Necrotizing Soft Tissue Infection of Abdominal Wall after Lipoabdominoplasty: Complication following Medical Tourism

Abstract

According to the International Society of Aesthetic Plastic Surgery, surgical and nonsurgical aesthetic procedures increased in 2019 by 7.1% and 7.6%, respectively, compared with 2018. 1 Cosmetic medical tourism saw a concurrent increase during this time. Countries receiving the highest percentage of foreign patients were Thailand (33.2%), Mexico (22.5%), and Turkey (19.2%). 1 Many patients travel abroad due to reduced cost, cultural similarity between patient and providers, easy accessibility, and availability of procedures not performed in home country. 2,3 However, foreign regulations and safety standards for facilities, drugs, medical products, and devices may vary, and in some circumstances, be more lax than in the United States, increasing risk of postsurgical complications. 2 Additionally, patients who travel for procedures often lack follow-up with their surgeons, delaying timely detection of complications. 3 Common complications following cosmetic surgery performed abroad include wound infection, poor wound healing, wound dehiscence, and thromboembolic events. [2][3][4] Patients are also at risk of postsurgical infection associated with foreign pathogens. 2,4 This case highlights a patient presenting with serious surgical and medical complications post-lipoabdominoplasty performed in Latin America, emphasizing burdens on home healthcare system and importance of patient education. CASE REPORTA 48-year-old woman with no reported medical history underwent elective ventral hernia repair, liposuction, and abdominoplasty in Latin America. The patient reportedly had anaphylactic shock after receiving diclofenac postoperatively, and was transported via air to our hospital in San Antonio, Texas. On hospital day 2, the patient underwent emergent exploratory surgery due to tender abdomen, hemorrhagic bullae (Fig. 1), and ecchymosis (Fig. 2) found on examination, suggesting infection. In the OR, necrotizing soft tissue infection (NSTI) of the abdominal wall was observed; necrotic sections of abdominal wall were debrided with two areas of fascial debridement in right and left upper quadrants. Bowel perforation at the hepatic flexure was incidentally

Complications of Medical Tourism in Aesthetic Surgery

“…This analysis incorporated a total of 44 studies that were published between 2007 and 2022. A detailed breakdown of the data extracted from each article is present in Supplemental Table 2, http://links.lww.com/SAP/A889 6–47 . The total number of patients that were reported in the literature to have undergone medical tourism for cosmetic procedures was 589 patients.…”

Challenges with medical tourism

“…A search on PubMed revealed 13 studies presenting original data on medical tourism-associated infectious complications published from July 1, 2022 to January 1, 2024 [2 ▪ ,8 ▪ ,9 ▪▪ ,10 ▪▪ ,11 ▪▪ ,13 ▪ ,14 ▪ ,19 ▪▪ ,20,21 ▪ –24 ▪ ]. Their characteristics are shown in Table 1.…”

“…Although her symptoms started in the early postoperative period, the patient was hospitalized in her home country seven days later, where she was admitted in the intensive care unit, received mechanical ventilation, and underwent surgical debridement [14 ▪ ]. After bariatric surgery in Latin America, a 48-year-old woman developed necrotizing SSI on the abdominal wall which was complicated by bowel perforation and anaphylactic shock after receiving diclofenac postoperatively [13 ▪ ]. The patient underwent extensive surgeries and received many antibiotic courses after being transported to a US hospital.…”

“…Candida species was detected on tissue cultures and the patient completed seven days of micafungin. During her hospitalization she also developed Acinetobacter pneumonia and Pseudomonas urinary tract infection [13 ▪ ]. NTM and fungal infections in medical tourists have been linked to gaps in infection prevention, particularly in inadequate sterile procedures or use of contaminated water [5,6 ▪ ,23 ▪ ].…”

“…A striking example is the recent outbreak of fungal meningitis with several deaths that occurred among United States (US) residents who received epidural anesthesia for cosmetic procedures in two clinics in Mexico [9 ▪▪ –11 ▪▪ ]. Currently, there is an increasing number of articles reporting infectious complications following medical tourism [9 ▪▪ –11 ▪▪ ,12 ▪ –14 ▪ ].…”