RESUMEN
BACKGROUND: The purpose of this study was to determine whether suction-assisted lipectomy (SAL) decreases the incidence of early cardiovascular disease risk factors or its biochemical and clinical risk indicators. METHODS: A systematic review of the literature was performed by conducting a predefined, sensitive search in MEDLINE without limiting the year of publication or language. The extracted data included the basal characteristics of the patients, the surgical technique, the amount of fat extracted, the cardiovascular risk factors and the biochemical and clinical markers monitored over time. The data were analysed using pooled curves, risk ratios and standardised means with meta-analytical techniques. RESULTS: Fifteen studies were identified involving 357 patients. In all of the studies, measurements of predefined variables were recorded before and after the SAL procedure. The median follow-up was 3 months (interquartile range (IQR) 1-6, range 0.5-10.5). The mean amount of extracted fat ranged from 2063 to 16,300 ml, with a mean ± standard deviation (SD) of 6138 ± 4735 ml. After adjusting for time and body mass index (BMI), leptin and fasting insulin were the only markers that were significantly associated with the amount of aspirated fat. No associations were observed for high sensitive C-reactive protein (hCRP), interleukin-6 (IL-6), adiponectin, resistin, tumour necrosis factor-α (TNF-α), Homeostasis Model of Assessment (HOMA), total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, free fatty acids or systolic blood pressure. CONCLUSIONS: Based on the results of our analysis, we conclude that there is no evidence to support the hypothesis that subcutaneous fat removal reduces early cardiovascular or metabolic disease, its markers or its risk factors.
Asunto(s)
Enfermedades Cardiovasculares/sangre , Lipectomía , Enfermedades Metabólicas/sangre , Adiponectina/sangre , Presión Sanguínea , Proteína C-Reactiva/metabolismo , Enfermedades Cardiovasculares/fisiopatología , Colesterol/sangre , Ácidos Grasos no Esterificados/sangre , Humanos , Insulina/sangre , Interleucina-1/sangre , Leptina/sangre , Lipoproteínas HDL/sangre , Lipoproteínas LDL/sangre , Enfermedades Metabólicas/fisiopatología , Resistina/sangre , Factores de Riesgo , Triglicéridos/sangre , Factor de Necrosis Tumoral alfa/sangreRESUMEN
BACKGROUND: Suction-assisted lipectomy is one of the most common procedures performed in plastic surgery. To minimize blood loss and to obtain adequate analgesia, a liquid solution is infiltrated into the subcutaneous plane before suction. The objective of this study was to determine whether the use of lidocaine in the infiltration solution reduces postoperative pain. METHODS: A prospective, randomized, double-masked, clinical trial was designed. Each side of patients' body zones to be treated with suction-assisted lipectomy was randomized to receive infiltration solution with or without lidocaine. Treatment allocation was performed using computer-generated random numbers in permuted blocks of eight. Pain was assessed using the visual analogue scale and registered 1, 6, 12, 18, and 24 hours after the procedure. RESULTS: The trial was stopped after a first interim analysis. The use of lidocaine in the dilute solution reduced pain by 0.5 point on the visual analogue scale (95 percent CI, 0.3 to 0.8; p<0.001). The effect was independent of the suctioned body zone (p=0.756), and lasted until 18 hours after surgery. Its analgesic effect was lost at the 24-hour postoperative control. Pain increased an average of 0.018 point on the visual analogue scale per hour (95 percent CI, 0.001 to 0.036; p=0.043). CONCLUSIONS: The use of lidocaine in the infiltration solution is effective in postoperative pain control until 18 hours after surgery. Nevertheless, its clinical effect is limited and clinically irrelevant, and therefore it is no longer used by the authors. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.
Asunto(s)
Anestésicos Locales/administración & dosificación , Lidocaína/administración & dosificación , Lipectomía/métodos , Dolor Postoperatorio/prevención & control , Adolescente , Adulto , Anestesia General/métodos , Intervalos de Confianza , Método Doble Ciego , Femenino , Humanos , Inyecciones Intralesiones , Cuidados Intraoperatorios/métodos , Lipectomía/efectos adversos , Masculino , Dimensión del Dolor , Estudios Prospectivos , Valores de Referencia , Medición de Riesgo , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: Dermal substitutes, such as Integra(®) introduced as a new alternative to our surgical arsenal and its use in burn treatment, in both acute and chronic phases, have gained great importance. OBJECTIVE: The aim of the experiment is to describe the results of the functional evaluation of patients with burned hands treated with Integra(®) in both acute and chronic phases. MATERIAL AND METHODS: A retrospective review of a transversal cohort. Patient characteristics evaluated were sociodemographic characteristics, burn mechanism, burn extension and depth, treatments received previous to Integra(®) and complications related to its use. Clinical and photographic evaluations were performed evaluating skin elasticity, range of articular movement, prehensile strength, pain and functional evaluation using the validated 400 Point Evaluation Test. RESULTS: A total of 17 burned hands in 14 right-handed patients, were treated with Integra(®), three being bilateral hand burns. Eleven were treated in the acute phase and in nine in the scar reconstruction phase. Range of articular motion was complete in 15 of 17 hands. In 88% of the hands, flexible skin coverage was achieved. No statistically significant difference was observed in prehension strength of the burned hand versus the contralateral non-burned hand. Sixteen hands had a painless evolution. The 400 Point Evaluation score was 92.8 ± 6.3% (80 - 100%). Nearly four-fifths (79%) of the patients returned to normal active working activities.