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Fat Embolism Syndromes Following Liposuction

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Abstract

Fat embolism syndrome (FES) after liposuction is likely a life-threatening disorder, though its incidence is low. The three chief clinical manifestations include respiratory insufficiency, cerebral involvement, and petechial rash. Although FES is a multisystem disorder, the most seriously affected organs are the lungs, brain, cardiavascular system, and skin. Many laboratory findings are characteristic but nonspecific. The pathogenesis of FES after liposuction has been looked at both mechanically and biochemically. Diagnosis is difficult; Gurd and Wilson’s diagnostic criteria based on clinical examination is still extensively used in clinics at present. There is no specific therapy for FES after liposuction for the moment, so prevention, early diagnosis, and supportive therapies are important. In this article we discuss the clinical presentation, pathogensis, and current methods to prevent FES and, if possible, ways to treat this complication.

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References

  1. Levy D (1989) The fat embolism syndrome. Clinical orthopaedics and related research. 261:271–276

    Google Scholar 

  2. Fulde GW, Harrison P (1991) Fat embolism–a review. Arch Emerg Med 8:233–239

    PubMed  CAS  Google Scholar 

  3. Glover P, Worthley LIG (1999) Fat embolism. Crit Care Resusc 1:226–274

    Google Scholar 

  4. Georgopoulos D, Bouros D (2003) Fat embolism syndrome: clinical examination is still the preferable diagnostic method. Chest 123(4):982–983

    Article  PubMed  Google Scholar 

  5. Jacobson DM, Terrence CF, Reinmuth OM (1986) The neurologic manifestations of fat embolism. Neurology 36:847

    PubMed  CAS  Google Scholar 

  6. Van Besouw JP, Hinds CJ (1989) Fat embolism syndrome. Br J Hosp Med 42:304–311

    PubMed  Google Scholar 

  7. Meeke RI, Fitzpatrick GJ, Phelan DM (1987) Cerebral oedema and the fat embolism syndrome. Intensive Care Med 13:291

    Article  PubMed  CAS  Google Scholar 

  8. Laub DR Jr, Laub DR (1990) Fat embolism syndrome after liposuction: a case report and review of the literature. Ann Plast Surg 25(1):48–52

    Article  PubMed  Google Scholar 

  9. Bulger EM, Smith DG, Maier RV, Jurkovich GJ (1997) Fat embolism syndrome: a 10-year review. Arch Surg 132:435–439

    PubMed  CAS  Google Scholar 

  10. Johnson MJ, Lucas GL (1996) Fat embolism syndrome. Orthopedics 19:41–48; discussion 48–99

    PubMed  CAS  Google Scholar 

  11. Adams CB (1971) The retinal manifestations of fat embolism. Injury 2:221

    Article  PubMed  CAS  Google Scholar 

  12. Taviloglu K, Yanar H (2007) Fat embolism syndrome. Surg Today 37:5–8

    Article  PubMed  CAS  Google Scholar 

  13. Chastre J, Fagon J, Soler P, Fichelle A, Dombret MC, Huten D, Hance AJ, Gibert C (1990) Bronchoalveolar lavage for rapid diagnosis of the fat embolism syndrome. Ann Intern Med 113:583–588

    PubMed  CAS  Google Scholar 

  14. Ross R, Johnson G (1988) Fat embolism after liposuction. Chest 93:1294–1295

    Article  PubMed  CAS  Google Scholar 

  15. Peltier LF (2004) Fat embolism: a perspective. Clin Orthop Relat Res 422:148–153

    Article  Google Scholar 

  16. Kenkel J, Brown S, Love E, Waddle JP, Krueger JE, Noble D, Robinson JB Jr, Rohrich RJ (2004) Hemodynamics, electrolytes, and organ histology of larger-volume liposuction in a porcine model. Plast Reconstr Surg 113(5):1391–1399

    Article  PubMed  Google Scholar 

  17. Arbus L, Fabre J, Bechac G, Lazorthes Y (1973) Clinical, ophthalmoscopic and biological findings in systemic fat embolism. Pathogenetic theory and treatment in 30 cases. Acta Neurochir (Wien) 29:89–104

    Article  CAS  Google Scholar 

  18. Liljedahl SO, Westermark L (1967) Aetiology and treatment of fat embolism. Report of five cases. Acta Anaesthesiol Scand 11:177–194

    Article  PubMed  CAS  Google Scholar 

  19. Malagari K, Economopoulos N, Stoupis C, Daniil Z, Papiris S, Müller NL, Kelekis D (2003) High-resolution CT findings in mild pulmonary fat embolism. Chest 123:1196–1201

    Article  PubMed  Google Scholar 

  20. Kao SJ, Yeh DY, Chen HI (2007) Clinical and pathological features of fat embolism with acute respiratory distress syndrome. Clin Sci (Lond) 113:279–285

    CAS  Google Scholar 

  21. Rae D, Porter J, Beechey-Newman N, Sumar N, Bennett D, Hermon-Taylor J (1994) Type 1 prophospholipase A2 propeptide in acute lung injury. Lancet 344:1472–1473

    Article  PubMed  CAS  Google Scholar 

  22. Karagiorga G, Nakos G, Galiatsou E, Lekka ME (2006) Biochemical parameters of bronchoalveolar lavage. Intensive Care Med 32:116–123

    Article  PubMed  CAS  Google Scholar 

  23. Hsu YH, Kao SJ, Lee RP, Chen HI (2003) Acute pulmonary oedema: rare causes and possible mechanisms. Clin Sci (Lond) 104:259–264

    CAS  Google Scholar 

  24. Parisi DM, Koval K, Egol K (2002) Fat embolism syndrome. Am J Orthop 31:507–512

    PubMed  Google Scholar 

  25. Nakamura K, Ienaga K, Yokozawa T, Fujitsuka N, Oura H (1991) Production of methylguanidine from creatinine via creatol by active oxygen species: analyses of the catabolism in vitro. Nephron 58:42–46

    PubMed  CAS  Google Scholar 

  26. Fabian TC (1993) Unravelling the fat embolism syndrome. N Engl J Med 329:961–963

    Article  PubMed  CAS  Google Scholar 

  27. Iverson RE, Lynch DJ (2003) The ASPS committee on patient safety. Practice advisory on liposucton. Plast Reconstr Surg 113(5):1478–1489

    Article  Google Scholar 

  28. Lequire VS, Shapiro JL, Lequire CB, Cobb CA Jr, Fleet WF Jr (1959) A study of the pathogenesis of fat embolism based on human necropsy material and animal experiments. Am J Pathol 35(5):999–1015

    PubMed  CAS  Google Scholar 

  29. Yves GI (2006) Complications of liposuction. Clin Plast Surg 33:129–163

    Article  Google Scholar 

  30. King EG, Wagner WW Jr, Ashbaugh DG, Latham LP, Halsey DR (1971) Alterations in pulmonary microanatomy after fat embolism. Chest 59:524

    Article  PubMed  CAS  Google Scholar 

  31. Pell AC, Hughes D, Keating J, Christie J, Busuttil A, Sutherland GR (1993) Brief report: fulminating fat embolism syndrome caused by paradoxical embolism through a patent foramen ovale. N Engl J Med 329:926–929

    Article  PubMed  CAS  Google Scholar 

  32. Gurd AR (1970) Fat embolism; an aid to diagnosis. J Bone Joint Surg 527:732–737

    Google Scholar 

  33. Gurd AR, Wilson RI (1974) The fat embolism syndrome. J Bone Joint Surg Br 56B(3):408–416

    PubMed  CAS  Google Scholar 

  34. Talbot M, Schemitsch EH (2006) Fat embolism syndrome: history, definition, epidemiology. Injury 37(Suppl 4):S3–S7

    Article  PubMed  Google Scholar 

  35. Schonfeld SA, Ploysongsang Y, DiLisio R, Crissman JD, Miller E, Hammerschmidt DE, Jacob HS (1983) Fat embolism prophylaxis with corticosteroids. A prospective study in high-risk patients. Ann Intern Med 99(4):438–443

    PubMed  CAS  Google Scholar 

  36. Robert JH, Hoffmeyer P, Broquet PE, Cerutti P, Vasey H (1993) Fat embolism syndrome. Orthop Rev 22:567–571

    PubMed  CAS  Google Scholar 

  37. Cárdenas-Camarena L (2003) Lipoaspiration and its complications—a safe operation. Plast Reconstr Surg 112(5):1435–1441

    Article  PubMed  Google Scholar 

  38. Kamal M, El-Ali TG (2006) Assessment of the risk of systemic fat mobilization and fat embolism as a consequence of liposuction: ex vivo study. Plast Reconstr Surg 117(7):2269–2276

    Article  CAS  Google Scholar 

  39. Worthley LIG, Fisher MM (1979) The fat embolism syndrome treated with oxygen, diuretics, sodium restriction, and spontaneous ventilation. Anaesth Intensive Care 7:136–142

    PubMed  CAS  Google Scholar 

  40. Wolfe WG, DeVries WC (1975) Oxygen toxicity. Annu Rev Med 26:203–214

    Article  PubMed  CAS  Google Scholar 

  41. Haddad FS (1951) Fat embolism. In: Annual Report. Beirut, Lebanon, The Orient Hospital, p 25

  42. Peltier LF (1988) Fat embolism: a perspective. Clin Orthop Relat Res 232:263–270

    PubMed  Google Scholar 

  43. Dudney TM, Elliott CG (1994) Pulmonary embolism from amniotic fluid, fat, and air. Prog Cardiovasc Dis 36:447–474

    Article  PubMed  CAS  Google Scholar 

  44. Marty AT (1974) Hyperoncotic albumin therapy. Surg Gynecol Obstet 139:105–108

    PubMed  CAS  Google Scholar 

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Correspondence to Song-Lin Yang.

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Wang, HD., Zheng, JH., Deng, CL. et al. Fat Embolism Syndromes Following Liposuction. Aesth Plast Surg 32, 731–736 (2008). https://doi.org/10.1007/s00266-008-9183-1

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  • DOI: https://doi.org/10.1007/s00266-008-9183-1

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