Abstract and Introduction
Summary: 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.
The gluteal fat grafting procedure has gained significant popularity in recent years. Despite its reputation, serious complications such as abscess formation, fat embolism, residual deformity, sepsis, and even death have been reported. Improper technique, specific sites of fat injection, and insufficient postoperative management can contribute to the development of these adverse outcomes. We present an unusual complication of Enterococcal faecalis pyomyositis infection within the subfascial compartment of the lateral thigh, following gluteal fat grafting. The importance of early diagnosis and treatment are discussed.
Plast Reconstr Surg Glob Open. 2021;9(4):e3515 © 2021 Lippincott Williams & Wilkins