An Unusual Complication Following Gluteal Fat Grafting

A Case Report

Ariel Neiman, MD; Omer Sadeh, MS; Shay Dudaie, BS; Aziz Shoufani, MD


Plast Reconstr Surg Glob Open. 2021;9(4):e3515 

In This Article

Case Report

An otherwise healthy 28-year-old woman presented to our emergency room with severe intense pain of the lateral right thigh 4 days after she underwent gluteal augmentation with a fat grafting procedure done abroad. Details regarding the surgical procedure were not attainable, but postsurgical incisions were noted in the superior gluteal regions most consistent with gluteal augmentation findings. Initial physical examination showed good general condition, body temperature of 36°C, and severe swelling of the right thigh with mild erythema. Blood tests revealed elevated WBC count (18,000/mm3) and CRP level 27. A Doppler ultrasound ruled out deep vein thrombosis. She was admitted to our plastic surgery department for observation and pain control. On postoperative day (POD) 5, Cefazolin 1 g TID was administered for suspected cellulitis. On follow-up during hospitalization, POD 4–7 showed mild improvement in the swelling of the right thigh and reduced pain. On POD 7, the patient's body temperature rose to 39°C, with elevated WBC count and CRP level. A computed tomographic scan image with contrast material confirmed subfascial accumulation of fluid (2.7 × 8 × 21 cm) in the lateral aspect of the thigh suspected for abscess (Figure 1). Additionally, subfascial fat accumulation below the right gluteus medius and minimus, with no signs of abscess, was noted on imaging. Transcutaneous drainage of the lateral thigh abscess with an FR10 catheter was done under ultrasound control. The drain was left in place for continuous drainage. On POD 9, 2 days following the drainage insertion, 350 cm3 liquified fat was collected. Clinical improvement included the elimination of fever, and substantial reduction in swelling and edema. On POD 10, the drainage stopped, leading to drain removal. Drain abscess cultures grew Enterococcus faecalis, prompting infectious disease specialists to recommend ampicillin, metronidazole, and ciprofloxacin. On POD 12, the patient's body temperature rose above 39°C, and WBC levels to 20,000/mm3. A second transcutaneous drainage was done under ultrasound control, which yielded 100 cm3 of purulent fluid (Figure 2). The intravenous antibiotics regimen did not change. On POD 13, elevation in body temperature and in WBC count (20,000/mm3) persisted. Further, MRI imaging showed residual collections in the lateral aspect of the right thigh. Considering the clinical situation and the MRI finding, immediate surgical drainage was done under general anesthesia. This resulted in approximately 1 L of purulent fluid, which contained large bulks of fat particles and blood clots that drained from the subfascial space (Figure 3). (See Video [online], which displays intraoperative findings.). The wound was left open and treated with vacuumassisted closure. At POD 48, a delayed closure was done.

Figure 1.

Computed tomographic scan image showing subfascial accumulation of fluid (2.7 × 8 × 21 cm) in the lateral right thigh.

Figure 2.

Transcutaneous drainage of 100 cm3 purulent fluid from the lateral thigh.

Figure 3.

Purulent fluid consisting of large fat particles and blood clot formation following incision and drainage.