Rapidly Fatal Necrotizing Fasciitis After Aesthetic Liposuction

Heitmann, Christoph; Czermak, Christoph; Germann, Günter

doi:10.1007/s002660010056

Cited by 60 publications

(21 citation statements)

References 7 publications

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“…Minor and major complications include necrotising fasciitis, toxic shock syndrome (usually with skin commensals Staphylococcus aureus, Streptoccus pyogens and beta haemolytic streptococcus, which have all been reported as near fatal complications of liposuction). [7][8][9] Major non fatal complications can occur in 0.14-0.38% of cases and include anaesthetic complications, deep venous thrombosis, pulmonary embolism and fat embolism. 1,3 Intraoperative acute fluid imbalance may cause acute renal failure, pulmonary oedema or cardiac failure and intraoperative cardiac arrest.…”

Section: Discussionmentioning

confidence: 99%

Splenic trauma during abdominal wall liposuction: a case report

2008

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SummaryA 35-year-old woman collapsed 18 hours after undergoing abdominal wall liposuction. Abdominal CT scan revealed a punctured spleen. She underwent an emergency splenectomy and made an uneventful recovery. Case reportA 35-year-old woman presented to plastic surgeons with increased adiposity in the lower trunk and upper thigh. She did not have any significant past medical or surgical history and was not taking any regular medications. Her preoperative haemoglobin level was 11.2 g/dL. She underwent abdominal wall and upper thigh tumescent liposuction through suprapubic and lateral abdominal wall stab incisions under general anaesthetic. She made an uneventful initial recovery from the anaesthetic and slept pain-free throughout the first night. Sixteen hours hours after surgery she complained of acute onset of severe generalized abdominal pain and abdominal distension and collapsed. On examination she had marked pallor and class II hypovolaemic shock. She responded to initial fluid resuscitation.She was transferred to an acute general surgery hospital. On admission she was noted to have marked pallor, severe hypovolaemic shock (class III) and a tense distended abdomen. The general surgery and anaesthetic team were paged as an emergency within five minutes of the patient arriving. She had superficial abdominal bruising at the site of liposuction and mild diffuse abdominal tenderness. There was no abdominal guarding or signs of peritonism present. The bowel sounds were reduced and digital rectal examination was normal. Her blood results revealed haemoglobin level of 3.6 g/dL. She made a moderate recovery to aggressive fluid resuscitation. She was urgently transfused six units of whole blood, type specific blood was given within 15 minutes, followed by cross-matched blood within one hour. After initial resuscitation her blood pressure was stable at 110/60. Her repeat haemoglobin level was 10.6 g/dL. She continued to have persistent tachycardia, with a pulse rate of 110 bpm.A rapid Focused Abdominal Sonography for Trauma (FAST) abdominal ultrasound scan was performed within 30 minutes, first by the emergency department consultant, then by the radiology specialist registrar. The FAST scan was positive for intra-abdominal fluid; the source of bleeding could not be identified, however, as the scan was difficult to interpret due to the recent liposuction. A computed tomography (CT) scan was done within a hour of the ultrasound scan. It showed a large volume of free intraperitoneal fluid in perihepatic space, paracolic gutters and pelvis. The spleen was displaced medially with heterogeneous haematoma seen laterally with active contrast extravasation indicating persistent bleeding. The haemorrhage was extraperitoneal but deep to the abdominal wall musculature (Figure 1).As the patient had continuing abdominal distension and pain she underwent an emergency laparotomy within 4 hours of arriving in the resuscitation room. Perioperatively, she received six units of packed red cells, three units of fresh frozen plasma, one un...

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Section: Discussionmentioning

confidence: 99%

Splenic trauma during abdominal wall liposuction: a case report

2008

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“…9 While this is the first case reported during a reconstructive procedure, there has been 1 report of group A STSS occurring in conjunction with necrotizing fasciitis after suction lipectomy. 13 In that instance, a 28-year-old previously healthy woman presented early in her postoperative course (day 2) with nonspecific influenza-like symptoms, as well as pain and local inflammation of the surgical site, and rapidly progressed to septic shock and multiorgan failure, resulting in death on postoperative day 5.…”

Section: Discussionmentioning

confidence: 99%

Streptococcal Toxic Shock Syndrome After Breast Reconstruction

Agerson

Wilkins²

2005

Annals of Plastic Surgery

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Streptococcal toxic shock syndrome (STSS) is an increasingly common disease entity but has rarely been described in the plastic surgery literature. We present the first known case of STSS associated with a reconstructive procedure. Two weeks postoperatively from a transverse rectus abdominis musculocutaneous flap for breast reconstruction, our patient presented with flulike symptoms and progressed rapidly to multiorgan failure. Though initially no nidus for infection was evident, the abdominal donor site was surgically debrided and found to contain group A Streptococcus. Following aggressive rehydration and antibiotic therapy, the patient gradually made a full recovery. In this case report, we review the presentation and epidemiology of STSS and compare it to the more common staphylococcal toxic shock syndrome. In addition, we discuss the management and outcomes of STSS, with an emphasis on raising clinical suspicion for this rare but dangerous entity.

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“…An NF patient's history often reveals recent minimal trauma or operative procedures (even esthetic liposuction); however, it may occur also in apparently intact skin [5,14,16,29]. NF is often caused by a polymicrobic infective process, supported especially by anaerobic and opportunistic bacteria.…”

Section: Etiology and Pathogenesismentioning

confidence: 99%

Necrotizing fasciitis: a surgical emergency

et al. 2010

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Accurate assessment and timely interventions are critical in the treatment of patients affected with necrotizing fasciitis, a rare, fulminating, potentially life-threatening, infectious process of the soft tissues. Understanding the natural history and unique characteristics of this disease is crucial to achieve early recognition, effective management and a favorable patient outcome. Classic symptoms include severe pain, erythema, mottling, crepitus, skin anesthesia, warmth, tenderness, bullous formations and edema in the affected area and fever. This article aims at reviewing the information known about this disease, collected from various sources. Radical surgical debridement, broad-spectrum antibiotics, negative pressure wound therapy and hyperbaric oxygen therapy are considered to be the cornerstones of treatment.

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Rapidly Fatal Necrotizing Fasciitis After Aesthetic Liposuction

Cited by 60 publications

References 7 publications

Splenic trauma during abdominal wall liposuction: a case report

Splenic trauma during abdominal wall liposuction: a case report

Streptococcal Toxic Shock Syndrome After Breast Reconstruction

Necrotizing fasciitis: a surgical emergency

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