Necrotizing fasciitis after aesthetic trunck liposuction

Necrotizing fasciitis is a rare complication that can occur after cosmetic surgeries, including Liposuction. We present a case of necrotising fasciitis in a 45-year-old man who underwent cosmetic liposuction of back and flanks, as well as abdominoplasty and periareolar mastopexy alio loco. The diagnosis of necrotising fasciitis was 16 days after operation, leading to pain out of proportion, localised redness, heat, swelling and dish-water like fluid secretion from the wound. Laboratory tests show an ongoing multiorgan dysfunction. Immediate surgical interventions were performed with a radical necrosectomy, including excision of the left latissimus dorsi and caudal trapezius muscle as well as parts of the autochthonous back muscle fascia. Microbiological examination showed Corynebacteria and coagulase neg. Staphylococcus. Multiple surgical treatments including programmed re-debridement on first, second and third postoperative days were performed. Firstly we kept the wound open with inserted swabs. After comprehensive ICU therapy with 4 days of mechanical ventilation, catecholamins and an extensive antibiotic therapy, the patient showed a rapid improvement in his general state of health. On the 5th day we performed a vacuum assisted closure therapy. We were able to close the wound by primary closure on the 9th day. 10 days after the initial operation the patient left the ICU and after 25 days he was discharged in an excellent state of health. This case shows the risk of necrotizing fasciitis even in cases after liposuction and that it can only be treated by immediate radical necrosectomy.