RESUMEN
BACKGROUND: Liposuction and gluteal lipoinjection are two of the most frequent surgical procedures in body contouring surgery, and two of the most important complications are microscopic (MIFE) and macroscopic (MAFE) fat embolism. Despite a high index of morbidity and mortality, few reports exist about these complications, and although they have the same causal agent, their etiopathogenesis, clinical evolution, treatment, prognosis, and prevention are totally different. Therefore, the authors performed a comprehensive review of the literature to exhaustively analyze both pathologic conditions and present the differences between them. METHODS: A detailed search was carried out in PubMed of studies on humans from 1946 to March of 2017 in any language and including the keywords microscopic fat embolism and macroscopic fat embolism with either liposuction or gluteal lipoinjection. The articles found were selected according to the search criteria and were analyzed to provide the final data and recommendations. RESULTS: Of the 1245 and 26 articles that were found on complications related to liposuction and gluteal lipoinjection, respectively, only 41 on liposuction and microscopic fat embolism and seven on gluteal lipoinjection and microscopic fat embolism met the specific criteria for inclusion in the analysis. Only two articles on liposuction and two on gluteal lipoinjection referred to macroscopic fat embolism as a complication. CONCLUSION: Although microscopic fat embolism and macroscopic fat embolism are pathologic conditions with high morbidity and mortality rates in association with liposuction and gluteal lipoinjection, few reports about them exist; therefore, the authors made recommendations based on this study for their diagnosis, prevention, and treatment.
Asunto(s)
Contorneado Corporal/efectos adversos , Nalgas/cirugía , Embolia Grasa/etiología , Lipectomía/efectos adversos , Complicaciones Posoperatorias/etiología , Contorneado Corporal/métodos , Embolia Grasa/diagnóstico , Embolia Grasa/patología , Embolia Grasa/terapia , Humanos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/patología , Complicaciones Posoperatorias/terapia , PronósticoRESUMEN
Sickle cell disease encompasses a wide range of genotypic presentation with particular clinical features. The entity affects millions of people, particularly those whose ancestors came from sub-Saharan Africa and other countries in the Western Hemisphere, Saudi Arabia, and India. Currently, the high frequency of S and C genes reflects natural selection through the protection of heterozygotes against severe malaria, the high frequency of consanguineous marriages, improvement of some public health policies and the nutritional standards in the poorer countries where newborns are now living long enough to present for diagnosis and management. Although there is a high burden of the disease, in many countries, the new-born sickle cell screening test is being performed and is rendering an early diagnosis; however, it is still difficult for sickle cell patients to find proper treatment and adequate follow-up. Moreover, in many countries, patients are neither aware of their diagnosis nor the care they should receive to prevent complications; also, they do not receive adequate genetic counseling. Hemoglobin SC (HbSC) disease is the most frequent double sickle cell heterozygosis found in Brazil. The clinical course tends to be more benign with fewer hospitalizations compared with double homozygotic SS patients. However, HbSC patients may present severe complications with a fatal outcome. We report the case of a 36-year-old man who presented to the emergency care facility with symptoms consistent with the diagnosis of sickling crisis. The outcome was unfavorable and death occurred just hours after admission. The autopsy revealed a generalized vaso-occlusive crisis by sickled red cells, bone marrow necrosis, and fat embolism syndrome.
Asunto(s)
Humanos , Masculino , Adulto , Médula Ósea/patología , Embolia Grasa/patología , Enfermedad de la Hemoglobina SC/complicaciones , Autopsia , Resultado Fatal , Enfermedad de la Hemoglobina SC/diagnóstico , Enfermedad de la Hemoglobina SC/patologíaAsunto(s)
Imagen de Difusión por Resonancia Magnética/métodos , Embolia Grasa/complicaciones , Embolia Grasa/diagnóstico por imagen , Papiledema/diagnóstico por imagen , Papiledema/etiología , Anciano , Embolia Grasa/patología , Femenino , Globo Pálido/diagnóstico por imagen , Globo Pálido/patología , Humanos , Embolia Intracraneal/complicaciones , Embolia Intracraneal/diagnóstico por imagen , Embolia Intracraneal/patología , Papiledema/patología , Retina/diagnóstico por imagen , Retina/patologíaRESUMEN
A cirurgia de lipoaspiração é com alguma frequência relacionada a consequências dramáticas ou fatais, causando grande repercussão no meio médico e principalmente na mídia leiga. Esse fato não deve fazer com que o cirurgião plástico evite essa cirurgia, mas sim estimulá-lo a conhecer profundamente a fisiopatologia inerente ao procedimento, buscando meios embasados de realizá-lo da forma mais segura possível, reduzindo ao máximo os riscos de complicações, principalmente as mais graves. Esse artigo teve o objetivo de realizar uma revisão bibliográfica a respeito especificamente da embolia gordurosa causada pela lipoaspiração, relacionada inúmeras vezes a pós-operatórios dramáticos e fatais. Além disso, ressalta alguns cuidados preventivos para uma maior segurança com esse procedimento.
Liposuction surgery is often associated with severe or fatal consequences, causing great repercussions in the medical field, and especially in the lay media . This should not cause the plastic surgeon to avoid the procedure, but rather should promote deeper knowledge of the basic pathophysiology. All means to accomplish the surgery in the safest possible way should be utilized, to minimize the risk of complications, especially the most severe risks. This article reviews the literature on liposuction-induced fat embolism, which is often associated with severe complications in the postoperative period, and even fatal outcomes. In addition, this study highlights several preventive measures that can be adopted to ensure greater safety of this procedure.
Asunto(s)
Humanos , Historia del Siglo XXI , Complicaciones Posoperatorias , Cirugía Plástica , Lipectomía , Embolia Grasa , Grasa Subcutánea , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/terapia , Embolia Pulmonar , Embolia Pulmonar/cirugía , Embolia Pulmonar/complicaciones , Embolia Pulmonar/mortalidad , Embolia Pulmonar/patología , Cirugía Plástica/métodos , Literatura de Revisión como Asunto , Lipectomía/métodos , Lipectomía/mortalidad , Factores de Riesgo , Embolia Grasa/cirugía , Embolia Grasa/complicaciones , Embolia Grasa/mortalidad , Embolia Grasa/patología , Grasa Subcutánea/cirugíaRESUMEN
PURPOSE: To evaluate the effects of fat embolism in organs such as lung and liver. METHODS: Twenty rabbits underwent autologous intramuscular fat grafting in the right thigh after liposuction. The groups were determined according to the postoperative day that occurred in euthanasia: 60, 90 and 120 day. Then, lung and liver were excised and sent to the histopathology laboratory for analysis in search of late injury secondary to a prior event of fat embolism in the tissues. RESULTS: The results showed a change in the macroscopic sample with discoloration of the liver tissue heterogeneously. There were no changes consistent with embolic effect under the microscope. CONCLUSION: The option of performing a technique of fat grafting with a less traumatic surgical procedure can be considered protective against embolic events, with no impact to late embolic events on the tissues.
Asunto(s)
Tejido Adiposo/trasplante , Embolia Grasa/etiología , Lipectomía/efectos adversos , Hígado/irrigación sanguínea , Pulmón/irrigación sanguínea , Animales , Modelos Animales de Enfermedad , Embolia Grasa/patología , Inyecciones Intramusculares , Lipectomía/métodos , Masculino , Periodo Posoperatorio , ConejosRESUMEN
PURPOSE: To evaluate the effects of fat embolism in organs such as lung and liver. METHODS: Twenty rabbits underwent autologous intramuscular fat grafting in the right thigh after liposuction. The groups were determined according to the postoperative day that occurred in euthanasia: 60, 90 and 120 day. Then, lung and liver were excised and sent to the histopathology laboratory for analysis in search of late injury secondary to a prior event of fat embolism in the tissues. RESULTS: The results showed a change in the macroscopic sample with discoloration of the liver tissue heterogeneously. There were no changes consistent with embolic effect under the microscope. CONCLUSION: The option of performing a technique of fat grafting with a less traumatic surgical procedure can be considered protective against embolic events, with no impact to late embolic events on the tissues.
OBJETIVO: Avaliar a repercussão da embolia gordurosa em órgãos como pulmão e fígado. MÉTODOS: Vinte coelhos foram submetidos à enxertia autóloga intramuscular de gordura em coxa direita após lipoaspiração. Os grupos foram determinados conforme os dias pós-operatórios (DPO) em que ocorreu a eutanásia: 60 DPO, 90DPO, 120 DPO. Em seguida, o pulmão e o fígado foram ressecados e encaminhados ao laboratório de histopatologia para análise em busca de lesão tardia secundária a evento de embolia gordurosa prévia nos tecidos. RESULTADOS: Foi evidenciada uma alteração na amostra a analise macroscópica com alteração da coloração do tecido hepático de forma heterogênea. Não houve alterações compatíveis com repercussão de processo embólico à microscopia. CONCLUSÃO: A opção pela realização de uma técnica de lipoenxertia menos traumática e com pequeno tempo cirúrgico pode ser considerada protetora para eventos embólicos, não havendo repercussão embólica a tardiamente.
Asunto(s)
Animales , Masculino , Conejos , Tejido Adiposo/trasplante , Embolia Grasa/etiología , Lipectomía/efectos adversos , Hígado/irrigación sanguínea , Pulmón/irrigación sanguínea , Modelos Animales de Enfermedad , Embolia Grasa/patología , Inyecciones Intramusculares , Lipectomía/métodos , Periodo PosoperatorioRESUMEN
BACKGROUND: Liposuction in plastic surgery consists of the removal of excess fatty tissue in healthy individuals. In recent decades, this procedure has become more common worldwide. Associated with liposuction, lipografting has also been used for improving body contours, and has become known as liposculpture. Liposuction sometimes causes complications, including fat embolism, as described in the medical literature. The present study aims at ascertaining whether there is intravascular mobilization of fat after mechanical liposuction surgery and/or fat graft when carried out using one of the most common specific procedures used for liposuction, the superwet technique. METHODS: A total of 30 Wistar rats were included in this study. Before the surgery, the animals were placed in the supine position and anesthetized with thiopental for 50 to 60 minutes, as it is generally performed in clinical practice. The animals were divided in the following 3 groups. Group A, consisting of 10 rats, served as controls, and were only anesthetized. Group B consisted of 10 rats, which underwent only liposuction. Group C also comprised 10 rats, which were liposuctioned and then lipografted in the dorsal region. Blood was collected just before and again, 48 hours after the procedure. After 48 hours, the animals were killed, and the lungs, kidneys, liver, and brain were histologically examined. RESULTS: All the collected samples were analyzed microscopically with 2 different stains, namely, hematoxylin and eosin, and Sudan black. Fat particles were found in the lungs of 3 animals in group B (those that underwent only liposuction) and in 6 animals of group C (liposuction and lipografting). No fat particles were found in any organ of the control group. CONCLUSIONS: With this experiment, the authors showed that there is a risk of systemic mobilization of fat after liposuction surgery and that this risk is even higher when fat grafts are also carried out.
Asunto(s)
Tejido Adiposo/trasplante , Embolia Grasa/etiología , Lipectomía/efectos adversos , Animales , Encéfalo/patología , Embolia Grasa/sangre , Embolia Grasa/patología , Riñón/patología , Lipectomía/métodos , Hígado/patología , Pulmón/patología , Masculino , Ratas , Ratas WistarRESUMEN
Fat embolism is defined as mechanical blockage of the vascular lumen by circulating fat globules. Although it primarily affects the lungs, it can also affect the central nervous system, retina, and skin. Fat embolism syndrome is a dysfunction of these organs caused by fat emboli. The most common causes of fat embolism and fat embolism syndrome are long bone fractures, although there are reports of its occurrence after cosmetic procedures. The diagnosis is made clinically, and treatment is still restricted to support measures. We report the case of a female patient who developed adult respiratory distress syndrome due to fat embolism in the postoperative period following liposuction and fat grafting. In this case, the patient responded well to alveolar recruitment maneuvers and protective mechanical ventilation. In addition, we present an epidemiological and pathophysiological analysis of fat embolism syndrome after cosmetic procedures.
Asunto(s)
Embolia Grasa/etiología , Lipectomía/efectos adversos , Síndrome de Dificultad Respiratoria/etiología , Embolia Grasa/patología , Femenino , Humanos , Persona de Mediana Edad , Periodo Posoperatorio , Síndrome de Dificultad Respiratoria/patología , SíndromeRESUMEN
A embolia gordurosa é definida como a ocorrência de bloqueio mecânico da luz vascular por gotículas circulantes de gordura. Acomete principalmente o pulmão, podendo afetar também o sistema nervoso central, a retina e a pele. A síndrome da embolia gordurosa é uma disfunção desses órgãos causada pelos êmbolos gordurosos. As causas mais comuns de embolia gordurosa e síndrome da embolia gordurosa são as fraturas de ossos longos, mas há relatos de sua ocorrência após procedimentos estéticos. O diagnóstico é clínico, e o tratamento ainda se restringe a medidas de suporte. Apresentamos o caso de uma paciente que evoluiu com síndrome da angústia respiratória do adulto por embolia gordurosa no período pós-operatório de lipoaspiração e lipoenxertia e respondeu bem às manobras de recrutamento alveolar e à ventilação mecânica protetora.Apresentamos também uma análise epidemiológica e fisiopatológica da síndrome da embolia gordurosa após procedimentos estéticos.
Fat embolism is defined as mechanical blockage of the vascular lumen by circulating fat globules. Although it primarily affects the lungs, it can also affect the central nervous system, retina, and skin. Fat embolism syndrome is a dysfunction of these organs caused by fat emboli. The most common causes of fat embolism and fat embolism syndrome are long bone fractures, although there are reports of its occurrence after cosmetic procedures. The diagnosis is made clinically, and treatment is still restricted to support measures. We report the case of a female patient who developed adult respiratory distress syndrome due to fat embolism in the postoperative period following liposuction and fat grafting. In this case, the patient responded well to alveolar recruitment maneuvers and protective mechanical ventilation. In addition, we present an epidemiological and pathophysiological analysis of fat embolism syndrome after cosmetic procedures.
Asunto(s)
Femenino , Humanos , Persona de Mediana Edad , Embolia Grasa/etiología , Lipectomía/efectos adversos , Síndrome de Dificultad Respiratoria/etiología , Embolia Grasa/patología , Periodo Posoperatorio , Síndrome de Dificultad Respiratoria/patología , SíndromeRESUMEN
A case of sickle cell disease diagnosed postmortem is described. A 37-year-old black woman presented with anemia, respiratory distress, and abdominal and back pain. Death followed an intramuscular injection of iron, and anaphylaxis was clinically diagnosed. At autopsy, massive fat and necrotic bone marrow embolization of pulmonary and renal vessels was found. In the vertebral column, multifocal areas of ischemic necrosis were present, and proved to be the source of this embolization. Sickled red cells appeared in bone marrow sinusoids, and signs of disseminated intravascular coagulation were present.
Asunto(s)
Anemia de Células Falciformes/diagnóstico , Médula Ósea/patología , Embolia Grasa/patología , Embolia/patología , Adulto , Anafilaxia/diagnóstico , Anemia de Células Falciformes/complicaciones , Anemia de Células Falciformes/patología , Diagnóstico Diferencial , Coagulación Intravascular Diseminada/etiología , Coagulación Intravascular Diseminada/patología , Embolia/etiología , Embolia Grasa/etiología , Femenino , Humanos , Infarto/complicaciones , Infarto/patología , Hierro/administración & dosificación , NecrosisRESUMEN
A propósito da observaçäo de 17 casos de embolia gordurosa em pacientes falecidos em conseqüência de traumatismo grave, com fratura de ossos longos, o autor estuda a anatomia patológica daquela condiçäo, destacando a sua importância como causa de morte. As lesöes observadas consistiam, essencialmente, em distúrbios da microcirculaçäo, caracterizadas por edema, hemorragia petequial, congestäo e necrose, além da presença do êmbolo de gordura. Além do comprometimento pulmonar, foram afetados o cérebro, rim coraçäo, baço, fígado e pele, sendo, provavelmente, de maior gravidade as lesöes encefálicas
Asunto(s)
Humanos , Embolia Grasa/patologíaRESUMEN
The authors studied the pathological aspects of the lungs in an experimental study made in dogs submitted to fat embolism. The histological aspects were of hemorrhagic edema when the lungs were fixed in the classical way as well when they were fixed inflated. The alveolar microatelectasias were only seen in lungs fixed in the classical way but not were seen in lungs fixed when inflated.