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.
