Fat Embolism in Common Carotid Artery after Temporal Lipofilling in Post-Cancer Reconstruction: A Case Report and Review of the Literature

Abstract

Background: Lipofilling is a common aesthetic and reconstructive procedure. Embolism is a possible complication of every filler, which can be lethal. We describe the case of a 56 years old man who had a fat embolism in the common carotid artery with fatal issue. Case presentation: Our patient initially had a left oropharynx cancer, treated by surgery and adjuvant radiotherapy. Many flaps and graft procedure has been tried to treat an ankyloglossia sequelae, and the effective procedure was a forearm free flap. Lipofilling was performed for a temporal defect after a temporal myocutaneous flap. A common carotid embolism was the source of a severe unilateral stroke, leading patient to the death 15 days after initial surgery. Discussion and conclusion: Reverse-flow mechanism explains the artery tropism of fat embolism in the face, contrary to veinous tropism for fat embolism in the body. Pressure of injection, needle (in contrast to blunt end cannula) and large syringe use are the factors of fat embolism in lipofilling procedure. Volume is not a significative factor.