{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T03:17:42Z","timestamp":1790824662709,"version":"4.1.0"},"reference-count":40,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,5,10]],"date-time":"2023-05-10T00:00:00Z","timestamp":1683676800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Introduction: Aesthetic surgery procedures are generally done in a relatively healthy population and carry a rather low risk compared to other surgical specialties. The incidence of complications in aesthetic surgery varies greatly depending on the type, wound cleanliness regarding the anatomical site, complexity of the surgery, patient\u2019s age, and comorbidities but is generally considered low. The overall incidence of surgical site infections (SSIs) in all aesthetic surgical procedures is around 1% in most of the literature while cases of necrotizing soft tissue infections are mostly found as individual reports. In contrast, treating COVID-19 patients is still challenging with many diverse outcomes. Surgical stress and general anesthesia are known mediators of cellular immunity impairment while studies regarding COVID-19 infection unquestionably have shown the deterioration of adaptive immunity by SARS-CoV-2. Adding COVID-19 to the modern surgical equation raises the question of immunocompetence in surgical patients. The main question of the modern post-lockdown world is: what could be expected in the postoperative period of perioperatively asymptomatic COVID-19 patients after aesthetic surgery? Case report: Here, we present a purulent, complicated, necrotizing skin and soft tissue infection (NSTI) after gluteal augmentation most likely triggered by SARS-CoV-2-induced immunosuppression followed by progressive COVID-19 pneumonia in an otherwise healthy, young patient. To the best of our knowledge, this is the first report of such adverse events in aesthetic surgery related to COVID-19. Conclusion: Aesthetic surgery in patients during the incubation period of COVID-19 or in asymptomatic patients could pose a significant risk for surgical complications, including severe systemic infections and implant loss as well as severe pulmonary and other COVID-19-associated complications.<\/jats:p>","DOI":"10.3390\/medicina59050914","type":"journal-article","created":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T04:29:01Z","timestamp":1683779341000},"page":"914","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Necrotizing Skin and Soft Tissue Infection after Gluteal Augmentation in a Perioperatively Asymptomatic COVID-19 Patient\u2014Complications of the Post-Lockdown Era? A Case Report"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4545-4335","authenticated-orcid":false,"given":"Milan","family":"Stoji\u010di\u0107","sequence":"first","affiliation":[{"name":"Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3209-5214","authenticated-orcid":false,"given":"Milana","family":"Juri\u0161i\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7885-467X","authenticated-orcid":false,"given":"Milana","family":"Marinkovi\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milan","family":"Jovanovi\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0526-1141","authenticated-orcid":false,"given":"Aleksa","family":"Igi\u0107","sequence":"additional","affiliation":[{"name":"Center for Radiology and Magnetic Resonance Imaging, Department of Interventional Radiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maja","family":"Nikoli\u0107 \u017divanovi\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"De Castro, A.P.B., Moreira, M.F., Bermejo, P.H.d.S., Rodrigues, W., and Prata, D.N. (2021). Mortality and Years of Potential Life Lost Due to COVID-19 in Brazil. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18147626"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e3890","DOI":"10.1097\/GOX.0000000000003890","article-title":"The Impact of COVID-19 on Patient Interest in Facial Plastic Surgery","volume":"9","author":"Sharma","year":"2021","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1007\/s00266-007-9068-8","article-title":"Infections After Plastic Procedures: Incidences, Etiologies, Risk Factors, and Antibiotic Prophylaxis","volume":"32","author":"Gravante","year":"2007","journal-title":"Aesthetic Plast. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1007\/s00266-006-0156-y","article-title":"Infections of Breast Implants in Aesthetic Breast Augmentations: A Single-Center Review of 3002 Patients","volume":"31","author":"Araco","year":"2007","journal-title":"Aesthetic Plast. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1797","DOI":"10.1097\/01.prs.0000209918.55752.f3","article-title":"Abdominoplasty and Abdominal Contour Surgery: A National Plastic Surgery Survey","volume":"117","author":"Matarasso","year":"2006","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Palubicka, A., Jaworski, R., Wekwejt, M., Swieczko-Zurek, B., Pikula, M., Jaskiewicz, J., and Zielinski, J. (2019). Surgical Site Infection after Breast Surgery: A Retrospective Analysis of 5-Year Postoperative Data from a Single Center in Poland. Medicina, 55.","DOI":"10.20944\/preprints201907.0076.v1"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1016\/j.cps.2006.04.005","article-title":"Complications of buttocks augmentation: Diagnosis, management, and prevention","volume":"33","author":"Bruner","year":"2006","journal-title":"Clin. Plast. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.cps.2017.12.001","article-title":"Complications in Gluteal Augmentation","volume":"45","author":"Shah","year":"2018","journal-title":"Clin. Plast. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Ferrara, N., Campobasso, C.P., Cocozza, S., Conti, V., Davinelli, S., Costantino, M., Cannavo, A., Rengo, G., Filippelli, A., and Corbi, G. (2022). Relationship between COVID-19 Mortality, Hospital Beds, and Primary Care by Italian Regions: A Lesson for the Future. J. Clin. Med., 11.","DOI":"10.3390\/jcm11144196"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Carvalho, V.P., Pontes, J.P.J., Neto, D.R.D.B., Borges, C.E.R., Campos, G.R.L., Ribeiro, H.L.S., and Amaral, W.N.D. (2022). Mortality and Associated Factors in Patients with COVID-19: Cross-Sectional Study. Vaccines, 11.","DOI":"10.22541\/au.166900682.26845210\/v1"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Bajoriunaite, A., Zaveckiene, J., Usaite, A., Dobiliene, O., and Tamosuitis, T. (2022). Multisystem Inflammatory Syndrome in a Young Adult (MIC-A) Following SARS-CoV-2 Infection. Medicina, 58.","DOI":"10.3390\/medicina58111515"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/S0002-9343(97)00160-5","article-title":"Population-Based Surveillance for Group a Streptococcal Necrotizing Fasciitis: Clinical Features, Prognostic Indicators, and Microbiologic Analysis of Seventy-Seven Cases","volume":"103","author":"Kaul","year":"1997","journal-title":"Am. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"195","DOI":"10.2147\/IJGM.S82999","article-title":"Necrotizing fasciitis: Epidemiology and clinical predictors for amputation","volume":"8","author":"Tantraworasin","year":"2015","journal-title":"Int. J. Gen. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1177\/1090820X10396701","article-title":"Buttock Augmentation with Solid Silicone Implants","volume":"31","author":"Senderoff","year":"2011","journal-title":"Aesthetic Surg. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1093\/asj\/sjw100","article-title":"Incidence and Risk Factors for Major Surgical Site Infections in Aesthetic Surgery: Analysis of 129,007 Patients","volume":"37","author":"Kaoutzanis","year":"2016","journal-title":"Aesthetic Surg. J."},{"key":"ref_16","first-page":"46","article-title":"Necrotizing Soft Tissue Infection as a Result of a \u201cBrazilian Butt Lift\u201d Procedure","volume":"2","author":"Matthews","year":"2017","journal-title":"Trauma Acute Care"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1016\/j.asj.2007.08.005","article-title":"Infection after augmentation gluteoplasty in a pregnant patient","volume":"27","author":"Alperovich","year":"2007","journal-title":"Aesthetic Surg. J."},{"key":"ref_18","first-page":"361340","article-title":"Multisite Infection with Mycobacterium abscessus after Replacement of Breast Implants and Gluteal Lipofilling","volume":"2015","author":"Cheretakis","year":"2015","journal-title":"Case Rep. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"24","DOI":"10.52547\/wjps.11.2.24","article-title":"Antibiotic Prophylaxis in Plastic Surgery: From Systematic Review to Operative Algorithm","volume":"11","author":"Brambullo","year":"2022","journal-title":"World J. Plast. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"179","DOI":"10.5811\/westjem.2020.6.46415","article-title":"Plastic Surgery Complications: A Review for Emergency Clinicians","volume":"21","author":"Montrief","year":"2020","journal-title":"West. J. Emerg. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.1128\/JCM.01421-08","article-title":"Virulence Potential of Escherichia coli Isolates from Skin and Soft Tissue Infections","volume":"47","author":"Gubina","year":"2009","journal-title":"J. Clin. Microbiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.1093\/cid\/ciu296","article-title":"Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America","volume":"59","author":"Stevens","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"4008","DOI":"10.1128\/JCM.02316-12","article-title":"Unusual \u201cFlesh-Eating\u201d Strains of Escherichia coli","volume":"50","author":"Shaked","year":"2012","journal-title":"J. Clin. Microbiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1099\/jmm.0.042366-0","article-title":"Life-threatening Escherichia coli cellulitis in patients with haematological malignancies","volume":"61","author":"Sunder","year":"2012","journal-title":"J. Med. Microbiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1007\/s00268-020-05501-6","article-title":"We Asked the Experts: Covid-19 Outbreak: Is There Still a Place for Scheduled Surgery? \u201cReflection from Pathophysiological Data\u201d","volume":"44","author":"Besnier","year":"2020","journal-title":"World J. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Kaufmann, K.B., Heinrich, S., Staehle, H.F., Bogatyreva, L., Buerkle, H., and Goebel, U. (2018). Perioperative cytokine profile during lung surgery predicts patients at risk for postoperative complications\u2014A prospective, clinical study. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0199807"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"123","DOI":"10.12688\/f1000research.6474.1","article-title":"Neutrophil Lymphocyte Ratio as a predictor of systemic inflammation\u2014A cross-sectional study in a pre-admission setting","volume":"4","author":"Venkatraghavan","year":"2015","journal-title":"F1000Research"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1093\/cid\/ciaa248","article-title":"Dysregulation of Immune Response in Patients with Coronavirus 2019 (COVID-19) in Wuhan, China","volume":"71","author":"Qin","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1001\/jamasurg.2020.2713","article-title":"Factors Associated with Surgical Mortality and Complications among Patients with and without Coronavirus Disease 2019 (COVID-19) in Italy","volume":"155","author":"Doglietto","year":"2020","journal-title":"JAMA Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"100331","DOI":"10.1016\/j.eclinm.2020.100331","article-title":"Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection","volume":"21","author":"Lei","year":"2020","journal-title":"Eclinicalmedicine"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.amjsurg.2021.04.005","article-title":"Increased complications in patients who test COVID-19 positive after elective surgery and implications for pre and postoperative screening","volume":"223","author":"Prasad","year":"2021","journal-title":"Am. J. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/S0140-6736(20)31182-X","article-title":"Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: An international cohort study","volume":"396","author":"Nepogodiev","year":"2020","journal-title":"Lancet"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1038\/s41598-020-79431-7","article-title":"Neutrophil-to-lymphocyte ratio and mortality in the United States general population","volume":"11","author":"Song","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"21519","DOI":"10.1038\/s41598-021-00927-x","article-title":"Prognostic value of neutrophil-to-lymphocyte ratio in COVID-19 compared with Influenza and respiratory syncytial virus infection","volume":"11","author":"Prozan","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"21541","DOI":"10.1038\/s41598-021-00901-7","article-title":"Association between preoperative neutrophil\u2013lymphocyte ratio and mortality after plastic and reconstructive surgery","volume":"11","author":"Sung","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1007\/s00266-020-01752-9","article-title":"Elective, Non-urgent Procedures and Aesthetic Surgery in the Wake of SARS\u2013COVID-19: Considerations Regarding Safety, Feasibility and Impact on Clinical Management","volume":"44","author":"Kaye","year":"2020","journal-title":"Aesthetic Plast. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e3119","DOI":"10.1097\/GOX.0000000000003119","article-title":"The Impact of COVID-19-based Suspension of Surgeries on Plastic Surgery Practices","volume":"8","author":"Sarac","year":"2020","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2311","DOI":"10.1016\/j.bjps.2021.05.020","article-title":"Impact of COVID-19 on Aesthetic Plastic Surgery Practice in the United Kingdom","volume":"74","author":"Joji","year":"2021","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1093\/asj\/sjaa287","article-title":"Can Outpatient Plastic Surgery Be Done Safely During a COVID-19 Surge? Results of a July 2020 Los Angeles Survey and Literature Review","volume":"41","author":"Teitelbaum","year":"2020","journal-title":"Aesthetic Surg. J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1093\/asj\/sjab364","article-title":"Aesthetic Surgery Practice Resumption in the United Kingdom During the COVID-19 Pandemic","volume":"42","author":"Joji","year":"2021","journal-title":"Aesthetic Surg. J."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/5\/914\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:32:11Z","timestamp":1760124731000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/5\/914"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,10]]},"references-count":40,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["medicina59050914"],"URL":"https:\/\/doi.org\/10.3390\/medicina59050914","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,10]]}}}