Another interesting topic arising out of last month’s BAAPS conference was the increased risk of developing Deep Venous Thrombosis (DVT), a potentially life-threatening condition, and the worrying lack of guidelines available.
Every surgical procedure carries risk and DVT or its more dangerous sequel, Pulmonary Embolism (PE), is one of those potential risks, particularly when the surgery is lengthy. Most cosmetic surgery procedures will extend beyond an hour, meaning the patient is more susceptible to this possible outcome.
A DVT is a blood clot that develops in a deep vein, typically in the leg. It can cause pain and swelling, although some people suffer no symptoms. However, one in ten people with DVT go onto develop a Pulmonary Embolism, which is where a part of the blood clot will break off into the bloodstream and may travel to the lungs or heart. It can cause breathlessness, chest pain and, in some people, result in fatal heart failure.
Increased risk of DVT in cosmetic surgery
Guidelines will help identify patients that have an increased risk of developing DVT after surgery; these include obesity, smoking, advanced age, use of oral contraceptives or HRT and a previous history of DVT.
In a 2014 study published in Plastic Surgery International, the authors stated the importance of identifying these risk factors in minimising DVT. A total of 1,254 patients were included in the study and the development of venous thromboembolism occurred in 1.35% of patients, which may seem relatively low incidence, but a DVT may be fatal. In those patients who developed DVT, it was more frequent in patients over the age of 40, who smoked, or were taking either HRT or oral contraceptives. Interestingly, the study compared types of cosmetic surgery – liposuction, breast augmentation, breast lift and rhinoplasty – and none of these procedures was isolated as a risk factor for this condition.
However, there is a slightly increased risk in surgery to the abdomen, buttocks and legs. The popularity of the Mummy Makeover, where various surgical manoeuvres to this part of the body are combined in one surgical procedure, meaning a longer surgical time, also demands close attention to ensure patient safety.
Prevention is key
There are a number of measures that can be taken to lower the risk of developing DVT. These include the use of compression garments during and after surgery, the use of sequential compression devices to the lower limbs during surgery and afterwards until mobilization has occurred, careful positioning of the legs during the operation and prescribing anticoagulation medication for patients at most risk.
Early ambulation is also essential; the risk of DVT is highest in the first two weeks after surgery so getting out of bed and moving around as soon as possible, balanced with the necessary rest, is extremely important.
Cosmetic surgery is purely elective so it needs to be as safe as possible for patients, which is why guidelines on identifying patients at risk and the optimal preventative measures to follow are mandatory.