Serratia marcescens infection in a patient after a fat graft: a case report

Serratia marcescens is a Gram-negative, facultatively anaerobic bacillus that has been implicated in hospital-acquired infections. Because no previous cases of delayed infections caused by S. marcescens after autologous fat injection have been reported, we introduce a case report. A 74-year-old woman underwent fat injection for aesthetic purposes and visited our hospital for left cheek swelling after this procedure. Blood tests showed a slightly elevated white blood cell count. Facial computed tomography demonstrated an abscess and emergency surgery was performed. A work-up of the necrotic tissue and drained abscess contents was conducted. Cultures showed growth of S. marcescens. Based on the culture results , a proper antibiotic was prescribed. Follow-up blood tests showed normal findings, and there was no recurrent infection or inflammation. In most acute infections after a fat graft, Staphylococcus aureus or Staphylococcus epidermidis can be suspected, while mycobacterial infections are often suspected in cases of delayed infection and chronic inflammation. However, clinicians should keep in mind that there may be infections of uncommon bacteria. When an atypical delayed infection is suspected after an autologous fat graft, it is important to perform aseptic wound culture and biopsy as soon as possible, use appropriate antibiotics, and conduct proper surgical treatment.

Delayed Orbital Hemorrhage around Alloplastic Implants after Blowout Fracture Reduction

Alloplastic implants have been used to repair orbital wall fractures in most cases. Orbital hemorrhage is a rare complication of these implants and has been reported rarely in Korea. The purpose of this article is to report a late complication case focusing on their etiology and management. A 20-year-old male patient underwent open reduction with Medpor (porous polyethylene) insertion for bilateral orbital floor fractures. The initial symptom occurred with proptosis in the right side as well as vertical dystopia, which had started 4 days earlier, 8 months after surgery. Any trauma history after the surgery was not present. We performed an exploration and removal of hematoma with Medpor titanium meshed alloplastic implant. A case of delayed orbital hematoma following alloplastic implant insertion was identified. It occurred within the pseudocapsule of the implant. One week after surgery, overall symptoms improved successfully, and no complications were reported during the 11-month follow-up period. Although rare, orbital hemorrhage is a potential complication of alloplastic orbital floor implants, which may present many years after surgery. As in the case presented, delayed hematoma should be included in the differential diagnosis of late proptosis or orbital dystopia.

Application of Osteotomies in Aesthetic Rhinoplasty

Nasal osteotomy for aesthetic results is required in patients who have broad nasal bone. Since the procedure is difficult, many operators hesitate the surgery. From January 2007 to July 2009, we performed 77 cases of nasal osteotomy, consisting of paramedian oblique medial osteotomy or median oblique-medial osteotomy and percutaneous lateral osteotomy. Most of the patients had satisfying results, however three patients had asymmetric shape and inappropriate inward movement of nasal bone which required revision with percutaneous lateral osteotomy. Osteotomy procedure varies, depending on surgeon's preference and experience, however, each surgeon should be aware of good and weak points of those procedures and use the most suitable method. In order to achieve maximal satisfying results, preoperative analysis of patients and minimal invasive handling should be done. Based on these efforts, this method could broadly be used in the aesthetic field.

Reconstruction of the Extended Region of the Upper Auricle Using the Superior Auricular Artery Island Flap

PURPOSE: The retroauricular flap has many advantages for facial reconstruction and is performed by many surgeons. However, it is difficult to perform due to limited rotation arc and length of pedicle. We successfully reconstructed the upper region of the auricle and its surroundings with retroauricular flap by using the superior auricular artery as a supplying pedicle. The purpose of this study is to present an anatomic study about the superior auricular artery and its clinical application. METHODS: We investigated the relationship between the superior auricular artery and its surrounding structures through anatomic studies with 7 fresh cadavers and then applied the findings clinically. From February to December 2008, we performed 7 cases of the superior auricular artery island flap to reconstruct the defects in patients operated on skin cancer. Sizes of the defects varied form 0.8 x 0.8 cm to 3.5 x 3.0 cm. RESULTS: We found that the superior auricular artery is a reliable pedicle for the retroauricular flap, based on anatomical studies. All wounds of the patients were successfully closed. The flap donor site was primary closed except in one patient with a large defect. The aesthetic outcomes of the donor and recipient sites were satisfactory. CONCLUSION: The superior auricular artery island flap has several advantages. Therefore, we suggest that the superior auricular artery island flap is a treatment of choice for reconstructing soft tissue defect at the upper region of the auricle and its surrounding area.