Plastic Surgery Complications: A Review for Emergency Clinicians

Abstract

The number of aesthetic surgical procedures performed in the United States is increasing rapidly. Over 1.5 million surgical procedures and over three million nonsurgical procedures were performed in 2015 alone. Of these, the most common procedures included surgeries of the breast and abdominal wall, specifically implants, liposuction, and subcutaneous injections. Emergency clinicians may be tasked with the management of postoperative complications of cosmetic surgeries including postoperative infections, thromboembolic events, skin necrosis, hemorrhage, pulmonary edema, fat embolism syndrome, bowel cavity perforation, intra-abdominal injury, local seroma formation, and local anesthetic systemic toxicity. This review provides several guiding principles for management of acute complications. Understanding these complications and approach to their management is essential to optimizing patient care. [West J Emerg Med. 2020;21(6)179-189.] aware of possible complications. METHODS This review focuses on the complications of the most common surgical procedures including liposuction, breast augmentation, abdominoplasty, and subcutaneous injections. We describe the expected presentations, evaluation, and emergent care required to manage post-cosmetic surgery complications. We performed a literature search of Medline,

Toxic shock syndrome complicated with symmetrical peripheral gangrene after liposuction and fat transfer: a case report and literature review

“…Blood, urine, and throat cultures are characteristically negative. Positive blood culture results are rare in staphylococcal TSS with less than 5% positive [ 1 ]. Despite a high fever and markedly increased white blood cell count, CRP, and PCT suggesting severe infection, the patient's blood culture results were consistently negative.…”

“…With more and more people pursuing the beauty of body shape, liposuction and autologous fat transplantation have become one of the most commonly used cosmetic surgery in the world [ 1 ]. The common complications of liposuction include seroma, hematoma, infection, lymphoedema, hyperpigmentation, asymmetry [ 2 , 3 ].…”

Severe Postoperative Bleeding Following Minor-to-Moderate Abdominal and Flank Liposuction Performed at a Day Surgery Center: A Case Report

“…Cosmetic procedures in general and liposuction specifically have gained popularity and are perceived by the public as minor procedures [ 9 – 11 ]. Liposuction is presented as being safe, relatively harmless, and quick [ 5 , 9 , 11 ].…”

“…Cosmetic procedures in general and liposuction specifically have gained popularity and are perceived by the public as minor procedures [ 9 – 11 ]. Liposuction is presented as being safe, relatively harmless, and quick [ 5 , 9 , 11 ]. Coupled with a lack of restrictive laws, it has become a procedure done by non-plastic surgeons and non-physicians [ 9 ].…”

LigaSure Impact™ reduces complications after abdominoplasty in weight loss patients

“…Seroma formation is the most common complication following abdominoplasty [ 3 ]. Hematoma, surgical site infection, wound dehiscence, and necrosis are frequently observed as well [ 4 ].…”