Rhytidectomy Complicated by a Postauricular Enterococcal Infection

Abstract

Introduction:

Facial rejuvenation and body contouring procedures are becoming more and more common. The patient seeking these types of operations will often undergo multiple procedures at one time. Procedures performed about the facial region are often classified as clean-contaminated cases. In light of the above-stated facts, postsurgical infection can be a concern. In 2001, postsurgical infections were approaching 500 000 per year among an approximate 27 million operations. Complication rates in surgery will vary depending on the type, length, and number of procedures. Cervicofacial rhytidectomy complications can range from hematoma and nerve damage to incision irregularities and infection. Postrhytidectomy infection has a complication rate of ≤1%. Staphylococcal and streptococcal variants are the typical bacteria found. Postrhytidectomy infections typically are cellulitic but can progress to abscess formation. We present an unusual case of a postrhytidectomy infection caused by an enterococcal variant in the postauricular region.

Materials and Methods:

A healthy 61-year-old woman sought treatment for facial rhytidosis, brow ptosis, hypoplastic lips, and trunkal adiposity. She subsequently underwent a rhytidectomy, endoscopic brow lift, fat transfer to the lips, perioral dermabrasion, a 35% trichloroacetic acid peel to her lower eyelids, and liposuction to the abdomen and flanks. The procedures were all carried out during one trip to the operating room over a 5-hour time span.

Results:

The patient subsequently developed postauricular infection on postoperative day 7. Despite antibiotic therapy, the left postauricular region became fluctuant and required incision and drainage. Antibiotics were manipulated until the cultures revealed she had developed an enterococcal infection sensitive to levafloxacin. The patient had a prolonged recovery after her rhytidectomy because of the enterococcal infection. She recovered and had acceptable scarring.

Discussion:

Although infection after rhytidectomy is ⩽1%, it can still prolong recovery. Performing a face-lift along with other procedures allows for increased operating time and the possibility of an increased risk of infection. The possibility of contamination with other bacterial variants also broadens when multiple body sites are addressed. Bacteria not typically seen with rhytidectomy infections need to be considered when caring for these complications. Attention to the events that occur pre-, intra-, and postoperatively can help us better care for possible postoperative complications. Prompt perisurgical care can help us maximize our outcomes.