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Questions pratiques de l'Université Montréal > Esthétique (body contouring) > Flashcards

Esthétique (body contouring) Flashcards

1
Q

Abdominal striae is evidence of what?

A

Attenuated of absent dermis

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1
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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2
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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3
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: Single anterior rectus sheath. No posterior rectus sheath Internal and transverse join the external and internal)

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4
Q

What is the vascular supply of each Huger zone

A

Zone 1: Superior and inferior epigastric systems

Zone 2: circumflex iliac and external pudendal vessels

Zone 3: intercostal, subcostal and lumbar vessels

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5
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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6
Q

What nerve provides sensation to the abdomen?

A

Intercostal nerves T7 to T12

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7
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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8
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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9
Q

Name 4 characteristics of a aesthetically pleasing umbilicus

A
  • superior hooding
  • inferior retraction
  • round or elipsoid shape
  • shallow
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10
Q

Name 3 absolute contra-indications to abdominoplasty

A
  • significant comorbidities
  • unrealistic surgical expectations
  • body dismorphic disorder
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11
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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12
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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13
Q

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

A

5cm

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14
Q

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

A
  • significant pain
  • numbness
  • dysesthesia of hip and medial thigh
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15
Q

What is the incidence of LFC nerve injury in abdominoplasty procedures

A

10%

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16
Q

What type of sutures should be used for the plication of the rectus muscle

A

permanant or long acting resorbable sutures

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17
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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18
Q

How does the umbilicus move in a miniabdominoplasty

A

2 cm inferiorly

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19
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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20
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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21
Q

What are the subcutaneous fat layers

A
  • subcutaneous fat (dense and adherent)
  • intermediate fat (safest layer)
  • deep fat (loose and less compact)
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22
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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23
Q

Name and describe the 2 types of cellulite

A

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

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

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24
Q

Name 5 agents that should be avoided when undergoing lipocuccion

A
  • Aspirin
  • NSAIDs
  • St. John Wort
  • Vitamin E
  • Anticoagulants
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25
Q

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

A

Patients undergoing large volume liposuccion (>5L)

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26
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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27
Q

Name 2 incisions that can be used for male breast liposuccion

A
  • anterior axillary fold
  • periareolar
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28
Q

Name 2 incisions that can be used for abdomen liposuccion

A
  • lateral lower abdomen
  • supra-pubic
  • umbilical
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29
Q

Name 2 incisions that can be used for bottox liposuccion

A
  • sacral
  • midaxillary line in panty line
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30
Q

Name 2 incisions that can be used for medial thigh liposuccion

A
  • medial groin crease
  • inguinal crease
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31
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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32
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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33
Q

Describe the wetting solutions and the estimated blood loss

A

Dry : None : 20-45%
Wet : 200-300ml per area : 4-30%
Superwet : 1ml infiltrate for 1ml aspirate : <1%
Tumescent: 3-4ml infiltrate for 1ml aspirate : <1%

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34
Q

How long is analgesia provided with wetting solution

A

18hrs

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35
Q

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

A

35mg/kg

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36
Q

In which circumstances should lipoccusion patients be kept in hospital

A

> 5L or 6hrs of surgery

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37
Q

Name 5 reasons for the use of tumescence

A
  • reduces pain
  • reduces blood loss
  • replacement of volume loss
  • dissipation of heat in UAL
  • increase cavitation in UAL
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38
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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39
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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40
Q

What are the stages of UAL

A

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

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41
Q

Name 3 complications specific to UAL

A
  • thermal injury
  • seroma
  • hyperpigmentation
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42
Q

What are the advantages and disadvantages of power assister liposuccion

A

Advantages
- decreased surgeon fatigue
- may improve skin tightning

Disadvantages
- equipment cost
- larger incision
- longer OR time
- thermal injury risk
- increase scaring in tissue bed

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43
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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44
Q

What are the stages of laser assisted liposucction

A

Stage 1: subcutaneous infiltration with wetting solution
Stage 2: Application of energy to subcutaneous tissue with laser probe
Stage 3: Evacuation of emulsified fat with SAL
Stage 4: Subdermal skin stimulation

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45
Q

What is the mechanism of action of UAL

A

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

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46
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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47
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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48
Q

Name 6 complications of lipocussion

A
  • Asymétry
  • Séroma
  • Hématoma
  • Dissatisfaction
  • Visceral perforation
  • DVT, PE , Sepsis, necrotizing fasciitis, lidocaine toxicity
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49
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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50
Q

What is SAFElipo

A

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

angled canulas only used in SAFElipo

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51
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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52
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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53
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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54
Q

What are the goals of reconstruction for the buttock in MWL

A
  • define the buttock
  • elevate the buttock
  • cover coccyx with additional soft tissue
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55
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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56
Q

What are the 2 types of bariatric surgery

A
  • Restrictive
  • Malabsorptive
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57
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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58
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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59
Q

What is the incidence of DVT in MWL patients

A

<0.1%

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60
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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61
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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62
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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63
Q

What is the difference between lower body lift and belt lipectomy

A

NEED TO ADD ANSWER

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64
Q

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

A

Doxycycline

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65
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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66
Q

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

A
  • liposuction
  • traditional abdominoplasty
  • mini-abdominoplasty
  • fleur de lys abdominoplasty
  • reverse abdominoplasty
  • high lateral tension abdominoplasty
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67
Q

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

A

Diver test: patient stands and flexes at the waist. Increased laxity will result in worsening of lower abdomen fullness

Pinch test: patient tenses the abdominal wall. Increased laxity if this significantly decreases the amount of abdominal fullness

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68
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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69
Q

Describe your markings for a high lateral tension abdominoplasty

A
  • 7 cm superior to vulvar comissure or base of penis
  • insision is below umbilicus centrally and above umbilicus laterally
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70
Q

List advantages of high lateral tension abdominoplasty

A
  • lateral thigh elevation
  • flatenned epigastrium
  • undermining limited to central region

** FIND RESSOURCE**

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71
Q

Where is the TAP bloc done

A

Bloc between internal oblique and transversals muscle

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72
Q

What are advantages and disadvantages of progressive tension sutures

A

Advantage
- reduces seroma formation
- ADD

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

*ADD MORE**

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73
Q

Name the 3 fascias of the arm

A
  • Fascia superficiel
  • Fascia investissant du muscle
  • Fascia clavico-pectoral
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74
Q

What 2 cutaneous nerves are at risk during brachioplasty

A
  • intercostal brachial
  • MABC (exists 14cm proximal to medial epicondyle)
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75
Q

What are the absolute contra-indications to brachioplasty (4)

A
  • neurological or vascular disorders of the upper extremity
  • collagen disorders (ie. Ehlers-Danlos, progeria)
  • lymphedema of the arms
  • unrealistic patient expectations
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76
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
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77
Q

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

A
  • crush
  • cauterize
  • burry in the muscle
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78
Q

Name 2 advantages of liposuccion in brachioplasty

A
  • large ressection possible
  • bulk reduction
79
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

80
Q

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

A

Anterior
- less visible
- more hypertrophic

Posterior
- more visible
- less hypertrophic

81
Q

What is the complication rate in brachioplasty

A

40%

82
Q

What are the limits of the femoral triangle

A

Superior : inguinal ligament
Inferior: adductor longus
Lateral: Sartorius

83
Q

What is the content of the femoral triangle

A

Femoral artery, vein and nerve

83
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
84
Q

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

A

anchoring of superficial fascia to Colles fascia on perineum

85
Q

What 2 techniques to prevent ptosis reccurence

A
  • anchoring of superficial fascia to colles fascia
  • plication of gracillis and adductor longus fascia

these are not needed in vertical lifts

86
Q

List complications of thigh lift (6)

A
  • seroma
  • hematoma
  • delayed wound healing
  • scar migration
  • prolongiued pain
  • swelling
  • change in shape of genital region
  • leg swelling (lymphedema)
  • DVT/PE
87
Q

Describe the Felicio classification

A

Labia minora enlargement

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

88
Q

Name 3 options for reduction of the labia minora

A
  • edge trim
  • wedge ressection patterns
  • de-epithelialization techniques
  • composite reduction
  • laser excision
89
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
90
Q

List both acute and chronic complications of labiaplasty

A

Acute
- infection
- hematoma
- dehiscence
- transient dyspareunia

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

91
Q

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

A
  • reduce excess redundancy
  • reduce fat volume
  • enhance contour
  • augment atrophy
92
Q

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

A
  • reduce skin excess
  • relase entrapment
  • resuspend to the pubic symphysis
93
Q

When does peak plasma concentration occur after infiltration of tumescence

A

10-14hrs

94
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
95
Q

What are the advantages and disadvantages of PAL

A

Advantages
- decreased surgeon fatigue
- larger volumes
- short procedure time

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

96
Q

What are advantages and disadvantages 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

97
Q

What is particular about water-assisted liposucction

A

Can be done in the office under local

98
Q

Describe water-assisted liposuction

A

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

99
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

100
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

101
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)
102
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
103
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

104
Q

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

A

167 minutes

105
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

106
Q

When peforming liposuction >5L how what is your replacement IV

A

Crystaloid at 0.25ml/kg or aspirate

107
Q

What is the end point of infiltration when performing liposuction

A

uniform blanching and skin turgor

108
Q

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

A

7-10 minutes (maybe double check this in a CME or something

109
Q

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

A
  • basilic vein
  • MABC
110
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

111
Q

What is the recommended upper limit for lipid emulsion

A

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

112
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

113
Q

What is the most catastrophic complication related to brachioplasty

A
  • overresection and inability to close the wound
114
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
115
Q

What should you do is the incision crosses the axilla

A

Add z-plasty to prevent contracture over the axilla

116
Q

In which patients is liposuction alone adequate when treating the arms

A

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

117
Q

Where should avoid placing your incision in brachioplasty and why

A

Medial epicondyle due to ulnar nerve injury risk

118
Q

What is the most common complication after brachioplasty

A

wide, unsightly scars

119
Q

Name 5 common complications of brachioplasty

A
  • wound dehiscence
  • HTS
  • infection
  • Seroma
  • Paresthesia
  • tethering across axilla
  • reccurent skin laxity
120
Q

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

A

seroma

121
Q

List the 3 major methods for buttock augmentation

A
  • autologous fat grafting
  • silicone implants
  • autologous flap augmentation (specially in MWL)
122
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

123
Q

What are the contraindications to buttock augmentation

A
  • pregnancy
  • neoplasm
  • severe comorbidity
124
Q

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

A

diamond shape

125
Q

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

A

450-1800cc per side

126
Q

List complications specific to implant based buttock augmentation (4)

A
  • extrusion
  • displacement
  • capsular contracture
  • implant exposure
127
Q

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

A
  • subcutaneous
  • submuscular
  • intramuscular
    -subfascial
128
Q

What is at risk when performing submuscular buttock implants

A

sciatic nerve injury

129
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
130
Q

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

A
  • keep injection cannula parallel to patient
  • subcutaneous injecion
  • avoid excess volume injection
  • maintain hydration of patient
131
Q

What vessel is usually involved in fat embolus syndrome

A

Inferior gluteal vein

132
Q

What factors increase the risk of fat emboli syndrome

A
  • increased volumes
  • intramuscular injections
  • injection near piriformis (gluteal vessels)
133
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

134
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

135
Q

In which percentage of the population is the umbilicus truely midline

A

1.7%

136
Q

What is the vector of pull in high-lateral tension abdominiplasty

A

Oblique

137
Q

What is particular about the fleur de lys technque

A

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

138
Q

What is a reverse abdominoplasty

A

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

139
Q

At which level is the incision made in reverse abdominoplasty

A

IMF

140
Q

What complications of skin redundancy can be seen in MWL patients

A
  • skin infections/rashes
  • MSK pain
  • functional impairement (ambulation, urination, sexual function)
  • psychological distress (depression, self-esteem)
141
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

142
Q

Name 4 ways to perform autologous gluteal augmentation

A
  • fat grafting
  • dermal/fat flaps
  • split myocutaneous flaps
  • perforator flaps
143
Q

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

A

Do not place tension on horizontal scar

144
Q

Name 3 contraindications to medial thigh lift

A
  • preexisting lymphedema
  • lower extremity SVT
  • presence of varicose veins (need to obliterate them prior to surgery)
145
Q

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

A

Saphenous vein

146
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)
147
Q

What must you do should the incision be carried into the axilla in brachioplasties

A

Z-plasty

148
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
149
Q

What body temperature should be aimed during body contouring procedures

A

> 35oC

150
Q

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

A

maintenance fluid + 10ml/kg/hr

151
Q

What percentage of MWL patients are anemic

A

50%

152
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
153
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
154
Q

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

A
  • Tobacco
  • Diabetes
  • Systemic steroid use
  • BMI >40
155
Q

Where is the femoral triangle in relationship to colle fascia

A

Lateral to it

156
Q

Where does Colles fascias attach

A
  • ishiopubic rami of bony pelvis
  • scarpas of the abdominal wall
  • posterior border of urogenital diaphragm
157
Q

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

A

medial thighplasty (crescent tighplasty)

158
Q

How can you treat laxity to middle third

A

short-scar vertical thighplasty

159
Q

How can laxity of entire thigh be treated

A

Full length vertical thighplasty

160
Q

What should be your dissection plane in medial thigh lift

A

deep to the superficial fascia to avoid great saphenous vein

161
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

162
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
163
Q

Name 4 causes of labia minora enlargement

A
  • Congenital (most common)
  • Pregnancy
  • OCP
  • Topical estrogen
  • Vulvar lymphedema
  • Dermatitis 2o to incontinence
164
Q

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

A

Hood redundancy

165
Q

Name 4 resection patterns for labia minora

A
  • zigzag technique
  • central wedge
  • w-plasty
  • inferior wedge w/ superior flap
  • direct excision
166
Q

When addressing labia with clitoral hood which should be done first

A

a) labia before hood

167
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

168
Q

What is the most common complication associated with labioplasty

A

Wound dehiscence

169
Q

How long should you wait before doing a revision following labiaplasty

A

minimum 4 months

170
Q

List 4 effects of fat grafting on irradiated skin

A
  • decrease collagen deposition
  • attenuates thickened epidermis
  • improves hyperpigmentation
  • diminishes vascular density
171
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)

Lower
Blood
Water
Lidocaine

172
Q

What are the 2 theories of fat grafting

A

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

173
Q

List 3 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

174
Q

Describe the Coleman technique

A
  • manual harvest
  • 5mm incision
  • infiltration 1:1 wetting solution
  • 3mm canula
  • Luer-Lok to prevent leakage
175
Q

What does fat sticking on the Codman neuropad indicate?

A

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

176
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

177
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

178
Q

What is the most common problem following fat grafting

A

edema postop

179
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*

180
Q

What are the 3 histologial zones of grafted fat

A

Peripheral zone (viable adipocytes)

Intermediate zone (inflammatory cells)

Central zone (necrosis)

181
Q

Name 4 ways to prepare harvested fat

A
  • centrifugation
  • sedimentation
  • washing
  • gauze-roling
182
Q

List 3 washing solution options in fat grafting

A
  • NS
  • 5% dextrose
  • RL
  • Sterile water
183
Q

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

A

sedimentation/straining

184
Q

How long after harvest do fat cells begin to degenerate

A

4hrs

185
Q

What is the limitting step in fat grafting

A

O2 diffusion

186
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
187
Q

How can you estimate the amount of necessary fat for fat grafting

A
188
Q

What are the 4 “S” of a successful fat graft

A
189
Q

What is the optimal thickness of the regeneration zone

A

1.6mm

190
Q

List 6 complications specific to fat grafting

A
  • fat resorption
  • fat necrosis
  • calcifications
  • pseudocyst formation
  • fat emboli
  • lipoid meningitis
  • fat migration
191
Q

How does BRAVA work

A

ADD ANSWER

192
Q

What are the 2 types of fat emboli

A

Micro-arterial fat emboli
- irritation of pneumocytes

Macro arterial fat emboli
- mechanical occlusion

193
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
194
Q

Describe the gluteal danger triangle

A
  • PSIS
  • Ischion
  • Greater trochanter

Questions pratiques de l'Université Montréal (43 decks)

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