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All About Fat Embolisms

In October 2017, an article was published in the British Medical Journal by Dr. Adam Ali titled “Fat Attacks! A Case of Fat Embolism Syndrome Post Liposuction” (Adam A., 2017).

http://www.ncbi.nlm.nih.gov/pubmed/28947428.

http://casereports.bmj.com/content/2017/bcr-2017-220789.abstract.

This particular report is in regard to a patient with lipedema who had a liposuction procedure performed on their lower legs and knees, and as a result suffered an incredibly rare complication known as Fat Embolism Syndrome. Just like any surgery, liposuction inherently comes with potentially devastating risks, and while this complication is rare, it does serve as a stark reminder that every effort needs to be made to reduce these risks on every procedure that is performed.

For those unfamiliar with the term, an embolism occurs when a mass of substance breaks off from the body and travels through the bloodstream, potentially clogging one of the body’s blood vessels. In the case of fat embolisms, a fat globule (or more commonly, multiple fat globules) has broken off in too small of a blood vessel and become lodged, causing one or more bodily systems to malfunction. Often, it is the smaller vessels of the lungs that are first affected, resulting in respiratory failure and other serious side effects.

Fat embolisms are a risk with traumatic injuries (especially long bone and pelvic fractures) and soft tissue damage, as well as orthopedic surgery and burns. And while they are extremely rare in the case of liposuction and fat transfer procedures, they are a real risk worth considering before undergoing any procedure. Learn more about fat embolisms below.

The Cause of Fat Embolisms

Fat embolisms are believed to be caused by fat escaping into the bloodstream via bone fractures, in which fat from the bone marrow enters the bloodstream, disease, or widespread bodily trauma. Liposuction can in rare instances cause fat embolism. This usually associated with large volume liposuction, where more than 5 liters of fat are removed using a larger diameter liposuction cannula without full tumescent anesthesia. With regards to fat transfer procedures, embolisms can be caused by injecting too large of fat globules (which should only be placed within the body as tiny droplets) or by injecting the fat globules at a time other than when the cannula is being withdrawn from the body.

Fat Embolism Prevention and Treatment

Liposuction patients normally face a number of risks that come inherently with the surgery they are receiving, and those patients with lipedema typically face the same risks. That being said, patients who do have lipedema are normally at a higher risk for complications as a whole for a number of reasons, including:

  • Presence of varicose veins increases the risk of bleeding and the risk of DVT and embolism. Lipedema ladies have an increased risk of varicose veins and venous insufficiency (Clavijo-Alvarez, 2011).
  • Lipedema patients have higher than average subcutaneous fat. The amount of fat removed per liposuction procedure is strongly correlated with the risk of complications from liposuction. The risk of complications goes up significantly (risk increase by 3x) for liposuction procedures that remove more than five liters of fat in a single surgery. The case report describes a liposuction surgery that removed 13.5 liters of lipoaspirate (Chow, 2015) (Gilliland MD, 1997) (Gilliland MD C. G., 1999).
  • Lipedema patients are generally heavier than most other patients having liposuction. The patient described in this case study had liposuction under general anesthesia. This patient, who suffered the fat embolisms, had a BMI of 65 (normal BMI is 18-25). Increased weight or high BMI is a risk for any surgery (Gupta, 2016).
  • The larger the diameter cannula – the more traumatic the liposuction (Venkatram J., 2008), (Skouge, 1990), (Lawrence N., 1996). In this case study, large diameter cannulas of five millimeters were used during the liposuction procedure of the lipedema patient who had the fat embolism. [personal communication with Dr Ali.]
  • The use of general anesthesia increases the risk of complications from all surgeries including liposuction. General anesthesia by itself can lead to life threatening complications – even death. General anesthesia causes temporary cardiac / circulatory depression and during general anesthesia the body is completely immobilized leading to increased risk of embolism (Gottschalk, 2011).

Now that we know that lipedema patients face a much high risk of complications with liposuction surgery, it is important to keep in mind that there are a number of precautions that can be taken to make the entire process a little smoother.

One of the best precautions that can be taken is to use lymph sparing techniques, as this can help to minimize any injury that patients with lipedema may experience as a result of the surgery (though it should be noted that these techniques should not be performed under general anesthesia due to suppression of both cardiac circulation and the peripheral muscle movement). While large diameter cannulas may remove fat more quickly, these have proven to be more traumatic to those with lipedema. Therefore, it is recommended with these techniques to use the smallest size cannula possible. Also, it is critical to have knowledge of the location of lymphatic collecting ducts and the course of lymphatic channel. Ultimately, lymph sparing techniques are much easier on the patient and make the procedure much lower risk for lipedema patients.

Fat embolisms are dangerous, and are a rare but serious risk after any liposuction or fat transfer procedure. However, in the hands of an experienced surgeon who takes proper precautions and has lots of experience with the procedure you’re interested in, they are exceedingly rare.

A careful surgeon will use small cannula for liposuction and limit liposuction volume. The experienced surgeon will know to minimize the size of the fat globules into droplet form, to use a blunt cannula in order to avoid penetrating any blood vessels, and to inject fat only while withdrawing the cannula from a patient’s body.

Should a patient begin experiencing a fat embolism, supportive measures are taken to ensure that their arteries receive proper oxygen amounts. Fluid intake is often also restricted, and diuretics are used in order to minimize the accumulation of fluids in the lungs.

Laser Lipo and Veins – Begin Your Journey to a Happier, Healthier You

For additional information on surgical risks like fat embolisms, as well as how we mitigate these risks during the procedures we offer, contact our office and schedule your consultation appointment with Dr. Wright and the other fantastic members of our medical staff today! Dr. Wright’s team is very experienced with liposuction in St. Louis, MO, and will be happy to walk you through each step of the process, all while keeping you safe!

 

References

Adam A., T. G. (2017, September 25). Fat Attacks! A Case of Fat Embolisation Syndrome Post Liposuction. British Medical Journal. doi: doi:10.1136/bcr-2017-220789

Chow, I. H. (2015). Is There a Limit? A Risk Assessment Model of Liposuction Volume on Complications in Lipoabdominoplasty. Plastic Reconstructive Surgery, 10-01.

Clavijo-Alvarez, J. M. (2011). Prevention of Venous Thromboembolism in Body Contouring Surgery. Plastic Surgery, 228-232.

Gilliland MD, C. G. (1999). Safety Issues in Ultrasound Assisted Large-Volume Lipoplasty. Clinical Plastic Surgery, 317-35.

Gilliland MD, C. N. (1997). Tumescent Liposuction Complicated by Pulmonary Edema. Plastic Reconstructive Surgery, 215-219.

Gottschalk, A. H. (2011). Is Anesthesia Dangerous? Dtsch Arztebl International, 469-474.

Gupta, V. W. (2016, June). Safety of Aesthetic Surgery in the Overweight Patient: Analysis of 127,961 Patients. Aesthetic Surgery, 36(6), 718-29.

Lawrence N., C. W. (1996). Liposuction. Advanced Dermatology, 11, 19-49.

Skouge, J. (1990). The biochemestry and development of adipose tissue and pathophysiology of obesity as it relates to liposuction surgery. Dermatology Clin, 8, 385-93.

Venkatram J., C. J. (2008, Jul-Dec). Tumescent Liposuction: A Review. Aesthetic Surgery, 49-57. doi:10.4103/0974-2077.44159

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