Liposuction cannula port site protection: An innovative strategy.

The incidence of friction burns at liposuction cannula port sites is a relatively common yet undesirable outcome of liposuction, especially with power or suction assisted liposuction. Skin protection strategies have been widely discussed in existing literature. These include the use of lubricating gels at cannula port sites, reducing the power of liposuction, freshening skin edges before closure, creating larger port sites, use of Tegaderm as well as specific skin protection devices. Specific skin protection devices can vary from costly patented2, 3 “accessories” to cheaper alternatives such as truncated 1 ml plastic syringes or nasopharyngeal cannulas as described by Bank and Song, Khoo et al. and Salhia et al.

In our experience, skin protection devices are advantageous. This is because the use of lubricating gels or Tegaderm can be displaced from repetitive motion or infiltration solution. Moreover, routine excision of skin edges or creation of larger port sites can result in longer and more visible scars. This is unappealing in our local Asian population, many of whom are predisposed to hypertrophic scarring.

The SAFE liposuction technique popularized by Wall and Lee is the senior author's preferred method of liposuction as it has better aesthetic outcomes and reduced contour deformities. This technique however mandates the use of a basket cannula for two additional stages of separation and fat equalization, compared to traditional liposuction. The basket cannula has a flared tip and its repetitive insertion and withdrawal can be markedly traumatic to the skin.

Despite the advantages that skin protection devices confer, a problem we have encountered is that these devices have a fixed luminal diameter, which does not accommodate the varying size of a basket cannula during repetitive insertion and withdrawal. This results in frequent dislodgement of the device. Hence an effective skin protection strategy is vital to minimize the development of friction burns or skin abrasions during SAFE liposuction.

We present a simple and economical method of SAFE liposuction cannula port site protection using a nasogastric tube. The nasogastric tube is readily available in the operating theater and has a low cost of approximately 8 USD. As nasogastric tubes are made of a mixture of rubber, polyurethane and silicone, they are soft and malleable unlike hard plastic syringes. They can also be reused for multiple port sites in the same patient.

The larger single lumen at its tip can be truncated and split along its length (Figure 1), with excision of 1/10th of the rubber tubing. This modified device is then secured to the port site with silk stitches (Figure 2). This allows sustained, durable protection of the skin as it is directly secured to the skin. More specifically, our modification of splitting the lumen of the nasogastric tube allows expansion of the cannula port site on insertion of the basket cannula and subsequent port site contraction on cannula withdrawal. This versatility in adapting to the fluctuating diameter of the basket cannula with repetitive motion as well as varying cannula sizes is advantageous compared to the rigid plastic syringe or intact luminal nasopharyngeal tubes.

Figure 1

The truncated larger single lumen which has been split to accommodate port site expansion and contraction.

Figure 2

Securing the nasogastric tube to the cannula port site with silk stitches.

Conflict of interest

The authors have no conflicts of interests to declare.

Funding

None.