Embolismo graso macroscópico y microscópico en cirugía de contorno corporal: implicaciones para el manejo anestésico-revisión narrativa

Soto-Hopkins, Sergio; Sánchez-López, Antonio; López Pérez, Fernando Jaziel

doi:10.58281/ccem25080501

Embolismo graso macroscópico y microscópico en cirugía de contorno corporal: implicaciones para el manejo anestésico-revisión narrativa

CRITICAL CARE & EMERGENGY MEDICINE VOL. 4

Macroscopic and microscopic fat embolism in body contouring surgery: implications for anesthetic management—narrative review

www.doi.org/10.58281/ccem25080501

5 agosto, 2025 agosto 5, 2025
Revisión narrativa, Volumen 4.

Sergio Soto-Hopkins 1, José Antonio Sánchez-López 2 , Fernando Jaziel López Pérez 3.

1 Anestesiólogo Cardiovascular, TJ Plast Centro de Cirugía Plástica, Tijuana, México.
2 Anestesiólogo Cardiovascular, UMAE en Cardiología Centro Médico Nacional Siglo XXI, Ciudad de México.
3 Urgencias Médico Quirúrgicas ,Hospital General de Zona 1, Saltillo. Coahuila.

Abstract

The global rise in plastic surgery procedures particularly gluteal lipoinjection has been accompanied by an increase in severe complications such as pulmonary fat embolism, which is currently the leading cause of mortality in this setting in Mexico. This review explores the pathophysiology of pulmonary fat embolism, distinguishing between its microscopic and macroscopic forms, and their direct role in acute right ventricular dysfunction. During gluteal lipoinjection, inadvertent intravascular fat injection may lead to pulmonary vascular obstruction, severe hypoxemia, pulmonary hypertension, and right ventricular failure. Diagnosis is often delayed due to limited clinical recognition and lack of specialized training.
Multicenter data indicate that macroscopic embolism is associated with high mortality rates (up to 86.1%), particularly when linked to intramuscular injection techniques. Consequently, current recommendations advocate for ultrasoundguided subcutaneous-only approaches. Autopsy findings frequently demonstrate fat infiltration into deep vascular structures, reinforcing the urgent need for stricter regulations and advanced surgical training. From the anesthetic standpoint, acute signs such as decreased end-tidal CO2, hypoxemia, and hypotension necessitate prompt hemodynamic management. Norepinephrine and inotropes are preferred agents to optimize afterload and myocardial contractility, respectively. Point-of-care ultrasound and tools like the Venous Excess Ultrasound Score score enable dynamic evaluation of venous congestion. Supportive strategies include lung-protective ventilation, selective pulmonary vasodilators (e.g., inhaled nitric oxide), and the correction of aggravating factors such as hypoxia, acidosis, and hypercapnia. In cases of fat embolism syndrome, early administration of methylprednisolone has shown clinical benefits in reducing both mortality and length of hospital stay.

Resumen

El aumento global de los procedimientos de cirugía plástica, en particular la lipoinyección glútea, ha conllevado un incremento de complicaciones graves, siendo el embolismo graso pulmonar actualmente la principal causa de mortalidad en este contexto en México. Este artículo revisa la fisiopatología del embolismo graso pulmonar, diferenciando sus formas microscópica y macroscópica, y su implicación directa en la disfunción aguda del ventrículo derecho. La inyección inadvertida de grasa en el torrente sanguíneo durante la lipoinyección glútea puede provocar obstrucción vascular pulmonar, hipoxemia severa, hipertensión pulmonar y falla ventricular derecha. El diagnóstico temprano es crucial, aunque frecuentemente se retrasa por la falta de reconocimiento clínico y capacitación especializada. Estudios multicéntricos han demostrado que el embolismo macroscópica presenta una elevada mortalidad (hasta 86.1 %), especialmente cuando se utilizan técnicas de inyección intramuscular. En consecuencia, las guías actuales recomiendan exclusivamente la técnica subcutánea asistida por ultrasonido. Los hallazgos postmortem evidencian la penetración de grasa en estructuras vasculares profundas, lo que subraya la necesidad de una regulación estricta y formación quirúrgica avanzada. Desde el punto de vista anestésico, destacan manifestaciones agudas como la caída del CO2 espirado, hipoxemia e hipotensión, que requieren una estrategia terapéutica centrada en la estabilización hemodinámica. La norepinefrina e inotrópicos
son fármacos de elección para optimizar la postcarga y la contractilidad, respectivamente. Herramientas como la ecografía y el puntaje Venous Excess Ultrasound Score permiten evaluar dinámicamente la congestión venosa. Se recomienda además una ventilación pulmonar protectora, el uso de vasodilatadores pulmonares y evitar factores agravantes como hipoxia, acidosis e hipercarbia. Finalmente, en el contexto
del síndrome de embolismo graso, la administración precoz de metilprednisolona ha mostrado eficacia clínica al reducir la mortalidad y la estancia hospitalaria.

Keywords

Gluteal lipoinjection, pulmonary fat embolism, macroscopic fat embolism, microscopic fat embolism, right ventricular fai- lure, liposuction.

Biografias de autores

Sergio Soto-Hopkins
Anestesiólogo Cardiovascular, TJ Plast Centro de Cirugía Plástica, Tijuana, México.

José Antonio Sánchez-López
Anestesiólogo Cardiovascular, UMAE en Cardiología Centro Médico Nacional Siglo XXI, Ciudad de México.

Fernando Jaziel López Pérez .
Urgencias Médico Quirúrgicas ,Hospital General de Zona 1, Saltillo. Coahuila.

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How to Cite / Como citar

[1]

Sergio Soto Hopkins, José Antonio Sánchez López, and Fernando Jaziel López Pérez. 2025. Embolismo graso macroscópico y microscópico en cirugía de contorno corporal: implicaciones para el manejo anestésico-revisión narrativa. CRITICAL CARE & EMERGENGY MEDICINE 4, (August 2025), 6–16. https://doi.org/www.doi.org/10.58281/ccem25080501

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