Here is the podium presentation I gave at the American Society of Aesthetic Plastic Surgery in San Diego 2008. It addresses atypical infections following blepharoplasty. Specifically a timeline, labs, and treatment.
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Atypical Eyelid Infections Following Blepharoplasty
1. Inflammatory and Infectious Lesions Following Blepharoplasty W. Thomas McClellan, M.D. John C. McCallum, B.A. Julius W. Few, M.D. Clinton McCord, M.D. Foad Nahai, M.D. T. Roderick Hester, M.D. Mark A. Codner, M.D.
12. Blepharoplasty < 2 Weeks Streptococcus Staphalococcus aureus Group A B Hemolytic Strep. - Necrotizing fasicitis Hypersensitivity Reaction Early Presentation
13. Blepharoplasty < 2 Weeks Early Presentation Diagnosis and Treatment I + D Routine Culture, Gram Stain of Fluid * Oral Antibiotics 7-10 days = Typical Pathogens Chemosis management if present -Patching, Tarsorhaphy, Conjunctiva incision +/- canthotomy = if edema/fluid cause vision loss Admit for Facial Cellulitis Rule out = Necrotizing fasciitis Re-evaluate frequently Antibiotic Regimens Superficial – Choice PO Cephalosporin Augmentin Clindamycin Facial Cellulitis – Combo IV Ampicillan/Sulbactam (Unasyn) Cefuroxime (Ceftin) Metronidazole (Flagyl) OR Clindamycin Ciprofloxacin (Cipro) Metronidazole (Flagyl) Failure to respond Vancomycin
20. >5 Weeks Post-op Late Presentation Blepharoplasty Dx and Treatment Lesion Disruption or Incisional Biopsy Routine Culture + Gram Stain +AFB + Fungal Atypical media and stains -Lowenstein Jensen Media at 30ºC 6wks - * Ziehl Neelsen Stain -Fluorescent auramine-O Stain Pathology -Tissue Identification + Polarized Light Typical Antibiotic Re-evaluate following initial cultures
21. >5 Weeks Post-op Late Presentation Blepharoplasty ( + ) Culture Multi-drug regimen including IV and PO Amikacin 7.5mg/kg IV bid – 8wks Imipenin 500 mg IV tid – 8 wks Clarithromycin 250mg PO bid – 12 wks Ciprofloxacin 500mg PO bid – 12wks Infectious disease consult Focus treatment on sensitivity results Weekly disruption of tissue Treatment for up to 12 weeks (-) Culture Review Pathology Consider Repeat Culture
23. >5 Weeks Post-op Late Presentation Blepharoplasty 6 months – await lesion stabilization Final aesthetic excision or scar revision and lid stabilization