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How to Save a Life From Macroscopic Fat Embolism: A Narrative Review of Treatment Options
Aqeel Lari1,2, Abeer Abdulshakoor3, Elie Zogheib4
1University Hospital of Amiens and University Hospital of Lyon, Lyon, France.
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.
Insights
Macroscopic fat embolism (MAFE) is a dangerous complication of gluteal fat grafting. This review proposes a treatment plan for MAFE, drawing lessons from pulmonary embolism management.
Area of Science:
- Plastic Surgery
- Cardiopulmonary Medicine
Background:
- Macroscopic fat embolism (MAFE) is a serious complication associated with gluteal fat grafting, carrying a high mortality rate.
- Despite preventive measures, MAFE remains a potential risk due to technical and human factors.
- A significant knowledge gap exists regarding the effective treatment of MAFE.
Purpose of the Study:
- To provide a comprehensive treatment plan for macroscopic fat embolism (MAFE).
- To adapt management strategies from massive thrombotic pulmonary embolism (PE) for MAFE.
- To highlight the potential role of extracorporeal membrane oxygenation (ECMO) in MAFE treatment.
Main Methods:
- This study is a narrative review.
- It analyzes pathophysiologic and hemodynamic similarities between MAFE and massive thrombotic PE.
- It proposes a management algorithm for MAFE based on PE treatment principles.
Main Results:
- MAFE shares critical cardiopulmonary decompensation features with massive PE.
- Lessons from PE management can inform MAFE treatment protocols.
- Extracorporeal membrane oxygenation (ECMO) is explored as a potential primary treatment modality for MAFE.
Conclusions:
- Effective treatment protocols for MAFE are urgently needed due to its high mortality.
- A structured management approach, informed by PE treatment, is proposed.
- Plastic surgeons performing gluteal fat grafting must be educated on MAFE management to improve patient outcomes.
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