Case Report on Necrotizing Fasciitis after Liposuction and Abdominoplasty

Summary

A woman developed necrotizing fasciitis 20 days after abdominoplasty and liposuction. Successful management involved aggressive surgical debridement, antibiotic bone cement application, VSD, and skin grafting. Quinolone-susceptible pathogens were identified. Multidisciplinary care achieved infection control and recovery, highlighting cosmetic surgery risks and the critical need for prompt intervention and asepsis.

Abstract

Liposuction and abdominoplasty are common cosmetic procedures, but they can lead to severe complications such as necrotizing fasciitis (NF), which is a life-threatening infection with rapid progression and significant mortality rates. NF can develop after surgical procedures due to bacterial colonization or inadequate postoperative care. In the case shown here, a 33-year-old woman presented with skin flap fascial necrosis with abdominal wall infection 20 days after undergoing abdominoplasty with liposuction at another private clinic. Initial management included incision and drainage of an abdominal wall sinus tract, debridement of necrotic tissue, and application of antibiotic bone cement, followed by vacuum sealing drainage (VSD). Postoperative blood tests and bacterial culture identified multiple pathogens, all susceptible to quinolones. Subsequent surgeries involved re-debridement and skin grafting. The patient received a comprehensive rehabilitation program, resulting in effective infection control and favorable outcomes. The case underscores the importance of early diagnosis and aggressive surgical debridement in managing NF. The use of antibiotic bone cement provided local high-concentration antibiotics and supported granulation tissue formation, contributing to the treatment of the wound. This rare complication highlights the potential risks of cosmetic surgery and the necessity of strict adherence to aseptic techniques.

Introduction

In recent decades, the field of plastic surgery has undergone significant expansion. Liposuction has become a common procedure in the field of plastic surgery, employed to decrease locally excessive fatty tissue in specific areas of the body. It serves as a solution for patients who are dissatisfied with the fat accumulation in specific areas of their bodies¹. The procedure can either be performed individually or in combination with other body contouring operations, such as abdominoplasty and mammoplasty, to achieve the ideal aesthetic form of the patient². Liposuction surgery can lead to various types of complications, ....

Protocol

This study was approved by the Clinical Research Ethics Committee of The First Affiliated Hospital of Zhejiang University School of Medicine (Reference Number: 2024-0844). Written informed consent was obtained. The study complied with the Declaration of Helsinki.

1. Patient admission and clinical evaluation

1. Initial presentation and history
   1. Skin flap necrosis was presented after the patient underwent prior cosmetic surgery and lasted for 20 days. Detailed medical history information was obtained.
2. Clinical assessment
   1. Physical examination was conducted, focused on the....

Results

This case demonstrates the synergistic effect of stepwise surgical debridement combined with antimicrobial stepping therapy and also highlights the efficacy of novel diagnostic methods like pathogen mNGS.The patient successfully underwent surgical exploration. Preoperative broad-spectrum antibiotic coverage with ertapenem sodium (1.0 g ivgtt qd) provided a safe window for surgery. Three staged debridement procedures progressively and thoroughly removed necrotic tissue. Culturing and mNGS of samples obtained during the in.......

Discussion

Liposuction and abdominoplasty are currently among the most common cosmetic surgical procedures. They achieve patients' desired aesthetic outcomes by reducing localized excess adipose tissue in specific body areas, making them highly popular^1,2,13. The fact that patients receiving cosmetic surgery are typically in good health and have high expectations makes it challenging for them to accept complications. Therefore, despite.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
3.0T MRI Scanner	General Electric Company	Not specified
Allis tissue forceps	Tonglu Changsheng Medical Instrument Co., Ltd.	CS-AL012
Bandage 8*600	Yongkang Weizhong Medical Instrument Co., LTD	WZ-BD822
Cotton balls	Henan Saizhong Medical Instrument Co., LTD	SZ-MQ100
Drain tube	Zhejiang Daweier Medical Technology Co., LTD	DW-YLF815
Dressing	Yongkang Weizhong Medical Instrument Co., LTD	WZ-FT326
Electrosurgical pencil	Xi 'an Surgical Medical Technology Co., LTD	XW-DDUNI25
Ertapenem sodium injection	Stone Pharmaceutical Group Ouyi Pharmaceutical Co., LTD	H20133325
Faropenem sodium granules	Hunan Warner Pharmaceutical Factory Co., LTD	H20080152
Fine gauze	Henan Saizhong Medical Instrument Co., LTD	SZ-SS422
Medium curved clamp	Tonglu Changsheng Medical Instrument Co., Ltd.	CS-ZW150
Mosquito forceps	Tonglu Changsheng Medical Instrument Co., Ltd.	CS-WS160
Moxifloxacin tablets	Bayer Pharma AG	H20140721
Nerve dissector	Shengxiang Medical Instrument Co., LTD	SX-BLZ280
Plastic surgery forceps, smooth	Shanghai Jinzhong Medical Instrument Co., LTD	JZ-YS344
Plastic surgery forceps, toothed	Shanghai Jinzhong Medical Instrument Co., LTD	JZ-WS368
Saline	CSPC Pharmaceutical Group Limited	CSPC-SS600
Scalpel handle #3	Shanghai Jinzhong Medical Instrument Co., LTD	JZ-DB334
Scissors	Shanghai Jinzhong Medical Instrument Co., LTD	JZ-ZZ580
Small suction tip	Yangzhou Pengyan Biotechnology Co., LTD	PY-FSXT106
Two-prong retractor	Shanghai Jinzhong Medical Instrument Co., LTD	JZ-LG253
VSD(AD-1-15*5*1)	Shanghai XiuHui Technology Co., Ltd.	Not specified