title: Necrotizing Fasciitis in Aesthetic Surgery: A Review of the Literature.
abstract: BACKGROUND
  Necrotizing fasciitis (NF) is a rare, potentially fatal, infective complication that can occur after surgery. Diagnosis is still difficult and mainly based on clinical data. Only a prompt pharmacological and surgical therapy can avoid dramatic consequences. There are few reports regarding NF as a complication after aesthetic surgical procedures, and a systematic review still lacks.
  
  
  METHODS
  We have performed a systematic review of English literature on PubMed, covering a period of 30 years. Keywords used were "necrotising fasciitis" matched with "aesthetic surgery complications", "breast surgery", "mammoplasty", "blepharoplasty", "liposuction", "facelift", "rhinoplasty fasciitis", "arm lift", "thigh lift", "otoplasty" and "abdominoplasty fasciitis". No additional search and temporal limitation were set.
  
  
  RESULTS
  Among 3782 papers concerning NF, only 18 were related to NF after an aesthetic surgical procedure. Liposuction was the most affected procedure, with buttocks and lower extremity the most involved anatomical regions. The majority of the infections were monomicrobial, promoted by Streptococcus pyogenes. In most cases, NF occurred within the third post-operative day with non-specific signs and symptoms. In 14 cases, a single or multiple surgical interventions were performed and survival was achieved in 11 patients.
  
  
  CONCLUSIONS
  In case of infection after aesthetic surgery, we should always bear in mind NF. Clinical hallmarks still guide NF management. Because early signs and symptoms are usually non-specific, a strict clinical control is highly suggested. Once clinical suspicion is raised, prompt antibacterial therapy should be administered, followed by surgical debridement in case of ineffective response.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Dipartimento di Chirurgia Plastica Ricostruttiva, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Via Morandi, 30, 20097, San Donato Milanese, Milan, Italy. ilmarchesiandrea@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Marchesi
authors.affiliation: Dipartimento di Chirurgia Plastica Ricostruttiva, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Via Morandi, 30, 20097, San Donato Milanese, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Marcelli
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Udine, Udine, Italy.
authors.forename: Pier C
authors.initials: PC
authors.lastname: Parodi
authors.affiliation: Department of Medical and Surgery Specialties, Section of Plastic Surgery, University of Catania, Catania, Italy.
authors.forename: Rosario E
authors.initials: RE
authors.lastname: Perrotta
authors.affiliation: Department of Reconstructive Plastic Surgery-Hand Surgery, AOU "Ospedali Riuniti", Ancona, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Riccio
authors.affiliation: Dipartimento di Chirurgia Plastica Ricostruttiva, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Via Morandi, 30, 20097, San Donato Milanese, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Vaienti
mesh_terms: D019115:Fasciitis, Necrotizing / Q000209:etiology* / Q000382:microbiology; D006801:Humans; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D013290:Streptococcal Infections / Q000209:etiology* / Q000382:microbiology; D013297:Streptococcus pyogenes / Q000302:isolation & purification*
keywords: Aesthetic surgery; Complication; Fournier; Gangrene; Necrotizing fasciitis