Thigh lift complication 3 years post surgery - what could be causing this? (Photos)

Question

I am becoming desperate to find an answer to what is happening. I had a mini thigh lift with groin incision. Also had a breast augmentation and tummy tuck at the same time. Approximately 6 weeks after surgery I developed a sore somewhat firm red area in the groin extending down the leg to the knee. I had a fever and vomiting with severe body aches and fatigue The incision was reopened in the office with no remarkable findings. I was treated with antibiotics and had resolution of symptoms. This continued to occur every 6 to 8 weeks. I have seen rheumatologist and other specialists to rule out other contributors with no answer I became sick of taking antibiotics and did not take them a few times that this flare up in my leg occurred and the symptoms resolved without them. Flare ups stopped for about 10 months and has now returned with the same symptoms: red area on leg beginning in groin down to mid leg, nausea And vomiting, fever, body aches, enlarged bilateral inguinal lymph nodes. My surgeon has been unable to come Up with a cause or solution In the past 3 years

Yasemin Aydinli, MD · Answer

What you are describing does not sound like a simple wound infection, and I would not accept "no cause found" after three years. The pattern you describe, meaning abrupt fever, vomiting, body aches and a red area spreading from the groin down the leg, settling and then returning every six to eight weeks in the same place, is the classic pattern of recurrent erysipelas in a limb whose lymphatic drainage has been disturbed. A mini thigh lift with a groin incision passes directly through the superficial inguinal lymphatic pathways, so this is a recognised, if uncommon, late complication. In your photographs I can see a firm raised linear cord running down the medial thigh along the line of the old scar, a blanched tethered area near the groin, and a well demarcated red patch further down the leg. That combination of a tethered scar plus recurrent sharply demarcated erythema fits impaired lymphatic drainage far better than a random skin infection.
There is a second possibility that I think has been overlooked, and that is retained permanent suture material. Thigh lift closures are usually anchored with permanent or slowly absorbing sutures to Colles fascia. A single suture can harbour bacterial biofilm and produce exactly this cycle of flare, partial response to antibiotics, quiet period, then flare again. Reopening the incision in the office would not find it, because that suture sits deep to the superficial layer that was explored, so I do not consider that negative exploration reassuring at all.
What I would want done is MRI of the thigh and groin with contrast to look for a sinus tract, a small fluid collection or a foreign body reaction, ultrasound of the groin, and lymphoscintigraphy to document whether lymphatic drainage on that side is impaired. If anything is found, formal exploration with excision of the scar tract and removal of all retained suture material, with tissue sent for routine culture plus atypical mycobacterial and fungal culture, not only a surface swab. An infectious diseases opinion is worthwhile. If lymphatic impairment is confirmed, long term low dose penicillin prophylaxis combined with compression therapy is the established approach for recurrent erysipelas, and in my experience that is often what finally breaks the cycle.
The reassuring part is that three years of this without progression makes anything sinister unlikely. The frustrating part is that it will not settle on its own until the underlying cause, most probably lymphatic obstruction or a retained suture, is actually identified and treated. Which of the two it is can only be determined by imaging and physical examination.

Thigh lift complication 3 years post surgery - what could be causing this? (Photos)

Answers (1)

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