by Jeffrey A. Klein, 470 pp, with 575 illus (75 full color), $250, ISBN 0-8151-5205-1, St Louis, Mo, Mosby, 2000.
Tumescent Technique by Jeffrey Klein, MD, is a very important addition to the liposuction literature, written by the man who pioneered tumescent anesthesia. Reading this book in its entirety, one can appreciate the clarity and consistency in quality of information provided by a single-authored text. The first 2 sections, "History of Tumescent Liposuction" and "Two Standards of Care for Liposuction," could have been subtitled "The Dangers of Super-wet or Nontumescent Liposuction." The first few chapters of the book set the tone for these sections, which are in essence an astute, opinionated editorial on the current state of liposuction practice. The author wades into the political debate over which specialty is most qualified to do liposuction. His treatise on the essential skills for good liposuction technique is eloquently argued. He advocates a less aggressive approach to liposuction focused on patient safety. There is a direct call to share knowledge and stop territorial interspecialty bickering. In chapter 5 there is a detailed analysis on the dearth of data on complications and fatal outcomes in regard to liposuction or any other procedures performed in ambulatory care facilities. Chapters 7, 9, 10, 11, and 13 should definitively discredit liposuction performed under general anesthesia with the super-wet technique. A thorough explanation of the physiology of fluid balances, a review of the literature on the dangers inherent to general anesthesia, and case reports of adverse events related to liposuction substantiate his compelling argument against the use of subtherapeutic doses of tumescent anesthesia in combination with general anesthesia for liposuction. Klein's digressions into defining terminology to set up his reasoning can be excessive, but in the end, his points are well supported. The chapter on complications has excellent photographs.
Lawrence N. Tumescent Technique: Tumescent Anesthesia & Microcannular Liposuction. Arch Dermatol. 2002;138(3):416-417. doi:10.1001/archderm.138.3.416