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Ultrasound for VTE Surveillance and Other Plastic Surgery Applications

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Evidence-Based Body Contouring Surgery and VTE Prevention

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Abstract

In view of the shortcomings of individual risk stratification and chemoprophylaxis, the author adopted ultrasound surveillance as a method to screen for deep venous thromboses in plastic surgery outpatients, starting in 2013. The findings were published for the first 100 and 200 patients, and the results for 1000 patients are being tabulated now.

The findings were surprising. In the first 200 patients, no deep venous thromboses were detected on Doppler ultrasound scans conducted the day after surgery. This finding supports total intravenous anesthesia with intraoperative preservation of the calf muscle pump. Deep venous thromboses do not seem to be developing during surgery in plastic surgery outpatients.

One distal thrombosis was detected in a 55-year-old patient 8 days after abdominoplasty and other procedures. The patient was treated with oral anticoagulants as an outpatient. Subsequent scans revealed resolution in 1 month.

Ultrasound scans are highly accurate, noninvasive, and well-tolerated by patients. Unlike the routine administration of anticoagulation, there is no added risk. The diagnosis is made before treatment rather than the reverse. Early detection of thromboses allows the surgeon to initiate treatment before the thrombosis propagates and becomes dangerous. Importantly, it avoids unnecessary bleeding and hematomas.

Numerous other applications of ultrasound technology have become apparent. Abdominal penetration can be a catastrophic complication of liposuction. This device can be used to screen liposuction and abdominoplasty patients for abdominal defects. Other uses include seroma management, evaluation of breast implants, detection of fat necrosis, and evaluation of soft tissue masses.

Ultrasound is a disruptive technology and there is natural resistance to change. As more surgeons (not just plastic surgeons) adopt this vital diagnostic tool, we are likely to learn much more about this serious and enigmatic complication.

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  1. Swanson Center, Leawood, KS, USA

    Eric Swanson MD

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Swanson, E. (2018). Ultrasound for VTE Surveillance and Other Plastic Surgery Applications. In: Evidence-Based Body Contouring Surgery and VTE Prevention. Springer, Cham. https://doi.org/10.1007/978-3-319-71219-2_13

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  • DOI: https://doi.org/10.1007/978-3-319-71219-2_13

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