Maintenance of subcutaneous cavities with CO2

Area of Science:

• Surgical Innovation
• Minimally Invasive Surgery
• Anesthesiology

Background:

• Mechanical retractors in endoscopic plastic surgery present significant drawbacks.
• A novel method using carbon dioxide (CO2) insufflation to create and maintain subcutaneous cavities was explored.

Purpose of the Study:

• To evaluate the efficacy of CO2 insufflation for creating subcutaneous cavities in a canine model.
• To assess the impact of different insufflation pressures and external compression on CO2 absorption and subcutaneous emphysema.
• To determine the safety and feasibility of this technique for endoscopic plastic surgery.

Main Methods:

• Sixteen dogs were divided into three groups (A, B, C) with varying CO2 insufflation pressures (15 mm Hg or 8 mm Hg) and external compression using Esmarch bandages.
• Pulmonary function was controlled with a volume-cycle ventilator.
• Arterial blood gas analyses (ABGA) were performed at multiple time points to monitor CO2 levels.

Main Results:

• Group A (15 mm Hg, no bandages) exhibited extensive subcutaneous emphysema and significant systemic CO2 increase (median 9.6 mm Hg).
• Group B (8 mm Hg, with bandages) showed minimal subcutaneous emphysema and a moderate CO2 increase (median 1.65 mm Hg), with no emphysema during insufflation.
• Group C (15 mm Hg, with bandages) demonstrated reduced emphysema compared to Group A, but higher CO2 levels (median 6.1 mm Hg) than Group B.

Conclusions:

• CO2 insufflation at 8 mm Hg, coupled with external compression (Esmarch bandages), effectively maintains open subcutaneous cavities while minimizing CO2 absorption.
• This technique significantly reduces the risk of subcutaneous emphysema, rendering the procedure safe for endoscopic plastic surgery.