Neiman Ariel, Sadeh Omer, Dudaie Shay, Shoufani Aziz
Plastic & Reconstructive Surgery Department, HaEmek Medical Center, Afula, Israel.
Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
Plast Reconstr Surg Glob Open. 2021 Apr 8;9(4):e3515. doi: 10.1097/GOX.0000000000003515. eCollection 2021 Apr.
Subfascial abscess of the lateral thigh is a relatively uncommon complication following gluteal fat grafting due to their subclinical presentation. Despite its rarity, subfascial abscesses can be dangerous and life-threatening when diagnosis is delayed. In this case report, we present a 28-year-old woman who presented to our hospital with swelling and erythema following a gluteal fat grafting procedure performed abroad. Our initial treatment which included transcutaneous drainage and systemic antibiotics was unsuccessful. This conservative approach was influenced by the patient's initial procedure and attempt to conserve aesthetic appearance. The severity of the complication was not entirely known until advanced radiological imaging (computer tomography imaging) was performed several days after hospitalization and revealed large subfascial abscess. Surgical drainage with fasciotomy was required due to a persisting high fever and fluid accumulation in the lateral thigh. Approximately 1 L of purulent fluid was collected, containing large bulks of fat particles and blood clots that drained from the subfascial space. The wound was left open and treated with vacuum-assisted closure. Direct penetration of cannula through fascial layer, insertion of harvested fat that exceeds intrinsic properties of fascia, or unknown intercompartment connections can lead to deep subfascial migration of fat. Aggressive measures that include immediate advanced radiological imaging should be performed when the severity of damage and migration of injected fat are unknown. Transcutaneous drainage is not effective for subfascial abscesses due to formation of large fat particles and blood clots that cannot be drained. Immediate incision and drainage should be considered for similar cases.
大腿外侧筋膜下脓肿是臀脂肪移植后一种相对罕见的并发症，因其临床表现不明显。尽管罕见，但如果诊断延迟，筋膜下脓肿可能很危险甚至危及生命。在本病例报告中，我们介绍了一名28岁女性，她在国外进行臀脂肪移植手术后因肿胀和红斑前来我院就诊。我们最初的治疗方法包括经皮引流和全身使用抗生素，但未成功。这种保守方法受到患者最初手术情况以及试图保留美观外观的影响。直到住院几天后进行了先进的影像学检查（计算机断层扫描成像）并发现巨大的筋膜下脓肿，才完全了解并发症的严重程度。由于持续高烧和大腿外侧积液，需要进行筋膜切开术的手术引流。大约收集了1升脓性液体，其中含有大量从筋膜下间隙引流出来的脂肪颗粒和血凝块。伤口敞开并用负压封闭引流治疗。套管直接穿透筋膜层、注入超过筋膜固有特性的采集脂肪或不明的间隔间连接可导致脂肪在筋膜下深层迁移。当注射脂肪的损伤和迁移严重程度不明时，应采取包括立即进行先进影像学检查在内的积极措施。由于形成了无法引流的大量脂肪颗粒和血凝块，经皮引流对筋膜下脓肿无效。对于类似病例应考虑立即切开引流。
