Yes SIRS or No SIRS? A Complication Following Cosmetic Medical Tourism
Bibliographic record
Abstract
Background: Fat transfer for buttock augmentation has become popular in the last quarter century. Increasingly, patients obtain the surgery internationally and return home in the early post-operative period. Complications after procedures performed internationally can be difficult to manage due to a paucity of medical and surgical history as well as challenges in obtaining salient records such as operative reports or communicating with the initial surgical team. In the case of fat grafting, complications including infection, hematoma, and injury to critical structures can occur at both the recipient and donor sites. Case: A 28-year-old female underwent large volume buttock fat grafting in the Dominican Republic and received a post-operative course of oral levofloxacin and clindamycin. After her return home, she presented to our institution on post-operative day 9 with buttock pain, tachycardia, and leukocytosis. Imaging of her buttocks showed questionable fluid collections, with no drainable abscess. Drainage of the fat grafted areas by Interventional Radiology recovered a small amount of fluid with negative initial bacterial cultures. Despite antibiotic therapy with vancomycin and meropenem and fluid resuscitation, she did not experience clinical improvement and definitive treatment required bilateral debridement of buttocks with intraoperative findings of large volume fat necrosis. Cultures from the wound grew Peptostreptococcus after a week of incubation, and the patient recovered without further surgical intervention. The case suggests that immediate post-operative antibiotics can select for slow-growing organisms, and diagnosis of large volume fat graft necrosis may be delayed given the absence of a clear abscess cavity on imaging.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".