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CASE REPORT

EXPERIMENTAL/SPECIAL TOPICS

Skin Ulcer: A Long-Term Complication After Massive Liquid Silicone Oil Infiltration Sara Carella • Andrea Romanzi • Mariangela Ciotti Maria Giuseppina Onesti

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Received: 23 May 2013 / Accepted: 27 August 2013 / Published online: 18 September 2013 Ó Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2013

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

S. Carella
A. Romanzi
M. Ciotti
M. G. Onesti Department of Plastic and Reconstructive Surgery, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy S. Carella (&) Department of Plastic and Reconstructive Surgery, ‘‘Sapienza’’ University of Rome, Via delle Provincie 65, 00100 Rome, Italy e-mail: [email protected]; [email protected]

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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. Keywords Liquid silicone injection
Siliconoma
Ulcer
Hyaluronic acid
Collagenase

The search for the ideal injectable filling material to use in correcting contour defects of the face and body is ongoing. To date, various materials including autologous fat, hyaluronic acids, poly-L-lactic acid, and calcium hydroxylapatite, currently are injected for this purpose. In the past, physicians used filler materials such as paraffin (mineral oil), beeswax, poly(tetrafluoroethylene), and other nonbiocompatible products. The concept of using materials for soft tissue augmentation actually began about 1950 with the use of fluid silicone, which co