What can a doctor do to reduce the risk of a pulmonary enbolism during surgery?

What do you do as a doctor to reduce the risk of a P.E in your pts. During SX?

Doctor Answers 5

Body lift - reducing risk of pulmonary embolism

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Thank you for asking about your body lift and pulmonary embolism.
  • This is my approach -
  • First, calculate risk of DVT 
  • If risk is high, give enoxaparin after surgery and maybe a leg ultrasound at 2 days looking for clots
  • If risk is moderate, consider no enoxaparin but a leg ultrasound the day after surgery to check for clots
  • (Blood clots begin during surgery)
  • If risk of low, no enoxaparin, no ultrasound.
  • But I always, always make sure body lift patients are up and walking the day after surgery
  • Even people at low risk can get blood clots if they stay in bed most of the time.
Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Lovenox to Prevent Pulmonary Embolism #bodycontouring

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  • We place all of our tummy tuck and lower body lift patients on Lovenox (an injectable blood thinner) for one week after their procedure. 
  • Tummy tuck and lower body lift patients are at an increased risk for developing a clot in their leg (DVT: deep vein thrombosis).  If this clot travels to the lungs this is called a pulmonary embolism (PE), and this can be disastrous.  
  • Therefore, in order to maximally prevent this from occurring we prescribe Lovenox for our patients.
  • There is theoretically an increased risk of bleeding on Lovenox, but in practice we have not seen an increase in post-operative bleeding. 
  • Other ways to help prevent a pulmonary embolism involve placing special squeezers on your calves during surgery, and these devices are known as sequential compression devices.  All surgeons use these.
  • Post-operatively, being active by walking around can also prevent a pulmonary embolism.
  • Definitely discuss your concerns with your plastic surgeon. 

How to avoid pulmonary embolism during surgery

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This is such a good question.    A full honest interpretation of your condition by your chosen Plastic Surgeon will help you greatly.  There will be intrinsic, internal blood conditions which you may have that have to be considered, as well as elements of your  age, weight, medical conditions, use of medicines, smoking, use of birth control pills, previous history of having a pulmonary embolus, varicose vein history, length and type of surgery, smoking etc.  Do you see what I mean?There is a product tha is called Lovenox, used as a blood thinner, that may be used when needed.  Pressure garments on the ledges, leg positions  with mild flexing at the knee, as well as the use of sequential compression devices applied to the legs or arms, started before the patient has general anesthesia begun in surgery, is so important.
Discuss this with your surgeon, and good luck to you.
Frank Rieger M.D.  Tampa Plastic Surgeon

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P.E. during surgery

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This is a good question and something that we as plastic surgeons take seriously. Taking a good history is the first step before surgery to identify high risk patients. Sequential compression devices during surgery, Lovenox or Heparin before surgery and early ambulation after surgery have all been shown to decrease the chances of blood clots.

Reducing PE

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Thank you for your question.   Your risk is defined by many factors. Some factors may include: if you have had cancer before, the length of your surgery, the medications that you may be on, your ability to walk after surgery and family history. The screening for PE starts before surgery. The things a doctor can do in surgery is to place compression stockings, and calf sqeezing devices. Also limit the time of surgery and if it is a long surgery, then work with your primary care.  On the other hand your job is to walk as much as possible after surgery and follow directions from your doctor. Taking precautions like going to a reputable Doctor rather than the cheapest person or a non-board certified person is also important. Reputable doctors care about their reputation and their patients. Find someone who is a board certified plastic surgeon, has a good reputation and takes time to make you feel comfortable.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.