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

• Published in: Aesthetic plastic surgery 2013-12, Vol.37 (6), p.1220-1224
• Main Authors: Carella, Sara, Romanzi, Andrea, Ciotti, Mariangela, Onesti, Maria Giuseppina
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - therapeutic use; Anti-Bacterial Agents - therapeutic use; Body Modification, Non-Therapeutic - adverse effects; Buttocks; Case Report; Debridement - methods; Female; Follow-Up Studies; Humans; Injections, Subcutaneous; Magnetic Resonance Imaging; Medicine; Medicine & Public Health; Middle Aged; Negative-Pressure Wound Therapy - methods; Otorhinolaryngology; Plastic Surgery; Risk Assessment; Silicone Oils - adverse effects; Silicone Oils - pharmacology; Skin Care - methods; Skin Ulcer - chemically induced; Skin Ulcer - pathology; Skin Ulcer - therapy; Transgender Persons; Treatment Outcome; Wound Healing - physiology
• ISSN: 0364-216X; 1432-5241
• DOI: 10.1007/s00266-013-0212-3

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 .