Grolleau J L, Rouge D, Chavoin J P, Costagliola M
Service de Chirurgie Plastique Reconstructrice et Esthétique, CHU de Toulouse, Hôpital Rangueil.
Ann Chir Plast Esthet. 1997 Feb;42(1):31-6.
The authors report the case of a young patient who developed extensive skin necrosis after ultrasound liposuction of the medial surface of the thigh. These lesions required excision, split-skin graft and installation of an expansion prosthesis. The medicolegal aspects of this case are discussed, in particular the responsibility of the doctor who performed this damaging procedure, from three points of view: damage, fault, causality. In this case, the damage corresponded to necrosis which can be due to a chemical, infectious or thermal mechanism. It is responsible for serious damages due to the number of operations, the length of hospital stay, immobilization, rehabilitation and the time off work. The aesthetic damage, the pretium doloris, and the inconvenience are certainly considerable, but was there fault in this case? Fault by clumsiness if the equipment was used abnormally; fault by negligence or imprudence when the equipment was not approved or when the operator was not a qualified physician, submitting his patient to undue risks. The causality is envisaged in the case of chemonecrosis and burns. It would be strongly presumed in a civil procedure in case of non-approved equipment. The authors are in favour of a hypothesis of a burn and review the current state of ultrasound liposuction, which was the subject of an intense media campaign several years ago.
作者报告了一例年轻患者的病例，该患者在大腿内侧进行超声吸脂术后出现广泛的皮肤坏死。这些病变需要进行切除、植皮和安装扩张假体。本文从损害、过错、因果关系三个角度讨论了该病例的法医学问题，特别是实施了这一破坏性手术的医生的责任。在该病例中，损害表现为坏死，其可能由化学、感染或热机制引起。由于手术次数、住院时间、固定、康复以及误工时间，坏死造成了严重损害。美学损害、疼痛赔偿和不便肯定相当大，但在这种情况下是否存在过错呢？如果设备使用异常，存在操作笨拙的过错；如果设备未经批准或操作人员不是合格医生，使患者承受不当风险，则存在疏忽或轻率的过错。在化学性坏死和烧伤的情况下会考虑因果关系。在设备未经批准的情况下，在民事诉讼中会强烈推定存在因果关系。作者支持烧伤的假设，并回顾了超声吸脂的现状，超声吸脂在几年前曾是一场激烈媒体宣传活动的主题。
