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UdeM PS questions > Esthétique 3 (body contouring) > Flashcards

Esthétique 3 (body contouring) Flashcards

1
Q

Abdominal striae is evidence of what?

A

Attenuated of absent dermis

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2
Q

What are the layers of the abdominal wall

A
  1. Skin
  2. Subcutaneous fat
  3. Scarpas
  4. Subscarpal fat
  5. Anterior rectus sheath
  6. Muscle (External, Internal, Transverse)
  7. Posterior rectus sheath
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3
Q

What are the differences between the superficial and deep layers of abdominal fat

A

Superficial layer: thicker, more dense, durable and robust blood supply

Deep: less dense, most blood supply from subdermal plexus and myocutaneous perforators

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4
Q

What is the arcuate line?

A

Transition point found half way between the umbilicus and symphysis pubis.

Above: distinct anterior and posterior rectus sheaths

Below: feuillet postérieur de l’oblique interne et l’aponévrose du transversalis fusionne à l’aponévrose antérieure
(il reste seulement le fascia transversalis en postérieur)

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5
Q

What is the vascular supply of each Huger zone

A

Zone 1: Superior and inferior epigastric systems

Zone 2: superficial circumflex iliac and external pudendal vessels

Zone 3: intercostal, subcostal and lumbar vessels

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6
Q

Describe the Huger zones of vascular supply

A

Zone 1: lateral to borders of the rectus sheath and above horizontal line drawn between the ASIS

Zone 2: below horizontal line between the ASIS down to pubic/inguinal creases

Zone 3: Lateral to zone 1 and superior to zone 2

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7
Q

What nerve provides sensation to the abdomen?

A

Intercostal nerves T7 to T12

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8
Q

dans quelle couche voyage les nerf cutanés à l’abdomen

A

entre muscle transverse et l’abdomen et l’oblique interne

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9
Q

What nerve is most at risk of injury during abdominoplasty and how can you reduce the risk

A

A: Lateral femoral cutaneous nerve

Risk can be reduced by preserving a layer of fat over the ASIS

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10
Q

What is the blood supply to the umbilicus? (4)

A
  • subdermal plexus
  • right and left deep inferior epigastric arteries
  • ligamentum teres (vascularisation of)
  • median umbilical ligament (vascularisation of)
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11
Q

Name 4 characteristics of a aesthetically pleasing umbilicus

A
  • superior hooding
  • inferior retraction
  • round or elipsoid shape
  • shallow
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12
Q

abdominoplastie: quelle couche de gras faut-il amincir et pourquoi

A

prioriser l’amincissement du gras sous-scarpal car a une vascularisation distincte de la peau (moins de risque de nécrose cutanée)

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13
Q

Name 3 absolute contra-indications to abdominoplasty

A
  • significant comorbidities
  • unrealistic surgical expectations
  • body dismorphic disorder
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14
Q

Décrire les critères du body dismorphic disorder (BDD)

A

PRIDE
Preocupation
Repetitive behevior
Impairement/Distress
Cant be explained by something else

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15
Q

Name 3 relative contraindications to abdominoplasty

A
  • upper abdominal scars
  • plans for future pregnancy
  • hx of thromboembolic event

subcostal scars are particularly concerning - not optimal candidates for traditional abdominoplasy

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16
Q

5 buts d’une abdominoplastie

A
  • Aplatir les contour
  • Corriger diastase des grands droits
  • Réparer hernies au besoin
  • Incisions basses et symétriques
  • Apparence esthétique du mons pubis
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17
Q

5 facteurs de complications d’une chx de body contouring

A

DB
fumeur
MWL
lipo aggressive
souminage extensif

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18
Q

qu’est-ce qu’un abdomen scaphoid

A

concavité vers l’intérieur de la parois adbominale (= le but)

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19
Q

List the componants of the SCIP Protocol (6)

A
  1. Do not use razors
  2. IV antibiotics 30-59mins prior to incision
  3. 24hrs of post-op antibiotics
  4. HbA1C must be <7
  5. Avoid intraoperative hypothermia
  6. Foley must be removed within 24hrs
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20
Q

How much space must be left between the incision and vulvar commisure

A

5cm

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21
Q

What are 3 clinical signs of injury to the lateral femoral cutaneous nerve

A
  • significant pain
  • numbness
  • dysesthesia of hip and lateral thigh
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22
Q

What is the incidence of LFC nerve injury in abdominoplasty procedures

A

10%

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23
Q

Qu’est-ce qu’une lipoabdominoplastie et quel est son avantage principal

A

Moins souminer sur les côtés (faire de la liposuccion à la place)

Préserve davantage de vascularisation de la parois abdo (80% vs 30% avec lipec traditionnelle)

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24
Q

position idéale de l’ombilic

A

ligne connectant le rebord supérieur des crêtes iliaque, croisant une autre ligne reliant l’apophyse xiphoide et le pubis

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25
Q

In which patients would you perform a miniabdominoplasty

A

Patients with primarily an excess of ISOLATED infra-umbilical skin and fat

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26
Q

How does the umbilicus move in a miniabdominoplasty

A

2 cm inferiorly

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27
Q

Name 4 ways in which the mini-abdominoplasty is different from the traditional abdominoplasty

A
  1. Shorter scar (12-16cm)
  2. Umbilicus remains attached
  3. More conservative resection of skin and fat
  4. Liposuction is needed to address the supra-umbilical region
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28
Q

Indication principale d’un high lateral tension abdominoplasty

A

Excès de peau vertical en infra-ombilical et horizontal en épigastrique

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29
Q

high lateral tension abdominoplasty: quel est le vecteur de traction

A

oblique

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30
Q

high lateral tension abdominoplasty:
1 avantage principal et 1 inconvénient

A

(+) permet aussi lift des cuisses antéro-latérales,
moins de souminage (limité à central)
(-) cicatrices plus longues et plus hautes

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31
Q

high lateral tension abdominoplasty: élément clef du marking

A

en central, l’incision va SOUS l’ombilic, en latéral, l’incision doit aller plus HAUT que l’ombilic

*ombilic peut être transposé

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32
Q

lipectomie circonférentielle: pourquoi ne pas trop souminer au-niveau du dos

A

car risque élevé de sérome

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33
Q

Why does epigastrium skin develop horizontal laxity?

A

Strong superficial fascial attachements to the linea alba, which limits the vertical descent of the skin

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34
Q

What are the subcutaneous fat layers et dans laquelle tu liposuccionne

A
  • subcutaneous fat (dense and adherent)
  • intermediate fat (safest layer)
  • deep fat (loose and less compact)
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35
Q

What are the zones of adherence in liposuction that must be preserved

A
  • distal iliotibial tract
  • gluteal crease
  • lateral gluteal depression
  • middle medial thigh
  • distal posterior thigh
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36
Q

physique de la liposucicon: qu’est-ce qu’un torr

A

un torr est la pression nécessaire pour supporter une colonne de mercure de 1mm de hauteur à 0 degrés et à gravité standard

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37
Q

décrire la relation entre la résistance et le rayon

A

la résistance augmente plus le rayon est grand

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38
Q

% de la solution d’infiltration qui est retiré durant la lipossucion

A

30% est retiré, donc 70% va être absorbé

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39
Q

5 buts d’infiltrer avant la liposuccion

A

Remplacement de volume
Hémostase
Contrôle de la douleur
Délimiter les plans
Dissiper la chaleur dans une UAL

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40
Q

3 syndromes prédisposants à l’obésités

A

Prader-Willis
Bardet-Biedl
X fragile

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41
Q

nommer les composants du lactate ringer

A

Na, Cl, K, Ca, lactates

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42
Q

Comment vérifier la progression de ta liposuccion

A

pinch test

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43
Q

Name and describe the 2 types of cellulite

A

Cellulite of adiposity (primary) - thérorie de Illouz
- hypertrophic fat cells in the superficial layer
- present when supine and erect
- not improved with skin tightning

Cellulite of laxity (secondary)- théorie de Lockwood
- increased skin and superficial fascia laxity
- only present when erect
- can be treated with tightning

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44
Q

Name 5 agents that should be avoided when undergoing lipocuccion

A
  • Aspirin
  • NSAIDs
  • St. John Wort
  • Vitamin E
  • Anticoagulants
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45
Q

When should you consider pre-operative CBC in patients undergoing liposuccion

A

Patients undergoing large volume liposuccion (>5L)

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46
Q

Name 5 things you can do to mitigate hypothermia in patients undergoing liposuccion

A
  • forced air warming blankets
  • cover exposed body areas
  • use of warm IV fluids
  • increase OR temperature
  • use warm wetting solution
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47
Q

Name 2 incisions that can be used for male breast liposuccion

A
  • anterior axillary fold
  • periareolar
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48
Q

Name 2 incisions that can be used for abdomen liposuccion

A
  • lateral lower abdomen
  • supra-pubic
  • umbilical
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49
Q

Name 2 incisions that can be used for bottox liposuccion

A
  • sacral
  • midaxillary line in panty line
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50
Q

Name 2 incisions that can be used for medial thigh liposuccion

A
  • medial groin crease
  • inguinal crease
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51
Q

Name 2 incisions that can be used for upper arm liposuccion

A
  • anterior axillary fold
  • posterior axillary fold
  • olecranon radial elbow crease
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52
Q

What are the components of Klein Solution

A
  • 1000ml NS
  • 50ml lidocaine 1%
  • 1ml of 1:1000 epinephrine
  • 12.5 ml of 8.4% bicarb
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53
Q

Describe the wetting solutions and the estimated blood loss

A

Dry : None : 20-40%
Wet : 200-300ml per area : 4-30%
Superwet : 1ml infiltrate for 1ml aspirate : <1%
Tumescent: 2-3ml infiltrate for 1ml aspirate : <1%

tumescent: infiltrer jusqu’à turgescence

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54
Q

How long is analgesia provided with wetting solution

A

18hrs

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55
Q

What is the maximum dose of lidocaine that can be used for tumescence

A

35mg/kg

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56
Q

In which circumstances should lipoccusion patients be kept in hospital

A

> 5L or 6hrs of surgery

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57
Q

Why is the use of high quantities of lidocaine possible when performing tumescence

A
  • diluted solution
  • slow infiltration
  • vasoconstriction of epinephrine
  • relative avascularity of fatty layer
  • high lipid solubility of lidocaine
  • compression of vessels by infiltrate
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58
Q

quand est le peak de la toxicité d’une solution tumescente

A

12-14h

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59
Q

Name 2 instances where UAL would be better than SAL

A
  • cutaneous laxity (causes theoretical tightning)
  • fibrous areas (ie. gynecomastia, flanks, back)
  • secondary liposuccion
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60
Q

What are the stages of UAL

A

Stage 1: subcutaneous infiltration of wetting solution
Stage 2: ultrasound to emulsify the fat (superficiel to deep)
Stage 3: evacuation of fat and final contouring with SAL

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61
Q

Name 3 complications specific to UAL

A
  • thermal injury
  • seroma
  • hyperpigmentation
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62
Q

What is the mechanism of action in laser assisted liposuccion

A

The laser disrupts cell membranes and emulsifies the fat by photothermolysis

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63
Q

What is the mechanism of action of UAL (pourquoi ca émulsifie les graisse)

A

Crystals in the probe convert electric energy into high frequency sound waves that created cavities and cellular fragmentation (cavitation)

Micromécanique: trauma directe
Thermique: friction +chaleur absorbée par les ultrasons produits
Cavitation

Les cristaux de la sonde convertissent l’énergie électrique en ondes sonores à haute fréquence qui créent des cavités et une fragmentation cellulaire

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64
Q

What are the primary and secondary endpoints of SAL/PAL

A

Primary
- final contour
- symmetrical pinch test

Secondary
- treatment time
- treatment volume

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65
Q

What are the primary and secondary endpoints of UAL

A

Primary
- loss of tissue resistance
- blood aspirate

Secondary
- treatment time
- treatment volume

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66
Q

Name 6 complications of lipocussion

A
  • Asymétry
  • Séroma
  • Hématoma
  • Dissatisfaction
  • Visceral perforation
  • DVT, PE , Sepsis, necrotizing fasciitis, lidocaine toxicity
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67
Q

How do you manage lidocaine toxicity

A

Infuse 20% lipid emulsion
- Bolus 1.5ml/kg IV over 1 minute
- continuous 0.25ml/kg/minute
- continue infiltration over at least 10 minutes after circulatory stability

*if blood pressure still low, double continuous infusion rate

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68
Q

What is SAFElipo

A

Non-thermal liposuction technique that includes redcution, equalization and augmentation. More aggressive treatment that uses angled canulas

angled canulas only used in SAFElipo

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69
Q

Classifier les différents grade d’obésité

A

Embonpoint IMC >25
Obésité IMC > 30kg/m2
Obésité sévère IMC > 35
Obésité morbide IMD > 40
Superobèse > 50

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70
Q
A
  • Excès cutanés sont circonférentiels
  • Liposuccion ne peut pas être seule modalité
  • Déficit nutritionnel à optimiser
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71
Q

What are the goals of trunc lipectomy in MWL

A
  • flatten contour
  • tighten abdominal wall
  • repari vental hernias
  • elevate mons pubis
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72
Q

What are the goals of reconstruction for the back in MWL

A
  • resect as many rolls as possible
  • create flat contour to the back
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73
Q

What are the goals of reconstruction in medial thigh lift in MWL (2)

A
  • restore flap contour to the medial thigh
  • minimize labial spreading
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74
Q

What are the goals of reconstruction for the buttock in MWL

A
  • define the buttock (créer une démarcation avec le dos)
  • elevate the buttock
  • cover coccyx with additional soft tissue
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75
Q

What are the goals of reconstruction for the arms in MWL

A
  • eliminate horizontal upper arm excess
  • eliminate lateral thoracic skin excess
  • smooth contour from lateral chest onto upper arm
  • reduce scar visibility and contractures
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76
Q

2 indications de chirurgie bariatrique

A

IMC >40
IMC >35 avec commorbidités

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77
Q

What are the 2 types of bariatric surgery

A
  • Restrictive
  • Malabsorptive
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78
Q

What are the sub-procedures for each type of bariatric surgery

A

Restrictive (stomach only)
- vertical banded gastroplasty
- laparoscopic adjustable gastic band
- gastric sleeve
- obera weight loss baloon

Malabsoptive
- Biliopancreatic diversion (BPD)
- BPD with duaodenal switch
- Roux-Y bypass

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79
Q

What would be the prefered operating sequence in patients with MWL

A
  1. Trunk, abdomen, Buttock and lower thigh
  2. Upper thorax, breast, arms
  3. Medial thighs
  4. Facial rejuvination
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80
Q

What is the incidence of DVT in MWL patients

A

<0.1%

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81
Q

What are your criteria for patient to be okay to undergoe MWL surgery

A
  • stable weight for past 6 months
  • 12-18 months post bypass
  • no metabolic or nutritional deficiencies
  • ideal BMI 25-30
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82
Q

5 stratégies pour prévenir complications d’une chx de bodycontouring

A
  • positionnement adéquat
  • padding
  • prévenir hypothermie
  • prophylaxie antithromboque
  • atb IV 30 min avant incision
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83
Q

What are the common nutritional deficiencies seen in bariatric patients (6)

A
  • iron deficiency anemia
  • Vitamin B12
  • calcium
  • potassium
  • zinc
  • Fat soluble vitamins (A,D,E,K)
  • protein deficiency
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84
Q

What preoperative workup is required for MWL patients

A
  • CBC
  • Electrolytes
  • Creat, BUN
  • Uric acid
  • Liver function
  • HbA1c
  • ferretin
  • proteins (albumin, prealbumin)
  • PT/PTT
  • fat soluble vitamins
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85
Q

What is the differences between lower body lift and belt lipectomy (5)

A
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86
Q

What can be used as a sclerosing agent for seroma in postop MWL surgery

A

Doxycycline

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87
Q

List potential complications of abdominoplasty (6)

A

Local (minor)
- hematoma
- seroma
- wound infection
- fat necrosis
- wound dehiscence
- standing cutaneous deformity

Systemic (major)
- DVT
- PE
- abdominal compartment
- systemic infection

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88
Q

List the different interventions that can be done to address the abdomen (5)

A
  • liposuction
  • traditional abdominoplasty
  • lipoabdominoplastie
  • mini-abdominoplasty
  • fleur de lys abdominoplasty
  • reverse abdominoplasty
  • high lateral tension abdominoplasty
  • lipectomie circonférentielle
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89
Q

What are the 2 tests that can be used to assess myofascial laxity

A

Diver test: patient stands and flexes at the waist. Si plus de fullness de l’abdomen inférieur lorsque penché = signe de laxité myofascial

Pinch test: patient mettre l’adbomen sous tension. Si fullness diminue = signe de laxité myofasciale

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90
Q

comment évaluer une diastase des grands droits

A

-palpation lorsque couchée
-fullness du upper abdomen qui s’améliore lorsque patient est couché. SI reste rond = gras intra-abdo et non diasthase

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91
Q

2 éléments clefs de votre technique de réparation d’un diastase des grands droits

A

Utiliser sutures non-résorbable
Débuter à l’apophyse xiphoide (pour éviter buldge épigastre)

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92
Q

What should be administered in a patient undergoing abdominoplasty that has a Caprini score >8

A

Enoxaparin 40mg s/c the night before and 7 days postop (NEED TO FIND RESSOURCE FOR THIS)

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93
Q

Where is the TAP bloc done

A

Bloc between internal oblique and transversals muscle

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94
Q

What are advantages (2) and disadvantages (3) of progressive tension sutures

A

Advantage
- reduces seroma formation
- diminue tension sur la plaie

Disadvantage
- increases risk of needing revision
- low margin for error
- time consuming

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95
Q

Name the 3 fascias of the arm

A
  • Fascia superficiel
  • Fascia investissant du muscle
  • Fascia clavico-pectoral
96
Q

What 2 cutaneous nerves are at risk during brachioplasty

A
  • intercostal brachial qui rejoint le MBC au bras
  • MABC (becomes superficial 14cm proximal to medial epicondyle)
97
Q

What are the absolute contra-indications to brachioplasty (3)

A
  • lympheodema of the arms
  • CRPS
  • unrealistic patient expectations

Relatif:
- neurological or vascular disorders of the upper extremity
- collagen disorders (ie. Ehlers-Danlos, progeria)
- PAR avancée
- perte de poids instable

98
Q

List 3 relative contra-indications for brachioplasty

A
  • severe comorbidity (ie. heart disease, thromboembolic)
  • unstable weight gain/loss
  • active smoker
  • history of keloid of HTS
99
Q

What should you do intra-op if you injure the MABC during brachioplasty

A
  • crush
  • cauterize
  • burry in the muscle
100
Q

Name 2 advantages of liposuccion in brachioplasty

A
  • large ressection possible
  • bulk reduction
101
Q

What important intra-op step must be done in mini-brachioplasties

A

suspention of the superficial fascia to the claviculo-pectoral fascia with permanant suture

102
Q

What is the difference between the anterior and posterior scar in brachioplasty

A

Anterior
- less visible
- more hypertrophic (poor dermal quality)

Posterior
- more visible
- less hypertrophic

103
Q

What is the complication rate in brachioplasty

104
Q

brachioplastie: où mettre la cicatrice

A

postérieure au sillon bicipital

*incision sinusoidale pour diminuer les risques de contracture

105
Q

décrire la classification du upper arm contouring

A

Type 1: excès de gras prédominent

Type 2: laxité prédominante
A: bras proximal
B: laxité tout le bras
C: laxité ad thorax latéral
* faire extended brachioplasty

Type 3: excès gras et peau
A: bras proximal
B: laxité tout le bras
2C: bras et thorax
* lipo + lipec

106
Q

Nommer différente techique de brachioplastie (4)

A

Minibrachioplastie
Brachioplastie standard
Avulsion brachioplasty
Extended brachioplasty

107
Q

position pour faire le marking d’une brachioplastie

A

épaule 90d ABD
coude à 90d flexion

108
Q

qu’est-ce qu’une avulsion brachioplastie

A

faire de la liposuccion agressive de la région avant de la réséquer

109
Q

What are the limits of the femoral triangle

A

Superior : inguinal ligament
Inferior: adductor longus
Lateral: Sartorius

110
Q

What is the content of the femoral triangle

A

Femoral artery, vein and nerve

111
Q

Name 4 contraindications to thigh lift

A
  • modifiable risk factors (residual obesity)
  • unrealistic expectations
  • unwillingness to accept lengthy scar
  • DVT
  • MWL with unstable chronic illness
112
Q

What important intra-operative consideration must be done in horizontal tigh lift

A

anchoring of superficial fascia to Colles fascia on perineum

113
Q

What 2 techniques to prevent ptosis reccurence

A
  • anchoring of superficial fascia to colles fascia
  • plication of gracillis and adductor longus fascia (suspension fascio-fasciale)

these are not needed in vertical lifts

114
Q

List complications of thigh lift (6)

A
  • seroma
  • lymphoceles
  • hematoma
  • delayed wound healing
  • scar migration
  • prolongiued pain
  • swelling
  • change in shape of genital region
  • leg swelling (lymphedema)
  • DVT/PE
115
Q

Describe the Felicio classification

A

Labia minora enlargement

1 : <2cm
2: 2-4cm
3: 4-6cm
4: >6cm

116
Q

Name 3 options for reduction of the labia minora

A
  • edge excision
  • central wedge resection
  • posterior wedge resection
  • W-plasty
  • central de-epithelialisation
  • laser excision
117
Q

What are the goals of labia minora reduction

A
  • reduction of hypertrophic labia
  • limit skin redundancy
  • obtain adequate colour match/contour
  • preservation of introitus
  • maintenance of n.vasc supply
  • preserve sensitivity to labium
118
Q

List both acute and chronic complications of labiaplasty

A

Acute
- infection
- hematoma
- dehiscence
- transient dyspareunia

Chronic
- Asymetry
- Clitoral exposition
- Fistula
- Delayed wound healing

119
Q

What are the goals of reconstruction in labiaplasty of the labia majora

A
  • reduce excess redundancy
  • reduce fat volume
  • enhance contour
  • augment atrophy
120
Q

What are the goals of correction for the hood of the clitoris

A
  • reduce skin excess
  • relase entrapment
  • resuspend to the pubic symphysis
121
Q

Name 3 key considerations when performing SAL

A
  • slower stroke rate to allow for cavitation
  • probe must be moving at all times
  • endpoint = loss of resistance
  • dry technique should NEVER be used
122
Q

What are the advantages and disadvantages of PAL

A

Advantages
- decreased surgeon fatigue
- larger volumes
- short procedure time
- bien pour les zones fibreuses

Disadvantages
- operator discomfort from vibration
- noise generation
- equipment cost

123
Q

What are advantages (3) and disadvantages (5) of LAL

A

Advantages
- decreased intraoperative blood loss
- decreased postop ecchymosis
- possible skin tightning

Disadvantages
- potential thermal injury
- equipement cost
- increased scarring of adipose tissue
- besoin d’une 2e personne qui regarde la température
- toxicité foie/rein

124
Q

4 étapes du LAL + type de laser utilisé

A

Infiltration
Application d’énergie aux tissus
Évacuation
Stimulation de la peau

NdYag: 1064

125
Q

What is particular about water-assisted liposucction

A

Can be done in the office under local

126
Q

Describe water-assisted liposuction

A

Dual purpose canula that emits jets of wetting solution with simultaneous suctioning of the fatty tissue and fluid

127
Q

What are the advantages and disadvantages of WAL

A

Advantages
- reduced pain for patient
- decreased need for GA
- patient awake and can change positions

Disadvantages
- equipment cost
- prolongued procedure time

128
Q

What are the stages of the WAL technique

A

Stage 1:Subcutaneous pre-infiltration with wetting solution

Stage 2: infiltration of rinsing solution and aspiration

129
Q

List the different types of liposuction techniques

A
  • SAL (suction assisted)
  • LAL (laser assisted)
  • PAL (power assisted)
  • WAL (water assisted)
  • RFAL (radio-frequency assisted)
130
Q

What are the steps in SAFElipo

A
  1. Step 1- Seperation: emulsify and liquify adipose tissue
  2. Step 2- Aspiration: multiport, non-expanded blunt canula with suction
  3. Step 3- Fat equalization: expanded tip, mutiwinged canula without suction
131
Q

4 principes du SAFE lipo

A
  • optimise le retrait du gras
  • préserve l’intégrité vasculaire
  • minimse rétraction cutanée
  • minimise les revisions nécessaire
132
Q

What are advantages and disadvantages of SAFElipo

A

Advantages
- reduced contour deformities
- enhanced skin tightning
- decreased ecchymosis
- wider areas of treatment
- enhanced precision

Disadvantages
- increased OR time needed

133
Q

How long does it take for 1L of isotonic fluid to be absorbed from the interstitium

A

167 minutes

134
Q

décrire votre réanimation liquidienne pendant une liposuccion

A
  • Crystalloid IV at maintenance rate (adjust to urine output and vital signs)
  • sonde urinaire si >5L prévu de lipo
  • Replacement IV of 0.25 ml/ml of aspirate over 5 L

considérer que 70% de l’infiltration va être absorbé

135
Q

Why is superwet preffered over tumescence technique

A

They have equivalant blood loss but superwet has a decreased postential for volume overload and congestive heart failiure

136
Q

What is the end point of infiltration when performing liposuction

A

uniform blanching and skin turgor

137
Q

What is the minimum amount of time you should allow to take advantage of maximal vasoconstriction of epi

A

7-10 minutes

138
Q

What structures do you need to be careful for when performing arm liposuction

A
  • basilic vein
  • MABC

Laisser du gras sur fascia profond à la jct tiers moyen et inférieur du bras pour protéger MABC

139
Q

Describe the healing course after liposuction

A

Day 1-3: Incisions drain
Day 3-5: Edema peaks and drainage slows down
Week 4-6: Edema resolves
Week 8-10: induration in large volume areas
Month 3-6: Final aesthetic result

140
Q

What is the recommended upper limit for lipid emulsion

A

10-12ml/kg over the 1st 30 minutes

141
Q

What is a key consideration that must be taken when performing brachioplasty to avoid injury to muscles and important neurovasc structures

A

Deep fascia layer should never be violated

142
Q

What is the most catastrophic complication related to brachioplasty

A
  • overresection and inability to close the wound
143
Q

In the event that you accidently over-ressect skin during brachioplasty, what can you do (2)

A
  • liposuction to debulk the remaining arm
  • STSG using the overesected tissue as donor site
144
Q

What should you do is the incision crosses the axilla

A

Add z-plasty to prevent contracture over the axilla

145
Q

In which patients is liposuction alone adequate when treating the arms

A

Type 1 arms
(minimal skin excess and moderate fat excess)

146
Q

Where should avoid placing your incision in brachioplasty and why

A

Medial epicondyle due to ulnar nerve injury risk

147
Q

What is the most common complication after brachioplasty

A

wide, unsightly scars

148
Q

Name 5 common complications of brachioplasty

A
  • wound dehiscence
  • HTS
  • infection
  • Seroma
  • Paresthesia
  • tethering across axilla
  • reccurent skin laxity
149
Q

What is the most common complication in brachioplasty not related to scarring

150
Q

List the 4 major methods for buttock augmentation

A
  • autologous fat grafting
  • silicone implants
  • autologous flap augmentation (specially in MWL)
  • agent de comblement
151
Q

nommer des exemples de lambeaux local pour auto-augmentation des fesses + complication la plus fréquente associées

A

Dermal fat flap
SGA perforator flap
Split gluteal muscle flap
Island fat flap
Purse-string gluteoplasty

Complication la plus fréquente: déhiscence de plaie

Janis 2022

152
Q

How do you decide between autologous and fat in buttock augmentation

A

Based on the amount of fat available. If enough fat, should go with fat grafting

153
Q

What are the contraindications to buttock augmentation

A
  • pregnancy
  • neoplasm
  • severe comorbidity
154
Q

What is the ideal shape of the inner gluteal fold in buttock augmentation

A

diamond shape

155
Q

nommer les 4 types de forme de fesse

A

Carré 40%
A-shape (poire) 30%
V-shape (pomme) 30%
Rond: 15%

ligne créee selon 3 points:
-upper lateral hip
-lateral thigh
-lateral mid-buttock

156
Q

décrire les caractéristiques d’une fesse idéale

A
  • légèrement convexe
  • légère dépression latérale (femme)
  • courbure lombaire de 45d
  • creux au niveau du V pré-sacré
  • Absence de ptose
  • Fossette supra-glutéales visibles (dimple of venus)
  • waist to hip ratio de 0,7
157
Q

What is the amount of fat needed for autologous fat grafting in buttock augmentation

A

450-1800cc per side

non indiqué si IMC < 20 ou > 30

158
Q

List complications specific to implant based buttock augmentation (4)

A
  • extrusion
  • displacement
  • capsular contracture
  • implant exposure
159
Q

What are the 4 possible planes where silicone implants can be inserted for buttock augmentation

A
  • subcutaneous
  • submuscular
  • intramuscular
    -subfascial
160
Q

What is at risk when performing submuscular buttock implants

A

sciatic nerve injury

161
Q

What clinical signs would raise your suspicison for fat embolus syndrome or macroscopic fat emboli in a patient who has just underwent buttock augmentation via fat grafting

A
  • confusion
  • petechiae
  • fever
  • respiratory distress
162
Q

List ways to reduce the risk of fat embolus syndrome in patients undergoing buttock augmentation

A
  • keep injection cannula parallel to patient (pas anguler downward)
  • subcutaneous injection
  • cannule >4mm à un seul trou
  • avoid excess volume injection
  • injecter tjrs en mouvement
163
Q

indication d’augmentation glutéale par implant

A

patient a peu d’excès adipeux

164
Q

décrire 2 mécanisme d’embolie graisseuse suite à un BBL

A
  1. Canulation directe d’un vaisseaux en injectant
  2. Injecter sous fascial entraine acculation de gras en espace sous-musculaire, ce qui augmente la pression, entraine traction sur les veines et ‘‘siphon effect’’ qui va amener gras dans la circulation veineuse
165
Q

décès associé au BBL

A

1:3000 (ad 1:6000)

166
Q

What vessel is usually involved in fat embolus syndrome

A

Inferior gluteal vein

167
Q

What factors increase the risk of fat emboli syndrome

A
  • increased volumes
  • intramuscular injections
  • injection near piriformis (gluteal vessels)
168
Q

What is the significance of scars in abdominoplasty planning (upper midline and subcostal)

A

upper midline: limit inferior movement of abdominal skin flap

subcostal: represent interruption of superolateral blood supply. Highest risk of complications

169
Q

What important information about striae must be shared with patients when consenting for abdominoplasty

A

Aboce umbilicus, striae will not be removed and may become more prominent

170
Q

In which percentage of the population is the umbilicus truely midline

171
Q

What is particular about the fleur de lys technique (2)

A

excision of BOTH lower abdominal skin and fat and supraumbilical horizontal excess

ne pas souminer au-delà de la zone à exciser

172
Q

What is a reverse abdominoplasty

A

Technique that allows for removal of isolated supraumbilical/epigastric excess through a transverse upper abdominal incision

173
Q

At which level is the incision made in reverse abdominoplasty

174
Q

What complications of skin redundancy can be seen in MWL patients (4)

A
  • skin infections/rashes
  • MSK pain
  • déficit fonctionnel (ambulation, urination, sexual function)
  • psychological distress (depression, self-esteem)
175
Q

In which direction is the thigh excess skin in MWL (a) and in which direction will you perform the lift (b)

A

a) horizontal
b) vertical

176
Q

How can you reduce the potential for labial spreading in medial thigh lift (1)

A

Do not place tension on horizontal scar

177
Q

Name 3 contraindications to medial thigh lift

A
  • preexisting lymphedema
  • lower extremity dVT
  • presence of varicose veins (need to obliterate them prior to surgery)
178
Q

What structure should be preserved during resection in the medial thigh lift

A

Saphenous vein

179
Q

Name 4 characteristics of the MWL breast

A
  • poor shape and skin elasticity
  • severe ptosis and volume loss
  • flattening of breast
  • distorted nipples (infero-medially translocated)
180
Q

List 3 particularities about rhytidectomy in the MWL patient

A
  • requires more undermining to acheive smooth contour
  • more agressive skin resection is required
  • **midline skin incision **in the neck should be considered if redundancy to significant for lateral pull
181
Q

What body temperature should be aimed during body contouring procedures

182
Q

What intraoperative fluid rate will you give your patient during MWL body contouring procedure

A

maintenance fluid + 10ml/kg/hr

183
Q

MWL: pourquoi stager les procédures diminuent le risque de complications

A
  • Diminue le temps d’anesthésie
  • Moins de perte sanguine
  • Diminue vecteurs de traction opposés
  • Permet faire chx révision lors des autres procédures
  • Favorise la mobilisation post-op si pas plein de sites opérés
184
Q

What percentage of MWL patients are anemic

185
Q

Name 4 ways to reduce the risk of DVT/PE in MWL patients

A
  • heparine or LMWH before surgery and during hospitalization
  • epidural analgesia
  • sequential compression devices
  • Early ambulation (day of surgery)
  • Incentive spirometry
186
Q

What can be done to manage lymphocele in MWL patient. (3)

A
  • serial aspirations
  • doxycycline injection
  • percutaneous drainage with closed suction drain
  • operative exploration and ligation of lymphatics
187
Q

List 4 factors that increase the risk of wound complications in MWL patients

A
  • Tobacco
  • Diabetes
  • Systemic steroid use
  • BMI >40
188
Q

Where is the femoral triangle in relationship to colle fascia

A

Lateral to it

189
Q

Where does Colles fascias attach

A
  • ishiopubic rami of bony pelvis
  • scarpas of the abdominal wall
  • posterior border of urogenital diaphragm
190
Q

cuisses: How is skin laxity in the upper 1/3rd treated

A

medial thighplasty (crescent tighplasty)

191
Q

How can you treat laxity to middle third

A

short-scar vertical thighplasty

192
Q

How can laxity of entire thigh be treated

A

Full length vertical thighplasty

193
Q

What should be your dissection plane in medial thigh lift

A

deep to the superficial fascia to avoid great saphenous vein

194
Q

What is particular about the fascio-fascial suspension technique in medial thigh lift

A

tension of the thigh lift is on the overlap of gracilis and adductor longue instead of Colles fascia

195
Q

Describe the ideal traits of the female external genitalia

A
  • labia minora does not protrude past the labia majora when standing
  • Labia majora conceals the labia minora with minimal bulkiness
  • inconscipuous clitoral hood
  • mons fat pad does not protrude in clothing
196
Q

Name 4 causes of labia minora enlargement

A
  • Congenital (most common)
  • Pregnancy
  • OCP
  • Topical estrogen
  • Vulvar lymphedema
  • Dermatitis 2o to incontinence
197
Q

What is the most common reason why patients seek revision surgery after labiaplasty

A

Hood redundancy

198
Q

When addressing labia with clitoral hood which should be done first

A

a) labia before hood

199
Q

When addressing the labia majora resection with the a) labia minora and b) the pubis, which should be done first?

A

a) minora before majora
b) pubic lift before majora

200
Q

What is the most common complication associated with labioplasty

A

Wound dehiscence

201
Q

How long should you wait before doing a revision following labiaplasty

A

minimum 4 months

202
Q

List 4 effects of fat grafting on irradiated skin

A
  • decrease collagen deposition
  • attenuates thickened epidermis
  • improves hyperpigmentation
  • diminishes vascular density

dowregulation de la réponse fibrotique de la radiation

203
Q

nommer 2 deux fractions cellulaires obtenues d’un lipoaspirat

A

stromal vascular fraction (SVF)
Adipose tissue-derived stem cell (ASCs)

204
Q

What are the 3 layers of the harvested fat after centrifugation

A

Upper layer
Oil from ruptured fat cells

Middle layer
Adipose tissue
(most viable at the bottom of this zone)

Lower
Blood
Water
Lidocaine

si demande 4e: SVF au plus bas

on décante la couche supérieure avec un coton, et on laisse drainer la inférieure via ouverture de la seringue

205
Q

pourquoi faut-il minimiser le contact avec l’air des cellules adipeuses centrifugées?

mais peut-être aussi juste overall peut-importe ton processus de refinement

A

entraine dessication des lyse des cellules adipeuse

206
Q

What are the 2 theories of fat grafting

A

1) Cellular replacement theory (histocytes replace fat)
2) Fat cell survival theory

207
Q

List 4 advantages and 3 disadvantages of fat grafting

A

Advantages
- safe
- innexpensive
- soft tissue contouring of donor
- low donor morbidity
- readily available
- natural appearance

Disadvantages
- resorption unpredictable
- results highly technique dependend
- volume will fluctuate with weight changes

208
Q

Describe the Coleman technique

A
  • manual harvest
  • 3 mm diameter, 17-gauge lumen, 15 or 23 cm length, blunt tip
  • infiltration 1:1 wetting solution
  • Luer-Lok to prevent leakage
209
Q

What does fat sticking on the Codman neuropad indicate?

A

Fat has been exposed to the air too long and should be discarded

210
Q

What dictates the level of fat placement in fat grafting and where should you place it

A

a) dictated by the goal

strenghten soft tissue: deep against bone or cartillahge

support skin for aesthetic appearsance: immediately under the skin

fill, plump or restore fullness: internediate between skin and underlyigng tissues

211
Q

Describe 3 cannula types for fat grafting

A

v-dissector: used for correction of scars

type 1: completely capped on the tip (minimizes injury to nerves, vessels, etc)

type 2: not completely capped ont he tip

Type 3 : flat on the end, allows dissection through tissue

212
Q

What is the most common problem following fat grafting

A

edema postop

213
Q

What can be done to treat/prevent edema following fat grafting

A
  • elevation and cold therapy ad 48hrs postop
  • microfoam tape for 3-4 days
  • pressure during sleep
  • massage DONOR site as soon as possible

** do not massage recipient for min 2weeks*

214
Q

What are the 3 histologial zones of grafted fat

A

Peripheral zone (viable adipocytes)

Intermediate zone (inflammatory cells)

Central zone (necrosis)

215
Q

5 facon d’augmenter la viabilité de la lipogreffe

A
  • PRP (dim reaction inflam, dim formation kystes huileux)
  • Ajouter le stromal vascular fraction à l’aspirat
  • Récolter à faible pression d’aspiration
  • Maintenir aspirat dans un système fermé
  • Prioriser washing plutôt que centriguger
  • injecter à basse vitesse (max 1cc par sec)
216
Q

5 principes de lipogreffe concernant l’injection

A
  • injecter dans directions différentes
  • injecter dans plans différents
  • injecter tjrs en mouvement
  • injecter à basse vitesse
  • injecter avec petite seringue (précision)
217
Q

après combien de temps le résultat d’une lipogreffe est-il permanent

218
Q

Name 4 ways to prepare harvested fat

A
  • centrifugation
  • sedimentation
  • washing
  • gauze-roling

washing = NS, glucose 5%, LR ou eau stérile
sédimentation = décanter pendant 1h

219
Q

List 3 washing solution options in fat grafting

A
  • NS
  • 5% dextrose
  • RL
  • Sterile water
220
Q

Which is the least traumatic method to prepare fat cells after fat harvest

A

sedimentation/straining

221
Q

How long after harvest do fat cells begin to degenerate

222
Q

What is the limitting step in fat grafting

A

O2 diffusion

223
Q

What are the 5 rules of fat grafting

A
  • no infection without movement
  • injection/movement <0.1cc/cm
  • small seringe
  • never 2 movements in the same direction
  • precision
224
Q

What is the optimal thickness of the regeneration zone

225
Q

6 indications de lipogreffe dans le sein

A

Poland
Micromastie
Sein tubéreux
Irrégularité post reconstruction
Déformité après radiotx
NAC recon

226
Q

Nommer les 3 plans d’infiltration du fat grafting pour une augmentation mammaire primaire

A

Sous-cutané
Pré-pectoral
Intramusculaire

on injecte pas directement dans le parenchyme

227
Q

bénéfice de la lipogreffe en radiothérapie

A

peau irradiée devient plus douce et souple
aide à la résolution de l’ulcération
améliore l’indice cicatriciel

faire lipogrreffe immédiatement après radiotx c’est mieux pendant que les tissus sont encore inflammés

228
Q

bénéfice de la lipogreffe pour les nerfs

A

Aide à la dlr liée aux névromes
Aide à la regénération nerveuse

229
Q

5 indications/utilité de la lipogreffe au visage

A
  • Augmentation malaire
  • Dépression des cicatrices d’acnée
  • Rejuvénation péri-orbitaire
  • Augmentation des lèvre
  • Lipoatrohpie (age, vih, drogue)
230
Q

2 utilité de lipogreffe aux main

A
  • avec fasciectomie Dupuytren
  • Rajeunissement du dorsum
231
Q

expliquer ce qu’est le PALF

A

Percutanous aponeurotomy and lipofilling: alternative dans le traitement des contractures de cicatrice

232
Q

List 9 complications specific to fat grafting

A
  • fat resorption
  • fat necrosis, microcalcifications
  • pseudocyst formation
  • fat emboli
  • lipoid meningitis
  • fat migration
  • déformation de contour
  • occlusion artérielle
233
Q

How does BRAVA work

A

ADD ANSWER

234
Q

What are the 2 types of fat emboli et leurs principales différences

A

Micro-arterial fat emboli (MIFE)
- Mécanisme: irritation of pneumocytes par les acides gras
- onset 24-72h post-op
- affecte: peau, poumon, SNC
- Scan:Ground-glass opacity, effusion pleurale
- Mortalité:10-30%

Macro arterial fat emboli (MAFE)
- Mécanisme: effet d’obstruction directe sur les vaisseaux
- onset immédiat
- affecte: cardiaque failure, bradycarde
- mortalité 99%

235
Q

List 5 risk factors in patients undergoing BBL for fat emboli

A
  • hematological disorder
  • anticoagulants
  • Family history of DVT
  • varicose veins
  • sciatic nerve compression
236
Q

Describe the gluteal danger triangle

A
  • PSIS
  • Ischion
  • Greater trochanter
237
Q

overall complication la plus fréquente des patients MWL qui ont une chx de contouring

A

déhiscence de plaie

UdeM PS questions (52 decks)

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