Status:
Ready to upload
Record number:
1690
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Rare, only 3 cases of atypical mycobacterium infections have been reported following a fat graft; they were on a hand, a leg, and a buttock. Another article warned of the risk of cryopreservation of fat by culturing cryopreserved fat. Among the 150 cryopreserved fat samples, cultures were positive for Staphylococcus epidermidis in 5 samples and Micrococcus species in 3 samples. (see 4th new reference suggested).
Time to detection:
4 weeks after replantation
Alerting signals, symptoms, evidence of occurrence:
Painful swelling and erythema at implantation sites on face.
Demonstration of imputability or root cause:
Computed tomography of neck showed multiple peripheral enhancing nodular lesions to forehead, both cheeks, and right nasolabial area compatible with abscesses. In an open pus fungus culture, Aspergillus fumigatus growth was observed. An open pus acid-fast bacilli culture returned positive. On the "Mycobacterium Other Than Tuberculosis (MOTT)" identification PCR, Mycobacterium fortuitum was found.
Groups audience:
Keywords:
References:
Reference attachment:
Suggest references:
- Mixed infection of an atypical Mycobacterium and Aspergillus following a cryopreserved fat graft to a face. Kim SK et al. J Craniofac Surg. 24(5):1676-8, 2013 Sep.
- 1. GaleaLA,NicklinS. Mycobacterium abscessus infection complicating hand rejuvenation with structural fat grafting. J Plast ReconstrAesthet Surg 2009;62:e15Ye16
2.DessyLA,MazzocchiM,FioramontiP,etal. Conservative management of local Mycobacterium chelonae infection after combined liposuction and lipofilling. Aesthetic Plast Surg 2006;30:717Y722
3. Kanjoor JR. Sepsis after autologous fat grafting: role of atypical mycobacteria. Plast Reconstr Surg 2011;127:2120Y2121 4. Kim JT, Seo WJ, Kim YH. Clinical considerations on contamination rates of cryopreserved autologous fat. J Korean Soc Plast Reconstr Surg 2009;36:685Y690
Note:
Add adipose tissue to the MPHO taxonomy, add the other references (EP)
Expert comments for publication:
This is specifically related to infection from a "cryopreserved autologous fat graft". The authors suggest that "in order to avoid infection after a fat graft, cryopreserved fat should not be used as a possible material." Contamination of the graft likely occurred during handling either at the harvest procedure (unlikely since some fat from the same lipectomy was used for reconstruction during the same surgical procedure and resulted in no harm), during cryopreservation steps, while it was stored for 2 months, during the thawing procedure, or during implantation. The root cause was not identified but it's not likely to be donor derived since the autologous donor was not reported to have abscesses or infections at time of harvest (lipectomy) or at implantation. Body site where harvest took place was also not reported.