Cuevas Bustos Raul, Cervantes Gutierrez Oscar, Perez Tristan Felix Alejandro, Acuña Macouzet Alejandro, Flores-Huidobro Martinez Angel, Jafif Cojab Marcos
Department of Surgery Hospital Angeles Lomas, Edo. Mexico, Mexico.
Universidad Anahuac, Edo. Mexico, Mexico.
Int J Surg Case Rep. 2020;77:677-681. doi: 10.1016/j.ijscr.2020.11.078. Epub 2020 Nov 22.
Liposculpture procedures have a complication rate of 5%, with the majority being minor complications. Infections in isolated liposuction procedures are as low as 0.1 % of cases. Necrotizing infections can occur after major traumatic injuries, as well as after minor breaches of the skin or mucosa. Here we present a case of a 53-year-old female patient who underwent cosmetic surgery and developed a necrotizing soft tissue infection and we will discuss the importance of early diagnosis, risk factors and preventive measures, treatment options and our management of this particular case.
53-year-old female patient with a history of multiple cosmetic surgeries, with no significant past medical history, she presented fever and disabling pain at the surgical site with extensive bullae formation; during her fourth post operative day, she presented septic shock that required vasopressor support and mechanical ventilation, accompanied by acute renal failure which required admission to the intensive care unit. The patient's relatives requested air transportation to bring the patient to our center. The patient remained hospitalized for 42 days in which 15 surgical interventions were performed including multiple surgical wound cleansing and debridement as well as placement of a negative pressure wound therapy system, flaps advancement, lesions reconstruction, graft procurements and insertions.
Antibiotic prophylaxis is recommended preferably with a second-generation cephalosporin, one hour prior to surgery and should be continued for 5-6 days afterwards. Likewise, prophylaxis with Flucloxacillin or gentamicin is recommended in the case of liposuction and or abdominoplasty. The microorganisms most frequently isolated in post-liposuction infections are Staphylococcus aureus, Streptococcus group A, Streptococcous pyogenes, and synergistic infections with anaerobes and facultative pathogens. Among the most severe complications of liposuction is necrotizing soft tissue infection (NSTI), which is an infection of the subcutaneous tissue that spreads to the underlying dermis and sometimes beyond including the fascia and muscle.
Rapid recognition of NSTI is life-saving and urgent, extensive debridement and prophylactic antibiotics are the mainstay treatment for this condition, multiple debridement procedures may be necessary for successful treatment.
脂肪雕塑手术的并发症发生率为5%，其中大多数为轻微并发症。单纯抽脂手术的感染率低至0.1%。坏死性感染可发生在重大创伤后，也可发生在皮肤或黏膜轻微破损后。在此，我们报告一例53岁女性患者，她接受美容手术后发生了坏死性软组织感染，并将讨论早期诊断的重要性、危险因素和预防措施、治疗选择以及我们对该特殊病例的处理。
一名53岁女性患者，有多次美容手术史，既往无重大病史，她在手术部位出现发热和剧痛，并伴有广泛的大疱形成；术后第四天，她出现感染性休克，需要血管活性药物支持和机械通气，同时伴有急性肾衰竭，需要入住重症监护病房。患者家属要求空运将患者送至我们中心。患者住院42天，期间进行了15次手术干预，包括多次手术伤口清洗和清创、负压伤口治疗系统的放置、皮瓣推进、创面重建、移植物获取和植入。
建议在手术前1小时预防性使用抗生素，最好使用第二代头孢菌素，术后应持续使用5 - 6天。同样，抽脂和/或腹部整形手术建议使用氟氯西林或庆大霉素进行预防。抽脂术后感染最常分离出的微生物是金黄色葡萄球菌、A组链球菌、化脓性链球菌以及厌氧菌和兼性病原菌的协同感染。抽脂最严重的并发症之一是坏死性软组织感染（NSTI），这是一种皮下组织感染，可蔓延至深层真皮，有时甚至累及筋膜和肌肉。
快速识别NSTI至关重要，紧急广泛清创和预防性使用抗生素是该病的主要治疗方法，可能需要多次清创手术才能成功治疗。
