[Necrotising fasciitis and myositis as serious complications after liposuction]

Three days after liposuction of the lower abdomen, a 41-year-old woman was admitted for toxic shock-like syndrome with necrotising fasciitis and myositis, caused by Lancefield-group-A beta-haemolytic streptococci. The patient was treated by radical debridement of the skin, subcutis, fasciae and part of the pectoral muscle, plus antibiotics. Postoperatively she required artificial respiration for respiratory insufficiency. One week after the operation the wound was covered by transplantation of autologous skin. The patient survived, but was seriously disfigured. Necrotising fasciitis is a progressive soft-tissue infection, characterised by widespread necrosis of the superficial and deep fascia, often associated with severe systemic toxic reactions. Unless quickly recognised and aggressively treated, the course is often fatal. Due to the absence of cutaneous findings in the early stages, diagnosis is difficult. Important diagnostic aids are routine laboratory tests, contrast-MRI and a combination of the finger test and frozen-section biopsy. Treatment consists of early radical debridement, broad-spectrum antibiotics and supportive care. In a later stage, soft-tissue reconstruction with autografts or artificial skin grafts and skin transposition can be performed.