Pavel PIMANCHEV 医师
整形外科医师
Simultaneous operations: How to get maximum results with minimal risks
Objectives: Extensive and long operations are accompanied by great risks.
- Somatic condition (physical status);
- Anesthesia;
- The scope of surgical intervention;
- Duration of surgery;
- Blood loss;
- Hypovolemia;
- Hypothermia;
- Thrombosis and / or thrombo / fat embolism;
All these factors must be taken into account at all stages. From the selection of a candidate for surgery to postoperative administration.
Introduction: Modern plastic surgery is moving forward and with it, the demands and expectations of patients are growing. Patients strive to get the maximum result from one surgical intervention. They want to correct the shape and size of the mammary glands, want to get rid of excess subcutaneous fat, from the overhanging belly, want to add volume and shape to the buttocks, etc. Surgeons themselves are chasing after the demands of patients. “Mommy makeover” - this fashionable operation is already on everyone's lips. But, we must not forget that such extensive operations are accompanied by great risks.
Materials / method: Physical status: patients from the ASA I group, rarely ASA II should be taken for such operations;
Volume of surgical intervention:
-Liposuction no more than 6-8% of body weight;
- The area of surgery no more than 45%
Duration of surgery:
- an operation longer than 2 hours increases the risk of complications by 50%
- every subsequent 30 minutes increases the risk by 14%;
Blood loss:
- 20-40 ml of blood for every 1 liter of aspirate;
- if blood loss is less than 15% of the CBV, then crystalloids are sufficient, if more, colloids such as dextran, albumin or blood may be required.
Results: Such operations should be performed by a team of at least 3 doctors to reduce the time of surgery. We do it with a team of 4-5 doctors. We perform more than 100 simultaneous operations per year and, by following the safety principles described earlier, we do not have any serious complications.
Conclusion: Successful simultaneous operations give great joy and satisfaction to both the surgeon and the patient. But, it is extremely important to understand and take into account all the possible risks in these operations. It is necessary to prepare for such operations in advance and understand that the patient's introduction does not end in the early postoperative period. It is important to remember the main principle of the doctor, formulated by Hippocrates "Primum non nocere" (do not cause more harm to the patient with treatment than the disease itself)
