RESUMO
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.
Assuntos
Humanos , História do Século XXI , Complicações Pós-Operatórias , Cirurgia Plástica , Lipectomia , Embolia Gordurosa , Gordura Subcutânea , Complicações Pós-Operatórias/cirurgia , Complicações Pós-Operatórias/terapia , Embolia Pulmonar , Embolia Pulmonar/cirurgia , Embolia Pulmonar/complicações , Embolia Pulmonar/mortalidade , Embolia Pulmonar/patologia , Cirurgia Plástica/métodos , Literatura de Revisão como Assunto , Lipectomia/métodos , Lipectomia/mortalidade , Fatores de Risco , Embolia Gordurosa/cirurgia , Embolia Gordurosa/complicações , Embolia Gordurosa/mortalidade , Embolia Gordurosa/patologia , Gordura Subcutânea/cirurgiaAssuntos
Humanos , Masculino , Adulto , Embolia Gordurosa/diagnóstico , Fraturas Expostas/complicações , Traumatismos da Perna/complicações , Ácidos Graxos/metabolismo , Embolia Gordurosa/tratamento farmacológico , Embolia Gordurosa/etiologia , Embolia Gordurosa/cirurgia , Traumatismos da Perna/cirurgia , Metilprednisolona/uso terapêuticoRESUMO
An analys is made of the frequency of fat-embolism in patients with battle wounds and in those who suffer traumatisms in every day life; it was found in a high percentage in both groups. It is noted that when tye symptom appear little after the traumatism, the percentage of death is higher (85%) than when they appear within 24 to 72 hours later (10-20%). During 5 year, in the Hospital Central Militar de Mexico 12 cases of fat-embolism have been diagnosed. The first ten were handled by the classic method: ventilatory assistance, corticoids, heparin, etc.; having 30% of deaths. The two last ones were treated by ligation of the inferior vena cava; none of the two died and there was a remarkable change in the course of the clinical manifestations. Based on the experience of the group, in more than 120 cases with ligation of the inferior vena cava due to pulmonary thromboembolism; there was a symptomatic paralelism found between the fat-embolia and the repeated venous embolism; and in our opinion we conclude that the progressiveness of the respiratory insufficiency is due to repeated fat-emboly more so than to the convertion of neutral fat into fatty acids through the action of lipasa in various tissues. With this hypothesis the inferior vena cava was ligated in two patients, and the results obtained were the ones mentioned before. It is emphasized that the procedure has a very low risk of death and there are minimum sequels, more in relationship to the previous flebitic state, than to the ligation itself. It is indicated that the corticosteroids, heparin, ventilatory and cardiac assistance be continued, besides elastic bandage, elevation of the pelvic limbs, exercises, etc. It is accepted that two cases cannot be enough to fully demonstrate how good the method is, but the changes of progress of these two cases after the ligation were so notable, that we are able to recommend this method in all those patients with an important fat-embolism. It is indicated that in the laboratory of Experimental Surgery of the H.C.M. experiments are being made to demonstrate what has been obtained clinically.
Assuntos
Embolia Gordurosa/cirurgia , Veia Cava Inferior/cirurgia , Acidentes de Trânsito , Adulto , Embolia Gordurosa/etiologia , Estudos de Avaliação como Assunto , Fêmur/lesões , Fraturas Ósseas/complicações , Fraturas Ósseas/cirurgia , Humanos , Ligadura/métodos , Masculino , Métodos , Fatores de TempoRESUMO
There is no specific treatment of fat embolism, whether the embolism is predominantly cerebral, pulmonary, renal or mesenteric. A 46-year old man had fractured his right femur for the third time in December 1971. Seventy hours later he developed the cardiovascular, respiratory, and cerebral manifestations of post-traumatic fat embolism. His chest radiograph at the onset of symptoms was consistent with fat embolism. He underwent cardiac and pulmonary embelectomy on 7 December 1971 and made a most dramatic recovery. His haemobronchorrhoea, dyspnoea, tachypnoea, hyperpyrexia, and profound shock disappeared at the end of the operation. His only post-operative cerebral disturbance was mild disorientation. The pathophysiological changes accompanying fat embolism are due to toxic vasculitis and fat macroglobule aggregations blockading the pulmonary arterioles and capillaries. The blockading concept is the basis for cardiac and pulmonary fat embelectomy. Only a larger series emboding a multicentre trial will show whether or not cardiopulmonary fat embelectomy is a specific treatment of massive fat embolism. The purpose of this paper is to report on the technique and result of embelectomy for a suspected fat embolus following fracture of the femur (Summary)