What is the management for gluteal fat necrosis?

Management of Gluteal Fat Necrosis

The treatment of symptomatic gluteal fat necrosis should be based on the size, symptoms, and characteristics of the lesion, with small asymptomatic lesions managed conservatively and symptomatic or large lesions requiring surgical intervention. 1

Clinical Presentation and Diagnosis

• Gluteal fat necrosis typically presents as painful, tender nodules or masses in the buttock region 2
• Diagnosis is primarily clinical but can be confirmed with imaging studies:
  • Ultrasound can help differentiate simple soft tissue masses from more complex lesions 2
  • MRI is the preferred imaging modality for accurate diagnosis, showing characteristic findings of central fat signal surrounded by a peripheral ring 3
• Histopathological confirmation is important for definitive diagnosis and to rule out other conditions that may mimic fat necrosis, such as malignancy 2

Management Approach

Conservative Management

• Small (<5 cm) and asymptomatic lesions can be managed conservatively with observation 1
• Simple analgesia may be used for mild pain control 3

Minimally Invasive Techniques

• For moderately sized areas of symptomatic fat necrosis:
  • Aspiration of fluid collections if present 1
  • Ultrasound-assisted liposuction for non-calcified lesions 1
  • Needle aeration techniques may be effective for oil cysts 1

Surgical Management

• Surgical excision remains the gold standard for symptomatic gluteal fat necrosis, particularly for:

  • Large lesions causing significant pain 1
  • Calcified areas of fat necrosis 1
  • Cases where conservative management has failed 1
  • When infection is present or suspected 4

• Complete debridement of necrotic tissue is essential to:

  • Relieve symptoms 1
  • Prevent infection 4
  • Allow for proper healing 4

Reconstruction Considerations

• Following extensive debridement, reconstruction may be necessary:
  • Local flaps may be used for smaller defects 4
  • For larger defects, especially in cases with compromised local vascularity, transposition flaps based on the lumbar artery perforators can be considered 4

Special Considerations

Prevention of Complications

• Prompt recognition and treatment are essential to prevent:
  • Infection of necrotic tissue 4
  • Progression to deeper tissues 5
  • Systemic complications such as sepsis 5

Etiology-Specific Management

• When fat necrosis is secondary to a specific cause (e.g., insulin injections), avoidance of further injections into the affected area is recommended 3
• In cases following pelvic trauma or embolization procedures, more extensive surgical intervention may be required due to the potential for larger areas of necrosis 5

Follow-up Care

• Regular follow-up is recommended to:
  • Monitor for recurrence 1
  • Assess wound healing after surgical intervention 4
  • Evaluate for development of contour irregularities that may require subsequent treatment 1

Pitfalls to Avoid

• Delaying surgical intervention when there are signs of infection or significant symptoms 4
• Inadequate debridement of necrotic tissue, which can lead to persistent infection 4
• Failing to consider the vascular supply when planning reconstruction, particularly in cases following embolization procedures 4, 5
• Misdiagnosis as other conditions (such as tumors or abscesses), leading to inappropriate management 2, 3