Liposuction Article - Use of Reston Foam - American Plastic Surgery of Hawaii Hawaii

S. Larry Schlesinger, M.D. and Andrew J. Kaczynski, M.D.

Maui, Hawaii, USA

Abstract. Use of Reston foam along with a pressure garment after liposuction results in three salutary effects: less waviness in the skin surface, a more comfortable recovery, and less blood loss and ecchymoses. Free fat cells are thought to be redistributed evenly by the pressure of the foam plus the pressure garment. The result is a smoother skin surface with less waviness. Reston foam is also comfortable under the pressure garment and there is less immediate postoperative tenderness. In addition, the use of the foam, in conjunction with the pressure garment, results in less postoperative bleeding and bruising. Consequently, there is also a decrease in the amount of postoperative fall in hematocrit. Since there is less of a drop in hematocrit and hemoglobin, there is also less postoperative anemia. The mechanism involved in the reduction in blood loss is thought to be a combination of overcoming capillary pressure and stabilization of the skin and subsurface blood vessels.

Key words: Liposuction - Abdomen - Anemia - Hemorrhage - Hip

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We have found that use of Reston foam (3M, St. Paul, MN) along with a pressure garment after liposuction has three salutary effects. One effect is less waviness and lumping in the skin surface thought to be due to a more even redistribution of free fat cells. It is the strong opinion of both authors that this redistribution of fat cells is more effective when the pressure garment is used in conjunction with Reston foam then when a pressure garment is used alone. The net result is a smoother skin surface, In addition, when Reston foam is used, the pressure garment becomes more comfortable because of the cushioning effect of the foam. There is less postoperative tenderness. Patients recover quickly and comfortably.

Fig. 1. Significant reduction of ecchymosis due to Reston foam application

Another significant effect of the foam plus pressure garment applied after liposuction is less blood loss along with less bruising on the skin surface. We have found that when using Reston foam postoperatively, we can suction up to 350 cc of fat for each corresponding 1% drop in hematocrit. Since there is less of a drop in hematocrit and hemoglobin, there is also reduced postoperative anemia and very often less ecchymoses.

The original impetus to our trying Reston foam was a lecture given by Dr. Fred Grazer [1]. He noticed less bruising in patients when Reston foam was used following liposuction of the calf and ankle areas. Between 1985 and 1988, we experimented with using Reston foam in multiple areas for varying lengths of time.

Theory: Pressure and Stabilization

Both pressure and stabilization contribute to decreased ecchymoses and therefore reduced blood loss. The pressure of the foam plus the postoperative pressure garment decrease bruising. The pressure pushes the surface capillaries closed thereby overcoming capillary pressure and reducing postoperative oozing. This reduction in bleeding is thought to be responsible for the reduction in the decrease in hematocrit.

Simultaneously, the foam's stickiness stabilizes the skin and the capillaries under the skin, so the foam plus skin move as a unit. Consequently, it is felt that microclots are not dislodged from the capillaries and thus means a decrease in the fall in hematocrit.

Another salutary effect of using Reston foam postoperatively, as suggested by Brody [2], is that the foam functions as an immobilizer: the less mobile an area, the less inflammation and improved healing in that area.

Methods and Materials

Reston foam is an adhesive-backed porous dressing applied over each area suctioned. We use it on virtually all our liposuction patients. Reston foam use is economical at a cost of less than $20.00 per surgery. We leave the foam on for 72 hours postoperatively. In warm climates a heat rash may develop if it is left on longer without untoward effects. A pressure garment is also applied and left on for two weeks. Since the foam is porous, bleeding, if present, may be noted on the first postoperative visit, but the foam is usually not removed until the third postoperative day. The Reston foam is replaced and kept on for additional days for those patients who had neck or abdomen surgery. These two areas very often become lumpy after liposuction. Since the foam is no longer sticky once it is removed, it is replaced inside the pressure garment or chin strap. In the abdominal area, the foam prevents an often found periumbilical roll of fat. We theorize that this roll of fat results from clumping of fat cells which have been released during the liposuction procedure and which will graft to any vascular area. In addition, the foam prevents deformities that may occur from folds or creases in the pressure garment or binder. A more even distribution of these free fat cells appears to be attributable to use of Reston foam leading t more comfort and better overall aesthetic results (Fig. 1).

Results

Two things to consider during liposuction are the amount of bleeding and the corresponding decrease in hematocrit the patient may experience. Hetter [3] has proposed the guideline that, on average, for every 136 mL of fat and fluid suctioned during suction-assisted lipectomy, there is a corresponding 1% drop in hematocrit. Since Hetter's original article, several innovations have contributed to less blood loss per volume of fat suctioned. Amoung these are smaller-diameter cannulas [4], improved surgical techniques, improved pressure garments, and now we believe the adjunctive use of Reston foam.

Fig. 2. Hematocrit and hemoglobin decreases in Reston foam patients

We have found in a random sampling of liposuction patients that when Reston foam was used, We were able to suction an average of 350 cc of fat for each corresponding 1% drop in hematocrit (Fig. 2). This results in the additional benefits of less anemia for a given amount of fat suctioned and the ability to suction more fat per patient.

Summary

Use of Reston foam plus a pressure garment after liposuction results in a smoother, less wavy skin surface. There is also less blood loss which is evident by the reduction in the decrease in hematocrit and less ecchymoses. This is thought to be due to stabilization of the skin surface and the overcoming of capillary pressure. Since there is less postoperative bleeding, there is less postoperative anemia. The foam also makes the pressure garment more comfortable and decreases the amount of postoperative tenderness. Patients recover more comfortably with fewer complications.

Additional Reading

Brandy DA: Reston foam for the reduction of ecchymoses post liposuction. Am J Cosmet Surg 7(2):87-91, 1990
Grazer FM: Expert commentary. In: Jackson IT (ed): Perspectives in Plastic Surgery, Vol 3, Num 1, St. Louis: Quality Medical Publishing, 1989, vol 3, pp 44-50
McCarthy JG (ed): Plastic Surgery, Philadelphia: W.B. Saunders, 1990, vol 6, 4026
Pittman G: Suction lipectomy of the face and body: practice refinement. In: Riley WB (ed): Plastic Surgery Educational Foundation Instructional Courses. St. Louis: C.V. Mosby, 1988, vol 1, pp 71-108
References

1. Grazer F: personal communication, 1985
2. Brody G: personal communication, 1989
3. Hetter GP: The effect of low-dose epinephrine on the hematocrit drop following lipolysis. Aesth Plast Surg 8:19-21, 1984
4. Hetter GP: personal communication, 1990
*Presented at the Northwest Society of Plastic Surgeons Meeting, Coeur d'Alene, Idaho, September 1988, and at the Lipoplasty Society of North America Annual Meeting, Toronto, Canada, October 1988 Address reprint requests to Larry Schlesinger, M.D., American Plastic Surgery of Hawaii Corporation, Kahului Bldg.,Suite 300, 33 Lono Ave., Kahului, HI 96732, USA