE: RIA reaming decreased cranial embolic events and may have an ameliorating effect on postoperative neurologic sequelae.


Assuntos
Artérias Carótidas , Embolia Gordurosa/etiologia , Embolia Gordurosa/prevenção & controle , Fixação Intramedular de Fraturas/efeitos adversos , Embolia Intracraniana/etiologia , Embolia Intracraniana/prevenção & controle , Animais , Modelos Animais de Doenças , Cães , Sucção , Irrigação Terapêutica
20.
Rev. bras. cir. plást ; 31(3): 436-441, 2016. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-2327

RESUMO

INTRODUÇÃO: Analisar dados da internet relacionados a mortes por embolia gordurosa, inicio da doença, e outras informações podem determinar a realidade atual no Brasil relacionada à incidência da síndrome de embolia gordurosa e qualquer repercussão na mídia, e também revisar as metodologias de prevenção e quais são os melhores métodos disponíveis para tratar a doença. MÉTODOS: Uma pesquisa no google foi conduzida de Janeiro de 2000 a Janeiro de 2014 utilizando os descritores "cirurgia plástica" e "morte". Foram incluídos e revisados artigos contendo as palavras "embolia", "embolia gordurosa" e "complicações em (ou de) cirurgia plástica". RESULTADOS: Incluiu-se 235 matérias novas relevantes ao longo dos 14 anos. Houve 45 casos de óbito relacionados com cirurgia plástica que ofereceu poucos dados para individualização. Desses pacientes, 44 eram mulheres. As causas possíveis mencionadas foram embolia pulmonar (cinco casos), perfuração das vísceras (cinco casos), hipertermia maligna (três casos), anestesia (dois casos), choque anafilático (dois casos), embolia gordurosa (um caso confirmado), e "outros" (cinco casos). CONCLUSÃO: Diretrizes de prevenção para embolia gordurosa em cirurgia plástica são requeridas, porém, há também necessidade de mais estudos baseados em evidência para entender mais claramente quais são os melhores métodos.


INTRODUCTION: To analyze data from the internet on deaths from fat embolism, time of onset, and other information that could determine current reality in Brazil regarding fat embolism syndrome incidence and any ,media repercussions, and also to review methods of prevention and what are the best methods available to treat this disease. METHODS: A Google search was conducted from January 2000 to January 2014 using the keywords "plastic surgery" and "death." We included and reviewed articles containing the words "embolism", "fat embolism" and "complications in (or of) plastic surgery". RESULTS: We included 235 relevant news stories over the 14 included years. There were 45 cases of death related with plastic surgery that offered few data for individualization. Of these patients, 44 were women. Possible causes mentioned were pulmonary embolism (five cases), perforation of viscera (four cases), malignant hyperthermia (three cases), anesthesia (two cases), anaphylactic shock (two cases), fat embolism (one confirmed case), and "other" (five cases). CONCLUSION: Guidelines to prevent fat embolism in plastic surgery are needed, however, there is also the need of more evidence based studies to understand more clearly what methods are best.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , História do Século XX , Vísceras , Estudo de Avaliação , Embolia Pulmonar , Embolia Pulmonar/mortalidade , Embolia Pulmonar/prevenção & controle , Cirurgia Plástica , Cirurgia Plástica/métodos , Cirurgia Plástica/mortalidade , Cirurgia Plástica/estatística & dados numéricos , Embolia Gordurosa , Embolia Gordurosa/mortalidade , Embolia Gordurosa/prevenção & controle , Anafilaxia , Anafilaxia/mortalidade , Anafilaxia/prevenção & controle , Hipertermia Maligna , Hipertermia Maligna/mortalidade , Hipertermia Maligna/prevenção & controle
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