Escherichia coli Necrotizing Fasciitis After Abdominoplasty Combined With Liposuction: A Report of a Case and Review of the Literature

Abdominoplasty and liposuction rank among the most common aesthetic plastic surgeries and are considered safe procedures, although intraoperative and postoperative complications can occur. Hematoma, seroma, infections, deep venous thrombosis, and death are some of the encountered complications. Necrotizing fasciitis is a rare, severe, and deadly soft-tissue infection that can develop in healthy patients who undergo common aesthetic operations such as abdominoplasty or liposuction. Early detection and treatment of these complications are crucial. This report documents a rare case of monomicrobial <i>Escherichia coli</i> necrotizing fasciitis after abdominoplasty combined with liposuction. Factors associated with a lower risk of complications include being a healthy non-smoker of normal weight, aged under 55 years, having a shorter interval between bariatric and cosmetic surgery, ensuring proper hand hygiene, and exercising extreme caution during abdominal flap undermining. Exceptionally rare cases of <i>E. coli</i> infections following abdominoplasty or liposuction were described in the literature. Several hypotheses can explain the <i>E. coli</i> infection that can complicate these surgeries, such as poor hand hygiene in some patients, contamination during perioperative care, delayed pre-processing cleaning of surgical instruments and the adhesive property of the instruments, post-sterilization contamination, and the translocation hypothesis. This report underscores the importance of early recognition and prompt management of necrotizing fasciitis, even in low-risk patients undergoing common aesthetic procedures.