Abdominal Wall Reconstruction Following Liposuction-Inflicted Abdominal Injuries: Review Of The Literature
Osama Darras, MD, PhD(c), Sara Yacoub, BA, MPH, Isaac Mordukhovich, BA, Diwakar Phuyal, MBBS, Raffi Gurunian, MD, PhD, Sarah N. Bishop, MD. Cleveland Clinic Foundation, Cleveland, OH, USA.

Background & Purpose

• Liposuction is the most common cosmetic procedure in the U.S., but it carries risks of serious complications.
• Complications from abdominal liposuction, like intraabdominal injuries, can be life-threatening and require prompt diagnosis
for better outcomes.
• Reconstruction of the abdominal wall may be needed, ranging from primary repair for small defects to complex methods
involving musculocutaneous flaps for larger defects.
• A unique case is presented involving bowel perforation from liposuction, leading to necrotizing fasciitis and complex
reconstruction with anterolateral thigh flaps.
• The study raises awareness of liposuction complications and highlights the need for improved patient assessment and
treatment strategies.

Case Presentation

• 51-year-old female with a BMI of 29.76 kg/m². Underwent gluteal fat grafting using abdominal fat
• Postoperative Day 6: admitted for altered mental status and lethargy, including jaundice.
• Notable for acute abdomen with purulent discharge. 5.
• CT showed partial small bowel obstruction, wall thickening, air bubbles suggesting bowel injury, extensive subcutaneous
edema, and signs of necrotizing fasciitis.
• Necrotizing fasciitis of the abdominal wall and buttocks.
• Exploratory laparotomy revealed extensive necrotic tissue, significant debridement of the abdominal wall and muscle.
• Left with an open abdomen and negative pressure wound therapy.
• Seven months later, the patient sought help for abdominal protrusion, with significant loss of domain and accompanying
gastrointestinal symptoms.
• Abdominal wall reconstruction proposed with Transverse Abdominis Release (TAR), mesh placement, and neurotized pedicled
anterolateral thigh flap with vastus lateralis muscle.
• The flap was tunneled under the rectus femoris and sartorius to adequately cover the defect.
• Both flaps were inset and sutured to the surrounding fascial edges after confirming proper coverage.
• Delayed skin grafting was opted for at the donor sites to achieve better contour and aesthetic results.
• Significant improvement in ambulation noted post-recovery, particularly in sitting down and standing up.
• Gastroenterological complaints became nearly negligible after surgery.
• The patient discontinued the use of the abdominal binder, enhancing comfort.
• Overall quality of life improved following the surgical intervention.
• The patient has been regularly attending outpatient clinic follow-up appointments for over a year.

References
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