Pulmonary Fat Embolism Following Liposuction and Fat Grafting: A Review of Published Cases

Fat embolism syndrome following cosmetic breast reduction liposuction

Fat embolism syndrome (FES) is a rare but potentially life-threatening complication that is primarily associated with long bone fractures, although cases have been reported following soft tissue trauma and cosmetic surgeries such as liposuction. The diagnosis of FES relies on clinical features with no specific laboratory or imaging findings. We present a case of FES in an otherwise healthy man presenting to the emergency room for evaluation of tachycardia, hypoxia and drowsiness on postoperative day 1 following breast reduction liposuction. Based on the clinical picture and symptomatology with diagnostic workup excluding alternative diagnoses, the patient was diagnosed clinically with FES and treated supportively with supplemental oxygen. The patient quickly made a full recovery and was discharged from the hospital the following day without any residual symptoms at his follow-up appointments.

Is That Innocent to Touch the Adipose Tissue?: An Autopsy Case Series of Fat Embolism Syndrome

ABSTRACT

Although fat embolism in the pulmonary or systemic circulation is usually associated with long bone fractures, it can also occur less frequently during surgical operations, such as liposuction, fat grafting, and joint repair. This study aims to present cases of macro fat embolism resulting in sudden death during the perioperative period. Three cases with a history of sudden death during the perioperative period were included in this study. The surgical operation histories, autopsy findings, and histopathological findings of the cases were evaluated. Fat globules were detected in the medium-sized vessel lumens in the lungs of the cases who died suddenly during surgery. Grade 4 fat embolism was observed in the capillaries, which stained positively with Oil-Red-O in all three cases. Fat embolism syndrome is a rare but life-threatening condition that should be considered in patients with respiratory distress and impaired neurological status in the postoperative period.

Comment on Kao et al. Pulmonary Fat Embolism Following Liposuction and Fat Grafting: A Review of Published Cases. Healthcare 2023, 11, 1391

I recently read the review article entitled "Pulmonary Fat Embolism Following Liposuction and Fat Grafting: A Review of Published Cases" by Kao et al [...].

Correction: Kao et al. Pulmonary Fat Embolism Following Liposuction and Fat Grafting: A Review of Published Cases. Healthcare 2023, 11, 1391

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Fat embolism: the hidden murder for trauma patients!

INTRODUCTION

fat embolism syndrome (FES) is an acute respiratory disorder that occurs when an inflammatory response causes the embolization of fat and marrow particles into the bloodstream. The exact incidence of FES is not well defined due to the difficulty of diagnosis. FES is mostly associated with isolated long bone trauma, and it is usually misdiagnosed in other trauma cases. The scope of this study was to identify and search the current literature for cases of FES in nonorthopedic trauma patients with the aim of defining the etiology, incidence, and main clinical manifestations.

METHODS

we perform a literature search via the PubMed journal to find, summarize, and incorporate reports of fat embolisms in patients presenting with non-orthopedic trauma.

RESULTS

the final literature search yielded 23 papers of patients presenting with fat embolism/FES due to non-orthopedic trauma. The presentation and etiology of these fat embolisms is varied and complex, differing from patient to patient. In this review, we highlight the importance of maintaining a clinical suspicion of FES within the trauma and critical care community.

CONCLUSION

to help trauma surgeons and clinicians identify FES cases in trauma patients who do not present with long bone fracture, we also present the main clinical signs of FES as well as the possible treatment and prevention options.

Intraoperative Cardiac Arrest During Liposuction: A Case Report

Background

With the popularity of liposuction surgery, more awareness should be obtained regarding complications. Liposuction has been thought of as a safe procedure with a very low incidence of major complications. However, life-threatening risks of liposuction have rarely been reported.

Methods

We present a case of a 36-year-old woman who developed cardiac arrest during a liposuction procedure, and we present a literature review.

Results

She was previously healthy and had no risk factors for pulmonary embolism. The diagnosis was made based on clinical presentation and the presence of an electrolyte disorder and a positive sign on computed tomography pulmonary angiogram (CTPA). Mild hypothermia treatment, symptomatic treatment, and supportive therapy were applied. As the respiratory and circulation were smooth, she was discharged to a rehabilitation hospital. Seven months after discharge, the patient was still in a coma with eye opening.

Conclusions

Spinal anesthesia, pulmonary embolism, and hyperkalemia are the most probable contributors to the cardiac arrest observed during the liposuction procedure in this specific case. There is a heightened imperative to vigilantly monitor for critical incidents during these operations and to meticulously identify associated risk factors during liposuction.

Conversion to Autologous Breast Reconstruction with Latissimus Dorsi and Immediate Fat Grafting in Patients with Previous Implant Failure: An Efficient, Reproducible, and Safe Technique

Introduction  Implant-based breast reconstructions (IBBRs) increased last years despite the growing indications for radiotherapy in the treatment of breast cancer. As a result, complications and reconstructive failures associated to IBBR have increased. Autologous breast reconstruction (ABR) using fat-augmented latissimus dorsi (FALD) has become popular in recent years. Methods  We aimed to evaluate conversion to ABR using latissimus dorsi and immediate fat grafting in 61 cases with IBBR failure. Results  Immediate reconstruction was found significatively related with an increased number of surgeries resulting from IBBR complications ( p  < 0.001). Note that 41% of the cases presented a grade III/IV Baker and Palmer capsular contracture, 29% implant extrusion, and 21% implant infection. Mean survival of the first implant was 16.95 months. ABR process was completed in 47% of cases with a single surgery. Statistically significant differences were observed between this fact and previous IBBR failure due to infection ( p  = 0.03) or extrusion ( p  = 0.01). Mean volume of fat graft was 429.61 mL, mean length of the surgical procedure was 3.17 hours, and the average length of hospital stay after surgery was 2.67 days. Only 3.3% of the cases developed some major complication. None of the cases presented reconstructive failure. Conclusion  FALD is a very safe total ABR technique, an important fact in patients with previous reconstructive failures. The large volume of fat that can be grafted in a single surgery allows the reconstruction of breast in a reasonable size. The reduced length of surgery and hospital stay make the FALD technique an option to consider when an autologous but efficient and safe reconstruction is desired.

Comparative Analysis of Stromal Vascular Fraction and Alternative Mechanisms in Bone Fracture Stimulation to Bridge the Gap between Nature and Technological Advancement: A Systematic Review

BACKGROUND

Various stimulation methods, including electrical, ultrasound, mechanical, and biological interventions, are explored, each leveraging intricate cellular and molecular dynamics to expedite healing. The advent of stromal vascular fraction (SVF) marks a significant stride, offering multifarious benefits in bone healing, from enhanced bone formation to optimal vascular integration, drawing a harmonious balance between innate mechanisms and scientific advancements.

METHODS

This systematic review was conducted focusing on literature from 2016 to 2023 and encompassing various bone healing stimulation mechanisms like SVF, electrical, ultrasound, and mechanical stimulation. The extracted data underwent meticulous synthesis and analysis, emphasizing comparative evaluations of mechanisms, applications, and outcomes of each intervention.

RESULTS

The reviewed studies reveal the potential of SVF in bone fracture healing, with its regenerative and anti-inflammatory effects. The purification of SVF is crucial for safe therapeutic use. Characterization involves flow cytometry and microscopy. Studies show SVF's efficacy in bone regeneration, versatility in various contexts, and potential for clinical use. SVF appears superior to electrical, ultrasound, and mechanical stimulation, with low complications.

CONCLUSIONS

This review compares bone healing methods, including SVF. It provides valuable insights into SVF's potential for bone regeneration. However, due to limited human studies and potential bias, cautious interpretation is necessary. Further research is essential to validate these findings and determine the optimal SVF applications in bone healing.