So I was reading my Aesthetic Surgery Journal July 2021 and saw an abstract printed which really resonated with me. “Local infiltration of Tranexamic Acid (TXA) in Liposuction: A Single Surgeon Outcomes Analysis and Considerations for Minimizing Postoperative Donor Site Ecchymosis.” They are asking, is there an easy way to make liposuction patients bruise less?
This title I am sure did not enthrall you as much as it did for me. A little background:
- Liposuction requires we infiltrate the fat tissue with fluid, tumnescent, which has anesthetic and epinephrine in it. The epi is specifically to limit bruising and bleeding.
- I definitely see a correlation with bruising. The more you bruise, the more pain and slower healing.
- I have patients take arnica, broemlain, wear compression garments, stop anything that leads to bruising ahead of surgery.
- I am a fan of TXA, but haven’t yet made the jump to using it in my tumnescent or giving it IV in lipo patients. But I have thought about it.
SO. This study was great for me to find.
- Single surgeon cohort study.
- Following liposuction, patients in the intervention group got 75cc of TXA (3 grams in saline) infiltrated into the liposuction donor site. Controls did not.
- Patient demographics, degree of bruising, surgical complications, and DVT were examined.
- Patients were equal- donor site location, tumnescent volume, aspirate volume, time to post op photo
- Blinded assessment of the postop photos were done by 10 evaluators.
- 120 patients total. (60 controls, 60 in study)
FINDINGS:
- TXA patients bruising was SIGNIFICANTLY LOWER than that of patients who did not receive
- Postop complications were similar
- They conclude further prospective randomized studies are warranted.
My thoughts?
SO EXCITING. I have had good experience with using TXA in my irrigation, and have noticed a tangible difference in my breast reduction/lift patients and abdominoplasty patients. (I am not using it in everyone yet.) If we can decrease bruising, my strong suspicion is that there will be less pain and recovery will be faster.
Why not just give TXA to everyone? It is always weighing risk/benefit, and our big concern here is does TXA increase the risk of blood clotting- DVT and PE? There are extensive studies on that in the ortho and trauma literature indicating no increased risk, but we plastic surgeons are still timid.
I have questions about how to optimally use TXA- would it be better in the tumnescent prior to liposuction? Do it as they did in this study and infiltrate it after the liposuction? Or do it as they did in a recent article about facelifting and give a smaller dose IV? Is it better to give it locally to where the injury is? Or systemically (where you put it into the IV)? Is it better to give just prior to injury or after the injury occurs?
I don’t know the answers, but I think it is super promising. Stay tuned.