Skip to main content
Top
Published in: Aesthetic Plastic Surgery 6/2013

01-12-2013 | Case Report

Skin Ulcer: A Long-Term Complication After Massive Liquid Silicone Oil Infiltration

Authors: Sara Carella, Andrea Romanzi, Mariangela Ciotti, Maria Giuseppina Onesti

Published in: Aesthetic Plastic Surgery | Issue 6/2013

Login to get access

Abstract

Background

Despite scientific literature replete with stories of disastrous results and disfigurement, illicit subcutaneous injections of highly viscous fluids in massive quantities still are performed, often by unqualified persons. The authors present a devastating long-term outcome from a massive volume of silicone oil injected subcutaneously into the buttocks of a 48-year-old transsexual patient and its ulceration treated only through regular medications.

Methods

The therapeutic protocol consisted of wound disinfection with iodopovidone, washing with saline solution, disinfection with sodium hypochlorite 0.05 %, and application of ointment containing Vibrio alginolyticus collagenase and hyaluronan. The follow-up evaluation was at 1 and 2 weeks and then at 1, 2, and 3 months. Weekly photographs were taken, and measurements of the lesion and evolution were estimated every 7 days.

Results

After 3 months of regular medications, the authors succeeded in closing the ulcer, avoiding invasive therapeutic options.

Conclusion

In the presence of the cutaneous ulceration above a massively infiltrated area, if the removal of all the injected oil is surgically definitely impossible, other conservative procedures should be considered. Our experience demonstrated how it is possible to manage a so prickly a case with a noninvasive approach such as periodic medications.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.​springer.​com/​00266.
Literature
1.
go back to reference Edgerton MT, Wells JH (1976) Indications for and pitfalls of soft tissue augmentation with liquid silicone. Plast Reconstr Surg 58:157–165PubMedCrossRef Edgerton MT, Wells JH (1976) Indications for and pitfalls of soft tissue augmentation with liquid silicone. Plast Reconstr Surg 58:157–165PubMedCrossRef
2.
go back to reference Selmanowitz VJ, Orentreich N (1977) Medical grade fluid silicon: a monographic review. J Dermatol Surg Oncol 3:597–611PubMed Selmanowitz VJ, Orentreich N (1977) Medical grade fluid silicon: a monographic review. J Dermatol Surg Oncol 3:597–611PubMed
3.
go back to reference Winer LH, Stenberg TH, Lehman R, Ashley FL (1964) Tissue reactions to injected silicone liquids. Arch Dermatol 90:588–592PubMedCrossRef Winer LH, Stenberg TH, Lehman R, Ashley FL (1964) Tissue reactions to injected silicone liquids. Arch Dermatol 90:588–592PubMedCrossRef
4.
go back to reference Narins RS, Beer K (2006) Liquid injectable silicone: a review of its history, immunology, technical considerations, complications, and potential. Plast Reconstr Surg 118(3 Suppl):77S–84SPubMedCrossRef Narins RS, Beer K (2006) Liquid injectable silicone: a review of its history, immunology, technical considerations, complications, and potential. Plast Reconstr Surg 118(3 Suppl):77S–84SPubMedCrossRef
5.
go back to reference Prather CL, Jones DH (2006) Liquid injectable silicone for soft issue augmentation. Dermatol Ther 19:159–168PubMedCrossRef Prather CL, Jones DH (2006) Liquid injectable silicone for soft issue augmentation. Dermatol Ther 19:159–168PubMedCrossRef
6.
go back to reference Chasan PE (2007) The history of injectable silicone fluids for soft tissue augmentation. Plast Reconstr Surg 120:2034–2040PubMedCrossRef Chasan PE (2007) The history of injectable silicone fluids for soft tissue augmentation. Plast Reconstr Surg 120:2034–2040PubMedCrossRef
7.
go back to reference Allevato MA, Pastorale EP, Zamboni M, Kerdel F, Woscoff A (1996) Complications following industrial liquid silicone injection. Int J Dermatol 35:193–195PubMedCrossRef Allevato MA, Pastorale EP, Zamboni M, Kerdel F, Woscoff A (1996) Complications following industrial liquid silicone injection. Int J Dermatol 35:193–195PubMedCrossRef
8.
go back to reference Hage JJ, Kanhai RC, Oen A, van Diest P, Karim R (2001) The devastating outcome of massive subcutaneous injection of highly viscous fluids in male-to-female transsexuals. Plast Reconstr Surg 107:734–741PubMedCrossRef Hage JJ, Kanhai RC, Oen A, van Diest P, Karim R (2001) The devastating outcome of massive subcutaneous injection of highly viscous fluids in male-to-female transsexuals. Plast Reconstr Surg 107:734–741PubMedCrossRef
9.
go back to reference Orentreich DS, Orentreich N (1989) Leg ulcers following subcutaneous injection of a liquid silicone preparation. Arch Dermatol 125:1283–1284PubMedCrossRef Orentreich DS, Orentreich N (1989) Leg ulcers following subcutaneous injection of a liquid silicone preparation. Arch Dermatol 125:1283–1284PubMedCrossRef
10.
go back to reference Lopiccolo MC, Workman BJ, Chaffins ML, Kerr HA (2011) Silicone granulomas after soft-tissue augmentation of the buttocks: a case report and review of management. Dermatol Surg 37:720–725PubMedCrossRef Lopiccolo MC, Workman BJ, Chaffins ML, Kerr HA (2011) Silicone granulomas after soft-tissue augmentation of the buttocks: a case report and review of management. Dermatol Surg 37:720–725PubMedCrossRef
11.
go back to reference Schwartzfarb EM, Hametti JM, Romanelli P, Ricotti C (2008) Foreign body granuloma formation secondary to silicone injection. Dermatol Online J 14:20PubMed Schwartzfarb EM, Hametti JM, Romanelli P, Ricotti C (2008) Foreign body granuloma formation secondary to silicone injection. Dermatol Online J 14:20PubMed
12.
go back to reference Ficarra G, Mosqueda-Taylor A, Carlos R (2002) Silicone granuloma of the facial tissues: a report of seven cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 94:65–73PubMedCrossRef Ficarra G, Mosqueda-Taylor A, Carlos R (2002) Silicone granuloma of the facial tissues: a report of seven cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 94:65–73PubMedCrossRef
13.
go back to reference Bigata X, Ribera M, Bielsa I, Ferrandiz C (2001) Adverse granulomatosis reaction after cosmetic dermal silicone injection. Dermatol Surg 27:198–200PubMedCrossRef Bigata X, Ribera M, Bielsa I, Ferrandiz C (2001) Adverse granulomatosis reaction after cosmetic dermal silicone injection. Dermatol Surg 27:198–200PubMedCrossRef
14.
go back to reference Chastre J, Brun P, Soler P, Basset F, Trouillet JL, Fagon JY, Gibert C, Hance AJ (1987) Acute and latent pneumonitis after subcutaneous injections of silicone in transsexual men. Am Rev Respir Dis 135:236–240PubMed Chastre J, Brun P, Soler P, Basset F, Trouillet JL, Fagon JY, Gibert C, Hance AJ (1987) Acute and latent pneumonitis after subcutaneous injections of silicone in transsexual men. Am Rev Respir Dis 135:236–240PubMed
15.
go back to reference Gurvitis GE (2006) Silicone pneumonitis after a cosmetic augmentation procedure. N Engl J Med 354:211–212CrossRef Gurvitis GE (2006) Silicone pneumonitis after a cosmetic augmentation procedure. N Engl J Med 354:211–212CrossRef
16.
go back to reference Rapaport MJ, Vinnik CH, Zarem H (1996) Injectable silicone: causes of facial nodules, cellulitis, ulceration, and migration. Aesthetic Plast Surg 20:267–276PubMedCrossRef Rapaport MJ, Vinnik CH, Zarem H (1996) Injectable silicone: causes of facial nodules, cellulitis, ulceration, and migration. Aesthetic Plast Surg 20:267–276PubMedCrossRef
17.
go back to reference Rollins CE, Reiber G, Guinee DG Jr, Lie JT (1997) Disseminated lipogranulomas and sudden death from self-administered mineral oil injection. Am J Forensic Med Pathol 18:100–103PubMedCrossRef Rollins CE, Reiber G, Guinee DG Jr, Lie JT (1997) Disseminated lipogranulomas and sudden death from self-administered mineral oil injection. Am J Forensic Med Pathol 18:100–103PubMedCrossRef
18.
go back to reference Morgenstern L, Gleischman SH, Michel SL, Rosenberg JE, Knight I, Goodman D (1985) Relation of free silicone to human breast carcinoma. Arch Surg 120:573–577PubMedCrossRef Morgenstern L, Gleischman SH, Michel SL, Rosenberg JE, Knight I, Goodman D (1985) Relation of free silicone to human breast carcinoma. Arch Surg 120:573–577PubMedCrossRef
19.
go back to reference Ellenbogen R, Rubin L (1975) Injectable fluid silicone therapy: human morbidity and mortality. JAMA 234:308–309PubMedCrossRef Ellenbogen R, Rubin L (1975) Injectable fluid silicone therapy: human morbidity and mortality. JAMA 234:308–309PubMedCrossRef
20.
go back to reference Beer K (2009) Delayed onset nodules from liquid injectable silicone: report of a case, evaluation of associated histopathology and results of treatment with minocycline and celocoxib. J Drugs Dermatol 8:952–954PubMed Beer K (2009) Delayed onset nodules from liquid injectable silicone: report of a case, evaluation of associated histopathology and results of treatment with minocycline and celocoxib. J Drugs Dermatol 8:952–954PubMed
21.
go back to reference Otte WM, Singla M, Sander JW, Singh G (2013) Drug therapy for solitary cysticercus granuloma: a systematic review and meta-analysis. Neurology 80:152–162PubMedCrossRef Otte WM, Singla M, Sander JW, Singh G (2013) Drug therapy for solitary cysticercus granuloma: a systematic review and meta-analysis. Neurology 80:152–162PubMedCrossRef
22.
go back to reference Wagner AE, Huck G, Stiehl DP, Jelkmann W, Hellwig-Burgel T (2008) Dexamethasone impairs hypoxia-inducible factor-1 function. Biochem Biophys Res Commun 372:336–340PubMedCrossRef Wagner AE, Huck G, Stiehl DP, Jelkmann W, Hellwig-Burgel T (2008) Dexamethasone impairs hypoxia-inducible factor-1 function. Biochem Biophys Res Commun 372:336–340PubMedCrossRef
23.
go back to reference Ackermann D (2007) Hypercalcemia in sarcoidosis: case report, prevalence, pathophysiology, and therapeutic options. Ther Umsch 64:281–286PubMedCrossRef Ackermann D (2007) Hypercalcemia in sarcoidosis: case report, prevalence, pathophysiology, and therapeutic options. Ther Umsch 64:281–286PubMedCrossRef
24.
go back to reference Grazer FM (1983) Suction-assisted lipectomy, suction lipectomy, lipolysis, and lipexeresis. Plast Reconstr Surg 72:620–623PubMedCrossRef Grazer FM (1983) Suction-assisted lipectomy, suction lipectomy, lipolysis, and lipexeresis. Plast Reconstr Surg 72:620–623PubMedCrossRef
25.
go back to reference Zandi I (1985) Use of suction to treat soft tissue injected with liquid silicone. Plast Reconstr Surg 76:307–309PubMed Zandi I (1985) Use of suction to treat soft tissue injected with liquid silicone. Plast Reconstr Surg 76:307–309PubMed
26.
go back to reference Zandi I (2000) Failure to remove soft tissue injected with liquid silicone with use of suction and honesty in scientific medical reports. Plast Reconstr Surg 105:1555–1556PubMed Zandi I (2000) Failure to remove soft tissue injected with liquid silicone with use of suction and honesty in scientific medical reports. Plast Reconstr Surg 105:1555–1556PubMed
27.
go back to reference Grippaudo FR, Spalvieri C, Rossi A, Onesti MG, Scuderi N (2004) Ultrasound-assisted liposuction for the removal of siliconomas. Scand J Plast Reconstr Surg Hand Surg 38:21–26PubMedCrossRef Grippaudo FR, Spalvieri C, Rossi A, Onesti MG, Scuderi N (2004) Ultrasound-assisted liposuction for the removal of siliconomas. Scand J Plast Reconstr Surg Hand Surg 38:21–26PubMedCrossRef
28.
go back to reference Loustau HD, Mayer HF, Catterino L (2009) Dermolipectomy of the thighs and buttocks to solve a massive silicone oil injection. Aesthetic Plast Surg 33:657–660PubMedCrossRef Loustau HD, Mayer HF, Catterino L (2009) Dermolipectomy of the thighs and buttocks to solve a massive silicone oil injection. Aesthetic Plast Surg 33:657–660PubMedCrossRef
29.
go back to reference Langer V, Bhandari PS, Rajagopalan S, Mukherjee MK (2013) Negative pressure wound therapy as an adjunct in healing of chronic wounds. Int Wound J. doi:10.1111/iwj.12132 Langer V, Bhandari PS, Rajagopalan S, Mukherjee MK (2013) Negative pressure wound therapy as an adjunct in healing of chronic wounds. Int Wound J. doi:10.​1111/​iwj.​12132
30.
go back to reference Anderson I (2001) The properties of hyaluronan and its role in wound healing. Prof Nurse 17:232–235PubMed Anderson I (2001) The properties of hyaluronan and its role in wound healing. Prof Nurse 17:232–235PubMed
31.
go back to reference Onesti MG, Fioramonti P, Carella S, Fino P, Sorvillo V, Scuderi N (2013) A new association between hyaluronic acid and collagenase in wound repair: an open study. Eur Rev Med Pharmacol Sci 17:210–216PubMed Onesti MG, Fioramonti P, Carella S, Fino P, Sorvillo V, Scuderi N (2013) A new association between hyaluronic acid and collagenase in wound repair: an open study. Eur Rev Med Pharmacol Sci 17:210–216PubMed
32.
go back to reference Ramundo J, Gray M (2009) Collagenase for enzymatic debridement: a systematic review. J Wound Ostomy Continence Nurs 36(6 Suppl):S4–S11PubMedCrossRef Ramundo J, Gray M (2009) Collagenase for enzymatic debridement: a systematic review. J Wound Ostomy Continence Nurs 36(6 Suppl):S4–S11PubMedCrossRef
33.
go back to reference Claeys A, Gaudy-Marqueste C, Pauly V, Pelletier F, Truchetet F, Boye T, Aubin F, Schmutz JL, Grob JJ, Richard MA (2010) Management of pain associated with debridement of leg ulcers: a randomized, multicentre, pilot study comparing nitrous oxide-oxygen mixture inhalation and lidocaïne-prilocaïne cream. J Eur Acad Dermatol Venereol 25:138–144PubMedCrossRef Claeys A, Gaudy-Marqueste C, Pauly V, Pelletier F, Truchetet F, Boye T, Aubin F, Schmutz JL, Grob JJ, Richard MA (2010) Management of pain associated with debridement of leg ulcers: a randomized, multicentre, pilot study comparing nitrous oxide-oxygen mixture inhalation and lidocaïne-prilocaïne cream. J Eur Acad Dermatol Venereol 25:138–144PubMedCrossRef
34.
go back to reference Mekkes JR, Zeegelaar JE, Westerhof W (1998) Quantitative and objective evaluation of wound-debriding properties of collagenase and fibrinolysin/desoxyribonuclease in a necrotic ulcer animal model. Arch Dermatol Res 290:152–157PubMedCrossRef Mekkes JR, Zeegelaar JE, Westerhof W (1998) Quantitative and objective evaluation of wound-debriding properties of collagenase and fibrinolysin/desoxyribonuclease in a necrotic ulcer animal model. Arch Dermatol Res 290:152–157PubMedCrossRef
35.
36.
go back to reference Hollander D, Schmandra T, Windolf J (2000) Using an esterified hyaluronan fleece to promote healing in difficult-to-treat wounds. J Wound Care 9:463–466PubMed Hollander D, Schmandra T, Windolf J (2000) Using an esterified hyaluronan fleece to promote healing in difficult-to-treat wounds. J Wound Care 9:463–466PubMed
37.
go back to reference Wisniewski HG, Hua JC, Poppers DM, Naime D, Vilcek J, Cronstein BN (1996) TNF/IL-1-inducible protein TSG-6 potentiates plasmin inhibition by inter-alpha-inhibitor and exerts a strong antiinflammatory effect in vivo. J Immunol 156:1609–1615PubMed Wisniewski HG, Hua JC, Poppers DM, Naime D, Vilcek J, Cronstein BN (1996) TNF/IL-1-inducible protein TSG-6 potentiates plasmin inhibition by inter-alpha-inhibitor and exerts a strong antiinflammatory effect in vivo. J Immunol 156:1609–1615PubMed
38.
go back to reference Kobayashi H, Terao T (1997) Hyaluronic acid-specific regulation of cytokines by human uterine fibroblasts. Am J Physiol 273(4 Pt 1):C1151–C1159PubMed Kobayashi H, Terao T (1997) Hyaluronic acid-specific regulation of cytokines by human uterine fibroblasts. Am J Physiol 273(4 Pt 1):C1151–C1159PubMed
39.
go back to reference Kangesu T, Manek S, Terenghi G, Gu XH, Navsaria HA, Polak JM, Green CJ, Leigh IM (1998) Nerve and blood vessel growth in response to grafted dermis and cultured keratinocytes. Plast Reconstr Surg 101:1029–1038PubMedCrossRef Kangesu T, Manek S, Terenghi G, Gu XH, Navsaria HA, Polak JM, Green CJ, Leigh IM (1998) Nerve and blood vessel growth in response to grafted dermis and cultured keratinocytes. Plast Reconstr Surg 101:1029–1038PubMedCrossRef
40.
go back to reference Campoccia D, Doherty P, Radice M, Brun P, Abatangelo G, Williams DF (1998) Semisynthetic resorbable materials from hyaluronan esterification. Biomaterials 19:2101–2127PubMedCrossRef Campoccia D, Doherty P, Radice M, Brun P, Abatangelo G, Williams DF (1998) Semisynthetic resorbable materials from hyaluronan esterification. Biomaterials 19:2101–2127PubMedCrossRef
Metadata
Title
Skin Ulcer: A Long-Term Complication After Massive Liquid Silicone Oil Infiltration
Authors
Sara Carella
Andrea Romanzi
Mariangela Ciotti
Maria Giuseppina Onesti
Publication date
01-12-2013
Publisher
Springer US
Published in
Aesthetic Plastic Surgery / Issue 6/2013
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI
https://doi.org/10.1007/s00266-013-0212-3

Other articles of this Issue 6/2013

Aesthetic Plastic Surgery 6/2013 Go to the issue