Singh Hardeep, Khazanchi Rakesh Kumar, Mahendru Sanjay
Division of Plastic, Reconstructive and Aesthetic Surgery, Medanta-The Medicity, Gurugram, India.
Indian J Plast Surg. 2019 May;52(2):238-241. doi: 10.1055/s-0039-1696079. Epub 2019 Sep 10.
Liposuction is one of the common cosmetic surgery procedures performed. Although rare, the complications associated with it are necrotizing soft tissue infection and bowel perforation. We would like to share our experience of such a complication that was managed successfully. We were referred a 65-year-old male patient with signs and symptoms of intestinal obstruction who had undergone liposuction of abdomen 1 week before and now had discoloration of the abdominal skin. The discoloration was present from just below the costal margin and was extending up to bilateral inguinal regions. Laterally the discoloration extended up to the mid axillary line on both sides. Imaging studies showed dilated small bowel. During laparotomy, he underwent debridement of all discolored skin and repair of the single jejunal perforation. Postoperatively patient was first managed on intravenous fluids, nasogastric aspiration and total parenteral nutrition for 10 days. The wound was managed with silver dressings that led to healthy granulations. The patient was at high risk for anesthesia for skin grafting; hence, he was managed with allograft for 10 days. The patient then underwent skin grafting once he was fit. The graft took up well and he resumed regular activities. This is unique as the patient had extensive necrotizing soft tissue infection of the abdominal skin after liposuction along with intestinal perforation and obstruction that was managed successfully due to aggressive surgical intervention, allograft, and good supportive care both in the intensive care unit and in ward.
抽脂术是常见的整形手术之一。尽管罕见，但与之相关的并发症有坏死性软组织感染和肠穿孔。我们想分享一例成功处理此类并发症的经验。我们接收了一名65岁男性患者，他有肠梗阻的症状和体征，一周前接受了腹部抽脂术，现在腹部皮肤变色。变色区域从肋缘下方开始，一直延伸至双侧腹股沟区。在身体两侧，变色区域向外延伸至腋中线。影像学检查显示小肠扩张。剖腹手术期间，对所有变色皮肤进行了清创，并修复了一处空肠穿孔。术后，患者首先接受了10天的静脉输液、鼻胃管抽吸和全胃肠外营养治疗。伤口用银敷料处理，形成了健康的肉芽组织。患者进行皮肤移植的麻醉风险很高，因此，给他使用同种异体移植物治疗了10天。患者身体恢复健康后接受了皮肤移植。移植效果良好，他恢复了正常活动。这一病例很独特，因为该患者抽脂术后腹部皮肤发生了广泛的坏死性软组织感染，同时伴有肠穿孔和肠梗阻，由于积极的手术干预、同种异体移植物治疗以及重症监护病房和病房的良好支持治疗，最终成功治愈。
