08 January 2009

The tumescent technique for liposuction uses a large volume of a dilute solution of lidocaine and epinephrine. The tumescent technique for liposuction has become the worldwide standard of care for liposuction because it has eliminated the common problem of surgical bleeding associated with older techniques.

Open Drainage and Bimodal Compression
It provides improved patient comfort, shortens the healing time, and decreases the number of postoperative visits to the surgeon. Open-drainage with bimodal compression is a modern technique that greatly reduces the degree of pain, swelling, bruising and convalescence time. Many surgeons and nurses continue to use antiquated post-liposuction care techniques that were used before the invention of the tumescent liposuction.

Minimizing Swelling, Bruising, & Tenderness
Swelling, bruising, tenderness are the result of 1) persistent blood-tinged tumescent anesthetic solution trapped under the skin after liposuction, and 2) injury to subcutaneous lymphatic capillaries caused by the liposuction procedure. Lymphatic capillaries are small vessels that drain fluid away from injured body tissues. Temporary injury to lymphatic capillaries as a result of liposuction cannot be avoided. However the persistence of blood-tinged tumescent solution trapped under the skin can be prevented. Older techniques for post-liposuction care do not facilitate rapid drainage of this blood-tinged anesthetic solution. The newer technique known as "open drainage" diminishes the swelling and speeds recovery after tumescent liposuction.

Prolonged High-Compression In the Old Days
Prolonged High-Compression in the old days was necessary. Before the tumescent technique for liposuction, bleeding was the major problem associated with liposuction. After a liposuction had been completed, patients had to wear a high compression garment for many weeks in order to minimize the problems caused by so much bleeding. Immediately after surgery the high compression garments were required to compress the bleeding vessels and stem the loss of blood. Patients continued to wear high compression garments for up to six weeks in order to decrease the swelling caused by the blood trapped beneath the skin.

Prolonged Compression Now Makes Matters Worse
Now that tumescent technique has become the standard of care, the traditional post-liposuction techniques, established before the invention of the tumescent technique, may now contribute to delayed healing and prolonged swelling. With tumescent liposuction there is no need for prolonged high compression because there is no significant bleeding during surgery, and virtually no blood remains trapped beneath the skin. After tumescent liposuction, closing incisions with sutures will prevent drainage of residual blood-tinged anesthetic solution, and encourage swelling. In addition, the prolonged use of excessive compression after tumescent liposuction will compress the subcutaneous lymphatic capillaries and impair the lymphatic drainage system that is responsible for removing fluid from injured tissues. After tumescent liposuction, the goal is to maximize the rate of drainage of residual blood-tinged tumescent anesthetic solution.

Preventing Swelling
Preventing swelling, bruising and inflammation before they occur by removing the subcutaneous blood-tinged fluids and encouraging lymphatic drainage is the ideal method for post-liposuction care. The method known as Open-Drainage achieves these results by encouraging open drainage by not closing incisions with sutures. The use of special pads that both absorb the messy blood-tinged drainage and reduces bruising by uniformly distributing the compression of elastic garments and using special elastic compression garments designed for optimal drainage as well as patient convenience and comfort.

Open DrainageOpen-Drainage
Open-Drainage after tumescent liposuction refers to the technique for maximizing the drainage of blood-tinged tumescent solution by using small adits which are tiny round holes (1 mm, 1.5 mm or 2 mm in diameter) made by skin-biopsy punch to facilitate postoperative drainage and placing adits in strategic locations in order to maximize gravity-assisted drainage. Allow the adits to remain open instead of being closed with sutures.

Fewer Postoperative Visits
Fewer postoperative visits to the surgeon's office can save time and hassle for the patient and the patient's family. Because there are no sutures to be removed, the patient can eliminate the need to return to the surgeon to have the sutures removed. Because there is less swelling, and pain with Open-Drainage, there is less need for the patient to return to see the surgeon in the early postoperative period for time-consuming follow-up examinations.

Super-Absorbent PadsSuper-Absorbent Pads
These prevent staining clothes and furniture, and to avoid the "sight of blood" that would otherwise accompany the drainage of blood-tinged tumescent fluid. For example, the HK Pads that measure 12 x 20 inches weigh just 6 ounces and have the capacity to absorb more than a liter (two pounds= 32 ounces) of water, or more than 5.5 times their own weight. In practice, the absorbent pads have two distinct functions. First, they absorb the large volume of tumescent drainage to improve patient comfort and hygiene, and secondly the pads distribute the elastic garment's compressive force more uniformly. This uniform compression narrows the gaps between interstitial collagen bundles in the dermis and prevents red blood cells from moving toward the skin surface where it appears as a bruise. HK Pads (US Patent 6,162,960) are the only commercially available pads of this type.

Adhesive Foam Pads
Adhesive foam pads such as Reston foam can decrease bruising, but not swelling, when applied to the skin over an area treated by liposuction. Reston foam has been associated with an increased risk of infection, skin ulceration and skin necrosis. Some surgeons continue to use Reston foam after liposuction.

Bimodal Compression
Bimodal Compression refers to the sequential use of two different stages of post-liposuction compression. During the first stage of bimodal compression, a high degree of compression is maintained for as long as drainage persists, plus an additional 24 hours past the time when all drainage has ceased. The second stage of bimodal compression begins 24 hours after all drainage has ceased, and employs either moderate compression or no compression. Optimal compression garments should maximize the rate of open drainage, while minimizing the risk of complications due to excessive compression such as blood clots in the legs and lungs. An ideal garment must also be able to accommodate bulky absorbent pads, and be easy for the patient to apply and remove without assistance.

Compression GarmentThe Ideal Elastic Compression Garment
The ideal elastic compression garment must be easily put-on and taken-off by the patient without assistance, and it must easily accommodate the use of bulky super-absorbent pads that are necessary when open-drainage is used to accelerate healing.

Traditional Elastic Compression Garments
Traditional garments usually have a zipper on the side and are made of an elastic cloth that is relatively resistant to stretching. Traditional garments are relatively difficult to put-on or take-off without assistance. This difficulty is especially troublesome for someone who has just had liposuction and is sore, swollen and unable to easily bend-over and wiggle into a tight garment.

GarmentGarments Designed for Open-Drainage
HK garments produced by HK Surgical, Inc., are examples of elastic compression garments that provide high compression, that are designed to accommodate bulky super-absorbent pads, and that are easy to put-on and take-off without assistance.

HK Torso Garments are elastic garments worn over the torso with additional elastic binders to provide adjustable compression after liposuction of the abdomen, hips, waist, or breasts HK Over-all Garments, are usually worn two at a time, one on top of the other, and are used after liposuction of the thighs or hips, or abdomen.

Each garment when worn alone provides a moderate degree compression, but when two garments are worn at the same time, their compression is additive, and together they provide a high degree of compression. It is much easier for a patient to put on two moderate-compression garments which can be done without assistance, than it is to apply a single high-compressive garment that often requires the assistance of a spouse or friend.

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