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Excerpt
The article by Grazer and de Jong concerning liposuction mortality (“Fatal Outcomes from Liposuction: Census Survey of Cosmetic Surgeons,”Plast. Reconstr. Surg. 105: 436, 2000) was indeed informative and frightening. I would like to add an additional source of concern, paraspinous muscle hemorrhage, by describing a case that occurred 3 years ago.
A woman in her mid-40s in an otherwise good state of health underwent full abdominoplasty with flank and back liposuction in an outpatient procedure by a cosmetic surgeon in a large metropolitan area. The patient reported persistent bleeding from her cannula incisions in the recovery area, but she was discharged. She was driven home by her daughter, who, fortunately, was a nurse. On the way home, the daughter noted a marked change in her mother’s mental status and took her to the closest emergency room, which happened to be at our military hospital. The patient presented in shock, with a hematocrit value of 18. Three liters of crystalloid brought her mean blood pressure above 60, and her repeat hematocrit value was 14. During 15 minutes of assessment and resuscitation, the abdominoplasty drains put out 300 cc. After rapid transfusion, she was taken to the operating room, where she was found to have a large amount of clot anteriorly and the usual multiple small oozing vessels. However, persistent vigorous bleeding from the flank liposuction tunnels required exploration and suture ligation (using extra-long pelvic instruments) of torn and bleeding paraspinous muscle.
Because of airway swelling, the patient was observed in the intensive care unit for several days. The final transfusion tally included multiple units of blood and two six-packs of platelets. Although the flank liposuction tunnels had to be considerably widened to control the bleeding, there was no abdominal skin loss, and the final aesthetic result was good.
There is a good chance that this woman would have died at home if her daughter had not been so vigilant. Just as pointed out in the article, combining liposuction (described by the operating surgeon as several liters tumescent) with other cosmetic procedures in an outpatient setting can have life-threatening results. A cosmetic procedure can incur as significant a risk as any other procedure and should be approached with the appropriate respect for both the procedure and aftercare.
