Fat Embolism After Autologous Facial Fat Grafting

2021 ◽  
Author(s):  
Nicolas S Dhooghe ◽  
Sebastiaan Maes ◽  
Bernard Depypere ◽  
Karel E Y Claes ◽  
Renaat Coopman ◽  
...  
Keyword(s):  
Preventive Measures ◽  
Improve Patient Safety ◽  
Treatment Options ◽  
Fat Embolism ◽  
Current Treatment ◽  
Fat Grafting ◽  
Safe Procedure ◽  
Online Databases ◽  
Raising Awareness ◽  
The Face

Abstract Background Autologous facial fat grafting has gained popularity in recent years and is considered to be safe. We present the case of a patient who died due to massive cerebral micro fat embolism after facial fat grafting. Objectives Raising awareness and providing more evidence on prevention and treatment of this potentially lethal complication of facial fat grafting. Methods A detailed report was made of the case. Two online databases were searched for similar cases of facial fat embolism resulting in neurological and/or visual symptoms. Thereafter a literature search was conducted to verify the etiology, current treatment options, and preventive measures. Results Forty-nine cases with similar events were found in the literature. The most common injected area was the glabella (36.1%), and an average of 16.7 ml fat was injected. The main complications are visual impairment, of which 88.5 % remained blind, and neurological symptoms, who never fully recover. Seven cases were fatal. Fat embolism can occur in veins and arteries of the face. Two possible pathways for fat embolism exist: the macroscopic, mechanical pathway with immediate signs and the microscopic, biochemical pathway with delayed symptoms. Mechanical embolectomy and corticosteroids are suggested treatment options but lack evidence. Several different preventive measures are described. Conclusions Although facial fat grafting is considered a safe procedure, one should be aware of the risk for fat embolism. Underreporting of this adverse event is likely. With no effective treatment and often detrimental outcome, preventive measures are of utmost importance to improve patient safety.

scholarly journals Stem Cells in Clinical Trials for Pelvic Floor Disorders: a Systematic Literature Review

2021 ◽  
Author(s):  
Stefano Manodoro ◽  
Matteo Frigerio ◽  
Marta Barba ◽  
Sara Bosio ◽  
Luigi Antonio de Vitis ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Stem Cell ◽  
Pelvic Floor ◽  
Pelvic Floor Disorders ◽  
Treatment Options ◽  
Current Treatment ◽  
Cochrane Library ◽  
Safe Procedure ◽  
Alternative Treatment Strategy ◽  
Beneficial Impact

AbstractPelvic floor disorders (PFDs) include a series of conditions that can be poorly tolerated, negatively affecting the quality of life. Current treatment options show unsatisfactory results and new ones are therefore needed. Stem cell (SC) therapy might be an alternative treatment strategy. This systematic review aims to define the state of art of SC therapy for PFDs in clinical trials, by systematically reviewing the available evidence. A systematic search strategy was conducted up to November 7, 2020, in PubMed, Scopus, Cochrane Library, and ISI Web of Science. Preclinical studies on animal models were not considered. Studies were included when the patients were affected by any PFDs and cells were isolated, cultured, and characterized as SC. The study protocol was registered in PROSPERO (CRD42020216551). A total of 11 prospective clinical studies were included in the final assessment, specifically 7 single-arm studies dealing with SC therapy for stress urinary incontinence and 4 with anal incontinence. Among the latter, there were two prospective, single-arm studies and two randomized controlled trials. No papers concerning the use of SC for prolapse repair were retrieved. Due to the great heterogeneity, data pooling was not possible. Stem cell injection resulted in a safe procedure, with few mild adverse side effects, mostly related to harvesting sites. However, a clear beneficial impact of SC treatment for the treatment of pelvic floor disorders could not be demonstrated. Further larger targeted studies with control arms are needed before any conclusions can be made.

scholarly journals Timolol for Treatment of Recalcitrant Pyogenic Granulomas: a Case Report and Review of the Literature

2017 ◽  
Vol 1 (3) ◽  
pp. 150-155
Author(s):  
Paige Hoyer ◽  
Priscilla Ly ◽  
Lindy Ross ◽  
Michael Wilkerson
Keyword(s):  
Current Literature ◽  
Treatment Options ◽  
Ophthalmic Solution ◽  
Pyogenic Granuloma ◽  
Vascular Tumor ◽  
Current Treatment ◽  
Multiple Form ◽  
The Face ◽  
Therapy Option ◽  
A Site

Importance: Pyogenic Granuloma (PG) is a benign vascular tumor that forms commonly on the face, oral mucosa, or a site of previous injury. Though some PGs resolve spontaneously, most require some-to-multiple form(s) of treatment to prevent bleeding, ulceration, and scarring. Current treatment options for PGs include cryotherapy, laser, electrodessication, curettage or shave excision, sclerotherapy, corticosteroid injections, and imiquimod 5% cream. Timolol 0.5% ophthalmic solution has been used as a noninvasive topical treatment for PG in the pediatric population.Objective: To present a case of successful treatment of a recalcitrant PG with topical timolol, and to report on the current literature for similar cases.Case Presentation: We present a case of a 40-year-old healthy female who developed a biopsy-proven PG on her index finger. This is the first reported case to successfully use tangential biopsy and electrodessication followed by twice daily topical Timolol to treat recalcitrant PG.Conclusions: This case supports the use of 0.5% Timolol ophthalmic solution and demonstrates that it is a safe and economical therapy for adult patients with recurrent PGs. A review of the current literature is discussed, and supports timolol as an easy and economical therapy option.

scholarly journals How to Save a Life From Macroscopic Fat Embolism: A Narrative Review of Treatment Options

2019 ◽  
Vol 40 (10) ◽  
pp. 1098-1107 ◽  
Author(s):  
Aqeel Lari ◽  
Abeer Abdulshakoor ◽  
Elie Zogheib ◽  
Nizar Assaf ◽  
Ali Mojallal ◽  
...  
Keyword(s):  
High Mortality ◽  
Treatment Plan ◽  
Treatment Options ◽  
Fat Embolism ◽  
Fat Grafting ◽  
Lessons Learned ◽  
Narrative Review ◽  
Management Algorithm ◽  
Number Of Factors ◽  
Treatment Aspect

Abstract Macroscopic fat embolism (MAFE) has grabbed the attention of the plastic surgery community in recent years because of its high mortality rate. Many articles on preventing MAFE during gluteal fat grafting are available in the literature. However, total prevention is difficult: a number of factors, both technical and human, mean that MAFE remains a potential complication. This review was written with the main goal of providing a treatment plan. MAFE shares many similar pathophysiologic and hemodynamic features with massive thrombotic pulmonary embolism (PE), especially the associated cardiopulmonary decompensation. Lessons learned from PE management were used to devise a management algorithm for MAFE. The use of extracorporeal membrane oxygenation and its potential application as a main modality of treatment for MAFE was explored. The lack of evidence in the literature for the treatment of MAFE, and its high mortality, lent urgency to the need to write an article on the management aspect in the form of a narrative review, to ensure that every plastic surgeon practicing gluteal fat grafting is knowledgeable about the treatment aspect of this deadly complication.

Rosacea

2021 ◽  
pp. 1-8
Author(s):  
Tamara Searle ◽  
Firas Al-Niaimi ◽  
Faisal R Ali
Keyword(s):  
Beta Blockers ◽  
Treatment Options ◽  
Current Treatment ◽  
Treatment Modalities ◽  
Modified Release ◽  
Ocular Rosacea ◽  
The Face ◽  
Brimonidine Tartrate ◽  
New Treatment ◽  
General Guidance

Rosacea is a common cutaneous condition affecting predominantly the face. It is historically characterised into four subtypes: erythematotelangiectatic, papulopustular, phymatous and ocular rosacea. This article describes the pathophysiology, clinical features and current treatment options for rosacea, and discusses updated diagnostic criteria. General guidance is required on the need to avoid possible triggers including dietary and environmental triggers. The strongest evidence supports the use of 0.75% metronidazole, topical azelaic acid or topical ivermectin for inflammatory rosacea. Erythema should be treated with brimonidine tartrate gel, oral medication such as beta blockers or vascular laser and light-based therapy. Oral doxycycline 40 mg modified release can be used as monotherapy or in combination with other treatments for recalcitrant disease. Further understanding of the pathogenesis of rosacea could allow identification and targeted avoidance of triggers and the development of new treatment modalities.

Using the mask – Do’s and Don’ts in the COVID-19 scenario

2020 ◽  
Vol 11 (SPL1) ◽  
pp. 901-906
Author(s):  
Sherly Deborah G ◽  
Archana R ◽  
Harini Narayanam
Keyword(s):  
Preventive Measures ◽  
Treatment Options ◽  
Face Mask ◽  
Nasal Discharge ◽  
The Novel ◽  
Physical Barrier ◽  
Protective Measures ◽  
Surrounding Environment ◽  
The Face ◽  
Novel Coronavirus

A face mask is a loose-fitting, disposable outfit that acts as a physical barrier between the mouth and nose of an individual and the potential pollutants in the surrounding environment. COVID-19 which is also called as 2019-nCov is caused by the novel coronavirus and it is spread by the salivary droplets or nasal discharge released when an infected person coughs or sneezes. In the current COVID -19 scenario, the face mask is designed to ameliorate the prevention of airborne transmission of the novel coronavirus. The use of face mask is competent only when the other personal preventive measures are ideally pursued. The effectiveness of the use of face mask depends strongly on the do’s and don’ts which has to followed while wearing a face mask. The purpose of this study is to analyze and summarize the published literature associated with the types, usage, risks, limitations, disposal and reusability of face mask. The availability of medication and treatment options are sparse and the development of vaccines for COVID-19 is going to take a longer time. Hence the most effective strategy to curb the spread of the disease is by the judicious use of face mask along with other personal protective measures.

Safety of Wireless Ultrasound-Guided Gluteal Fat Grafting

2020 ◽  
pp. 074880682093856
Author(s):  
Alan Wong ◽  
Alexander D. J. Selsky ◽  
Alexander Zuriarrain
Keyword(s):  
Ultrasound Guidance ◽  
Improve Patient Safety ◽  
Subcutaneous Tissue ◽  
Fat Embolism ◽  
Fat Grafting ◽  
Ultrasound Guided ◽  
Fat Transfer ◽  
Autologous Fat ◽  
Autologous Fat Transfer ◽  
User Friendly

Gluteal fat grafting (or autologous fat transfer to the buttocks) is one of the fastest growing procedures in plastic surgery. However, as the popularity of the procedure has grown, so has the number of fatalities and complications. Fatalities are mainly linked to fat embolism, which can occur when fat is injected into the gluteal muscles, instead of subcutaneously. The use of wireless ultrasound imaging during the procedure can help reduce the chances of intramuscular fat injection and improve patient safety. Here, we present a 36-year-old female underwent circumferential liposuction with autologous fat transfer to the bilateral buttocks. From liposuction, 3500 mL of fat was harvested and 1000 mL of fat was injected into each buttock with wireless ultrasound guidance. We identified the subcutaneous plane where fat was to be injected, avoided penetrating the muscular fascia, and observed (in real-time) fat being introduced into the subcutaneous tissue. Wireless ultrasound-guided gluteal fat grafting is an effective and reliable method of visualizing the anatomy of the gluteal region and preventing intramuscular injection of fat. The technology is readily available, very user-friendly and serves as a great learning tool. Based on our positive experience using ultrasound guidance, larger comparative studies should be conducted to confirm its value.

Radiation-Induced Tissue Damage: Clinical Consequences and Current Treatment Options

2021 ◽  
Vol 35 (03) ◽  
pp. 181-188
Author(s):  
Hillary Nepon ◽  
Tyler Safran ◽  
Edward M. Reece ◽  
Amanda M. Murphy ◽  
Joshua Vorstenbosch ◽  
...  
Keyword(s):  
Treatment Options ◽  
Current Treatment ◽  
Fat Grafting ◽  
Treatment Modalities ◽  
Clinical Implications ◽  
Autologous Fat Grafting ◽  
Skin Cancers ◽  
Clinical Consequences ◽  
Radiation Induced ◽  
Pharmaceutical Agents

AbstractRadiation therapy is a valuable tool in the treatment of numerous malignancies but, in certain cases, can also causes significant acute and chronic damage to noncancerous neighboring tissues. This review focuses on the pathophysiology of radiation-induced damage and the clinical implications it has for plastic surgeons across breast reconstruction, osteoradionecrosis, radiation-induced skin cancers, and wound healing. The current understanding of treatment modalities presented here include hyperbaric oxygen therapy, autologous fat grafting and stem cells, and pharmaceutical agents.

An Overview of Dementias

2012 ◽  
Vol 21 (3) ◽  
pp. 75-84
Author(s):  
Venkata Vijaya K. Dalai ◽  
Jason E. Childress ◽  
Paul E Schulz
Keyword(s):  
Clinical Presentation ◽  
Treatment Options ◽  
Current Treatment ◽  
Great Variability ◽  
Health Concern ◽  
Public Health Concern ◽  
Life Threatening ◽  
The Common ◽  
Neurodegenerative Dementias ◽  
Made In

Dementia is a major public health concern that afflicts an estimated 24.3 million people worldwide. Great strides are being made in order to better diagnose, prevent, and treat these disorders. Dementia is associated with multiple complications, some of which can be life-threatening, such as dysphagia. There is great variability between dementias in terms of when dysphagia and other swallowing disorders occur. In order to prepare the reader for the other articles in this publication discussing swallowing issues in depth, the authors of this article will provide a brief overview of the prevalence, risk factors, pathogenesis, clinical presentation, diagnosis, current treatment options, and implications for eating for the common forms of neurodegenerative dementias.

Antiretroviral Treatment-Associated Labia Majora Lipohypertrophy: A Rare Case and Plastic Surgical Treatment Options

2017 ◽  
Vol 2 (1) ◽  
pp. 43
Author(s):  
Akmal Hisham ◽  
Devananthan Ilenghoven ◽  
Wan Syazli Wan Ahmad Kamal ◽  
Salina Ibrahim ◽  
Shah Jumaat Mohd Yussof
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Daily Living ◽  
Treatment Options ◽  
Hiv Positive ◽  
Highly Active ◽  
Labia Majora ◽  
The Face ◽  
Central Fat

The emergence of highly active antiretroviral therapy (HAART) has revolutionized the prognosis of HIV-infected patients. However, the extended use of HAART is associated with a disfiguring complication termed lipodystrophy, a disorder of body fat maldistribution causing peripheral fat loss (lipoatrophy) and central fat accumulation (lipohypertrophy). Lipoatrophy commonly affects the face, legs, buttocks and arm, whilst lipohypertrophy frequently favours the abdomen, breast and dorsocervical region. To our knowledge, we present only the second documented case in the literature of a labia majora lipohypertrophy in a HIV-positive patient receiving long-term HAART. The severity of labial abnormality caused significant physical and functional morbidities. Labiaplasty with dermolipectomy of the labia majora and excisional lipectomy of the mons pubis was successfully performed. At a 6-month follow-up, patient had no recurrence with resolution of symptoms and resumption of normal activities of daily living (ADL).

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