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Understanding Fatal Fat Embolism in Gluteal Lipoinjection: A Review of the Medical Records and Autopsy Reports of 16 Patients

Bayter-Marin, Jorge Enrique, M.D.; Cárdenas-Camarena, Lázaro, M.D.; Aguirre-Serrano, Herley, M.D.; Durán, Héctor, M.D.; Ramos-Gallardo, Guillermo, M.D.; Robles-Cervantes, José Antonio, M.D.

Plastic and Reconstructive Surgery: November 2018 - Volume 142 - Issue 5 - p 1198-1208
doi: 10.1097/PRS.0000000000004904
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Discussion

Background: Deaths secondary to gluteal lipoinjection are relatively recent events of major importance. However, little is known in relation to their behavior and clinical evolution. Therefore, an analysis was performed of case records from clinical cases that encountered this problem, correlating the results with the findings during autopsies.

Methods: An analysis was performed of records from patients who died secondary to gluteal lipoinjection. Patient-specific data, surgical procedure, clinical picture, evolution, and outcome were analyzed. The findings of the autopsies and the involvement of other organs were also analyzed and correlated.

Results: From 2000 to 2009, 16 files were obtained that fulfilled the indicated requirements. There were no statistically significant differences in the general characteristics of the patients, such as age, body mass index, or volume lipoinjected or liposuctioned. The clinical pictures were similar in all cases, and the autopsy findings showed the presence of microembolism in all cases and macroembolism in the most severe cases.

Conclusions: The most significant parameter of severity in patients who undergo gluteal lipoinjection is the presence of fat in macroscopic form in the circulation. The volumes of liposuctioned or lipoinjected fat have little influence. Hypoxemia, hypotension, and bradycardia are the characteristic clinical features. Although there is no specific treatment, immediate aggressive vital support to attempt to stabilize the patient is crucial.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

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Mérida, Yucatán; and Zapopan and Puerto Vallarta, Jalisco, México; and Bucaramanga and Bogota, Colombia

From private practice; the Divisions of Plastic Surgery and Internal Medicine, Jalisco Institute of Reconstructive Surgery “Dr. José Guerrerosantoss”; the Jalisco College of Plastic, Esthetic and Reconstructive Surgery; Clínica “El Pinar,” National University of Colombia, and the National Institute of Legal Medicine and Forensic Sciences Regional Colombia.

Received for publication December 27, 2017; accepted April 26, 2018.

Disclosure:The authors have no conflict of interest to declare in relation to the content of this article.

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Lázaro Cárdenas-Camarena, M.D., INNOVARE Cirugía Plástica Especializada, Av Verona 7412, Col Villa Verona, Zapopan, Jalisco, México 45019, drlazaro@drlazarocardenas.com

Copyright © 2018 by the American Society of Plastic Surgeons