Commentary on: Vibration Exposure Safety Guidelines for Surgeons Using Power-Assisted Liposuction (PAL) Free

Although hand-arm vibration syndrome (HAVS) is recognized within fields such as construction, forestry, and manufacturing where there is frequent exposure to hand-held vibrational equipment, this syndrome has generally received minimal attention as an occupational hazard within healthcare. Our use of vibrating tools may seem trivial compared to those who handle jackhammers or chainsaws, but the threshold for developing this devastating chronic condition may surprisingly be within reach of surgeons who find themselves performing power-assisted liposuction (PAL) regularly.

As the authors have summarized, HAVS is a complex condition resulting from prolonged exposure to vibration from hand-held tools.¹ The constellation of symptoms overlaps significantly with that of compression neuropathy (eg, carpal tunnel syndrome) and vascular disorders (eg, Raynaud’s phenomenon and hypothenar hammer syndrome). The clinical manifestations, including vasospasm, neurogenic pain, and musculoskeletal derangements, have been well documented. However, the pathophysiology, diagnosis, and management of HAVS remain insufficiently studied and incompletely understood. Furthermore, HAVS is progressive and currently considered irreversible. Among hand specialists, clinical experience with this disorder is widely variable and perhaps correlates most with whether one’s patient population includes a particular cross-section of industrial workers well covered by workers’ compensation insurance.

Given the paucity of studies into HAVS in our field, the authors have thoughtfully generated meaningful and seminal data that are relevant to plastic surgeons. One particular strength of their study is the fact that standardized methods were utilized to examine not only the vibration emission of the PAL device in a controlled setting, but also “real-world” vibration exposure for surgeons during actual liposuction procedures. The authors cogently translated and contextualized their findings against a limited body of information that primarily exists within occupational safety literature. I concur with the their hypothesis that vibrational energy exposure from a PAL device could be affected by factors such as cannula size, patient tissue characteristics, and surgeon technique. Most compelling to me is the finding that certain conditions (specifically a larger cannula size in this study) could significantly lower the exposure threshold for injury well below that reported by the manufacturer—which in the context of occupational safety should ring alarm bells. The main caveat I would draw from a hand surgery perspective is to emphasize one of the author’s initial discussion points—that is, the existing recommendations and guidelines for the management of HAVS derive primarily from epidemiologic data in heavy industrial fields.^2,3 Within these constraints, I believe that the authors did formulate rational conclusions and reasonable recommendations that deserve consideration by any surgeon who performs PAL on a regular basis.

In addition to future efforts to refine our understanding of the vibration injury risk with PAL, I hope this study will continue to stimulate further investigation into the large knowledge gaps about HAVS. From a global perspective, the dose-response relation between vibration exposure and the development of HAVS is not well studied; and thus, the very diagnosis and staging of this condition still remain challenging.^4-6 Much of the pathophysiology also has yet to be elucidated, despite important advances over the years to better understand the vascular and neurologic injuries involved.^7-11 In conclusion, I commend the authors on their timely investigation into an ignored but potentially serious occupational hazard for plastic surgeons.

Disclosures

The author declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Funding

The author received no financial support for the research, authorship, and publication of this article.

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