The Effects of Using Tranexamic Acid in Tumescent Solution During Rhytidectomy Surgery

Introduction: Tranexamic acid (TXA) is a common adjunct to assist in hemostasis in a wide variety of applications. Although TXA has gained more popularity in facial cosmetic surgery, there are limited studies evaluating the effects of TXA in rhytidectomy patients, especially when used in tumescent solution. Purpose: The purpose of this study was to evaluate the effects of TXA on surgical time, postoperative ecchymosis, and need for aspiration when used in tumescent solution during cervicofacial rhytidectomy procedures. Materials and Methods: The authors designed a retrospective cohort study from an eligible population of all patients treated with cervicofacial rhytidectomy using tumescent solution at Williamson Cosmetic Center in Baton Rouge, LA, from January 1, 2019, to December 31, 2019. The outcome variables were surgical time, need for postoperative aspiration, and the duration of bruising postoperatively. The primary predictor variable was the use of TXA in the tumescent solution. Statistical analysis was performed using t tests and chi-square analyses. Results: Overall, 70 patients were included in the study with a mean age of 61.4 ± 7.2 years and 90% were female. Forty-five patients were in the TXA group and 25 in the non-TXA group. The use of TXA in tumescent solution was statistically significant for reducing ecchymosis ( p < .001). The majority of patients in the TXA group (60%) had bruising cleared by day 7, whereas the majority of patients in the non-TXA group (52%) had bruising cleared by day 28. There was a statically significant reduction in frequency of postoperative aspiration in the TXA group (8.9% in TXA group vs 40.0% in the non-TXA group, P = .002). The study did not demonstrate a significant difference in surgical time between the two groups. Discussion: Although there is a lack of recognition of the potential benefits of TXA, there has been an increased off-label use by numerous surgical specialties. Routes of administration include topical, oral, intravenous, local infiltrative, and by tumescent anesthesia. Improvements in intraoperative hemostasis and postoperative ecchymosis are some of the main benefits of TXA. Conclusions: Utilizing TXA in tumescent solution in patients undergoing cervicofacial rhytidectomy procedures is associated with an improvement in postoperative ecchymosis duration and a decreased need for postoperative aspiration compared with the non-TXA group.

Comparative evaluation about the efficacy of the use of variable concentrations of Epinephrine in Tumescent solution for control of bleeding in patients with abdominal liposuction

Introduction: The use of epinephrine for controlling the blood loss has gained out in many dermatological surgeries; however, its use in liposuction has not been studied. In this regard, we aimed to figure out the effectiveness of using epinephrine in tumescent solution during liposuctions surgery. Material and Methods: In this study we present a prospective, double-blind, nonrandomized study evaluating the effects of adding epinephrine to tumescent solution intra-operative in patients undergoing liposuction. Thirty-six patients including 6 males and 29 females undergoing liposuction were divided into two groups. In case group we use 1-1.4 mg/L epinephrine (based on the location of surgery) in tumescent solution; and control group did not receive epinephrine. Lab data such as hemoglobin and hematocrit as well as clinical data including blood pressure and heart rate were recorded before, after 1h and 6h of liposuction. Results: In this study, we observed that both case and control group faced a significant dropped in their hemoglobin and hematocrit; however, the decrement was significant lower in case group. In addition, both groups had a stable hemostasis after 1h and 6h of surgery. In this regard, we did not observe any significant difference between heart rate and blood pressure of two groups. Conclusion: The results of this study suggest that using epinephrine as vasoconstriction agent in tumescent solution might decrease the rate of bleeding and increase the chance of stable hemostasis both during and after abdominal liposuction.

Other useful facts

This chapter assembles a variety of useful facts and concepts of use in everyday oral and maxillofacial surgery. This includes the composition of products such as Carnoy’s solution, Whitehead’s varnish, and tumescent solution; the uses of botulinum toxin in oral and maxillofacial surgery; key terms used in statistics which are of use in the interpretation of published data; important facts surrounding the anatomy of the infratemporal fossa; levels of critical care commonly encountered in the UK; medical radiation exposure regulations and guidance; wound care evaluation and management; revalidation; and less commonplace aspects of oral and maxillofacial surgery, such as facial transplantation.

A Combined Prilocaine-Lidocaine Tumescent Solution Has Lower Clinical Side Effects Compared With Lidocaine Only

In awake liposuction surgery, the extent of surgery that can be performed in a single session is limited to the toxic threshold levels of the anesthetic. Today, lidocaine is the most commonly used anesthetic. The purpose of this study was to evaluate the clinical safety of a combined prilocaine-lidocaine tumescent solution, and to compare its efficacy and safety to patients receiving lidocaine only. In this cross-sectional study, the efficacy and the occurrence of clinical side effects of a prilocaine-lidocaine tumescent solution were compared with a standard solution containing lidocaine only. All patients received the same dose of prilocaine-lidocaine (n = 142) and of lidocaine (n = 142), respectively. Both tumescent solutions provided similar and effective local anesthesia during lipoaspiration. There were significantly more early signs of toxicity (nausea, irritation, light-headedness, and tachycardia) in patients receiving the standard lidocaine solution. A tumescent solution containing both lidocaine and prilocaine reduces the occurrence of early signs of toxicity of 1 or both anesthetics. It is a safe solution, provided the surgeon has extensive knowledge of potential adverse effects, and the guidelines of care for liposuction are strictly followed.

High-Definition Liposculpture in Males Using Power-Assisted Liposuction and Local Anesthesia

In high-definition liposculpture, the body is being shaped in a manner that it creates an athletic appearance and defined, contoured look. Typical areas in the male patient include arms, pectoralis, the area over the serratus muscle, lower back, as well as lateral and medial abdomen. This is sometimes combined with fat grafting to areas over the deltoid muscle and/or pectorals. High-definition liposculpture poses a new challenge to local anesthesia using lidocaine alone. Sufficient analgesia has to be achieved in multiple areas, without reaching systemic toxic levels of lidocaine. To reduce the risk of systemic side effects, we added prilocaine to the tumescent solution. Prilocaine differs from lidocaine in its metabolizing pathway, and combining both anesthetics therefore allows for higher tumescent volumes. In a prospective study, 48 male patients underwent high-definition liposculpture. The mean injected volume was 9.4 L. There were no side effects resulting from the high volumes of tumescent solution. Minor complications included seroma (2); 3 patients required touch-up. To conclude, a combination of lidocaine and prilocaine enables treatment of the entire torso and arms in a single session. Potential systemic effects of each anesthetic, lidocaine and prilocaine, need to be known to the user.

Acute post-operative edema. A major morbidity after hair transplant.

Objectives: To evaluate the efficacy of different modalities for the prevention of post-operative edema in patients undergoing hair transplant. Study Design: Prospective study. Place and Duration of Study: Department of Plastic Surgery, Bashir Hospital (private), Sialkot from March 2016 to April 2018. Patients and Methods: Male patients with typical male baldness patterns were serially included in the study. Informed consent was taken both for the surgery and purpose of research. Patients were followed up daily for one week to assess the post-operative edema. However patients were also called for follow up after three months to see the late complications. Patients not giving consent for the study were excluded from the data. Data was entered and analysis done by SPSS v 22. Results: Total 97 patients were operated. Two groups A&B each of 45 and 57 patients were selected randomly. Group A which was administered tumescent solution including steroid showed maximum prevention of edema, success rate (93.3%). Group B having oral steroid course postoperatively for 5 days showed less promising results with success rate of (57.8%). Conclusion: The results of this study revealed that addition of steroid (Triamcinolone) to the tumescent solution had more promising results regarding the prevention of post-operative edema.