From Esthetic Medicine to Optimizing Reconstructive Outcome: A Feasibility Trial on Secondary Refinement of Fasciocutaneous Anterolateral Thigh Flaps with Cryolipolysis

Nagel, Sarah S.; Rauh, Annika; Siegwart, Laura C.; Hundeshagen, Gabriel; Kotsougiani-Fischer, Dimitra; Kuepper, Simon; Kneser, Ulrich; Hirche, Christoph

doi:10.1055/s-0042-1755259

Cited by 4 publications

(3 citation statements)

References 30 publications

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“…A novel and less invasive strategy in thinning a flap can be the use of cryolipolysis as described recently by Nagel et al 36 Cryolipolysis showed to be effective in reducing both the subcutaneous adipose tissue layer and the flap circumference.…”

Section: Discussionmentioning

confidence: 99%

Perfusion Dynamics during Secondary Flap Debulking with Liposuction

Geeroms,

Lu,

Hsu

et al. 2023

J Reconstr Microsurg

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Background Lower extremity trauma often necessitates reconstruction with flap transfer. One of the reconstructive goals is a thin soft tissue coverage with appropriate contour. Therefore, a secondary debulking of the flap is usually performed. Methods Debulking through conventional lipectomy is compared with liposuction followed by excision of the defatted flap excess. Demographic data, surgical details, and postoperative outcomes are compared and analyzed. The perfusion dynamics of the flaps undergoing liposuction debulking are studied by means of perioperative indocyanine green fluorescence angiography, as well as postoperative laser Doppler imaging. Results Patients undergoing lipectomy (n = 69; 57.5%) or liposuction (n = 51; 42.5%) debulking had a similar rate of postoperative complications. Partial necrosis was observed in 7.2% (lipectomy) versus 7.8% (liposuction) of flaps. Fluorescence angiography showed a substantial decrease in flap perfusion following the infiltration with an epinephrine-containing tumescent solution (74.3% ± 8.2% prior to infiltration versus 16.8% ± 7.1% after infiltration; p < 0.001), resulting in a dark flap appearance. Laser Doppler imaging confirmed the hypoperfusion on postoperative day 1. Conclusion Secondary debulking of a lower extremity flap can be safely and efficiently performed through liposuction combined with peripheral excision of the defatted flap in a single stage. Perfusion studies may show a misleading hypoperfusion of the defatted flap, which does not accurately predict subsequent necrosis or complications.

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Section: Discussionmentioning

confidence: 99%

Perfusion Dynamics during Secondary Flap Debulking with Liposuction

Geeroms,

Lu,

Hsu

et al. 2023

J Reconstr Microsurg

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“…In addition to direct excision, liposuction, tissue shaving with an arthroscopic cartilage shaver, cryolipolysis, and skin grafting are methods of debulking flaps ( 6 , 7 ). Direct excision is the first method of consideration for flap debulking.…”

Section: Discussionmentioning

confidence: 99%

An innovative method of reconstructed penis reduction: a case report

Kang

Kim

et al. 2022

Transl Androl Urol

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Background: Surgery to reduce the size of the reconstructed penis is uncommon. Patients who have undergone total penis reconstruction may want to reduce the size of their reconstructed penis due to convenience issues. To reduce reconstructed penis size, surgical treatment is essential. However, no research has thus far reported on this methodology.Case Description: A 50-year-old Asian man experienced a nearly total loss of his penis due to trauma 30 years ago. He underwent nearly total penis reconstruction using a tubed abdominal flap. The patient's reconstructed penis showed hypospadias, which caused discomfort during urination. The length of the penis was 17 cm. The patient felt that the reconstructed penis was too large, and a reduction surgery was planned for corrective action. Y-shape incision lines were applied on both lateral sides of the reconstructed penis to reduce the circumference, and curved incision lines were applied on the front and back of the penis to construct the neomeatus and glans of the penis. The incision was made, and the remnant tissue was dissected, with attention paid to avoid damage to the neourethra. After the tissue resection, the neourethra was isolated and resected to fit the height of the penis to construct the neomeatus and correct the hypospadias. An approximation was performed after the reconstructed penis reduction.Conclusions: Two years after the surgery, there were no complications, such as urethral stricture or fistula, and the patient was satisfied with the shape and size of the reduced penis (9 cm). The surgical reconstructed penis reduction procedure introduced in this case report achieved satisfactory aesthetic and functional results.

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“…10,12 Recently, cryolipolysis has been used outside of the context of fat reduction for cosmetic purposes, including secondary refinement of fasciocutaneous anterolateral thigh flaps, regression of lipedematous scalp, and treatment of notalgia paresthetica. [13][14][15] As the use of noninvasive procedures to reduce body fat continues to grow, both in and out of the cosmetic world, it is important to continuously review and appropriately document adverse events and complications in clinical practice. Healthcare professionals must stay abreast of these new insights so that they can inform their patients about these potential risks.…”

Section: Introductionmentioning

confidence: 99%

Literature review of adverse events associated with cryolipolysis

Deligonul,

Yousefian,

Gold

2023

J of Cosmetic Dermatology

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BackgroundCryolipolysis is a noninvasive procedure for localized fat reduction and body contouring. This technique utilizes controlled cooling to induce adipocyte apoptosis without damage to overlying skin and other tissue. Although the procedure was once thought to be relatively harmless, recent studies have shed light on the risks of adverse effects (AEs).AimsThe aim of this article was to review AEs in cryolipolysis as published in clinical data.MethodsA comprehensive search was performed in PubMed, using relevant keywords such as “cryolipolysis,” “CoolSculpting,” “adverse effects,” “complications,” and “side effects” with no set data range. The search was limited to studies published in English. The selected studies encompassed a variety of study designs, including randomized controlled trials, prospective cohort studies, case series, case reports, and reviews.ConclusionsSince its FDA approval in 2010, our understanding of the potential risks and complications associated with cryolipolysis has grown significantly, and shown that the procedure may not be as harmless as once thought. Continued post‐market surveillance of cryolipolysis devices combined with documenting of AE cases help providers better understand the true risks associated with this procedure. As “cryolipolysis” and “CoolSculpting” are often used interchangeably, further research is needed to understand if AEs such as paradoxical adipose hyperplasia (PAH) that occur both inside and outside the United States are CoolSculpting cases or linked to other devices. Additionally, further studies are needed to understand the pathophysiology of such sequelae as PAH, and to better recognize the risks and potential complications associated with cryolipolysis so that we can more accurately inform patients.

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From Esthetic Medicine to Optimizing Reconstructive Outcome: A Feasibility Trial on Secondary Refinement of Fasciocutaneous Anterolateral Thigh Flaps with Cryolipolysis

Cited by 4 publications

References 30 publications

Perfusion Dynamics during Secondary Flap Debulking with Liposuction

Perfusion Dynamics during Secondary Flap Debulking with Liposuction

An innovative method of reconstructed penis reduction: a case report

Literature review of adverse events associated with cryolipolysis

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