Pavel PIMANCHEV 医师
整形外科医师
Simultaneous surgeries: how to achieve maximum results with minimal risks
Objectives: 1. Correct patient selection
2. Risk assessment
3. Preoperative preparation for simultaneous operations
4. Surgical and anesthetic administration during surgery
5. Postoperative patient administration
Introduction: Modern plastic surgery is advancing, and with it, so are patient demands and expectations. Patients strive to achieve maximum results from a single surgical procedure. They want to improve the shape and size of their breasts, remove excess subcutaneous fat, remove a sagging belly, add volume and shape to their buttocks, and so on. Surgeons themselves are also chasing these patient demands. The "Mommy Makeover" is a trendy procedure that's already on everyone's lips. However, we must not forget that such extensive and lengthy procedures come with significant risks.
Materials / method: - Somatic condition (physical status);
- Anesthesia;
- Extent of surgery;
- Duration of surgery;
- Blood loss;
- Hypovolemia;
- Hypothermia;
- Thrombosis and/or thrombo/fat embolism;
All these factors must be considered at all stages, from selecting a candidate for surgery to postoperative administration.
We have performed over 150 surgeries over 3 years and have studied the most appropriate ways to reduce risks and maximize results.
Results: Physical status: Patients in ASA status classification group should be considered for such surgeries, rarely ASA II
Anesthesia (local):
Our solution is 1000 ml of 0.9% NaCl + 2 ml of 10% lidocaine (0.2 g of lidocaine) + 1 ml of epinephrine 1:1000;
Surgical scope:
- Liposuction no more than 6-8% of body weight;
- Surgical area no more than 45%
Surgery duration:
No more than 6 hours;
Blood loss:
- 20-40 ml of blood for every 1 liter of aspirate;
-Patients with hemoglobin levels below 80 g/L and symptoms should receive a blood transfusion (plasma and/or r-mass)
Conclusion: Successful simultaneous surgeries bring great joy and satisfaction to both the surgeon and the patient. However, it is crucial to understand and consider all possible risks associated with these procedures. It is essential to prepare for such surgeries in advance and understand that the patient's recovery does not end in the early postoperative period. It is important to remember the physician's fundamental principle, formulated by Hippocrates, "Primum non nocere" (do not treat the patient with more harm than the disease itself).
