Less maligned, but cut from the same cloth, other silicone implants also have adverse effects

The immunopathology of siliconosis. History, clinical presentation, and relation to silicosis and the chemistry of silicon and silicone

Recent evidence confirms the fundamental involvement of the human immune system in the reaction to implantation of silicone-based medical devices. An as yet-to-be particularized epitope of many complex substances sharing siloxane structures is presented through the MHC-II apparatus with development and retention of T cell memory. This memory can be tested for in practical terms using one or more forms of silica, which links the immuno-histopathology and autoimmune attributes of "silicosis" with those of "siliconosis." The lesions of siliconosis are typical of those for persistent antigens and delayed, cell mediated hypersensitivity. The basic descriptive pathology of the reaction to silicone has been known since soon after introduction of silicones in medical procedures, with the exception of some details related to the more recent discoveries on the role of cytokines in the immunopathic process. The clinical consequences of siliconosis are common and can be severe in some individuals implanted with silicone devices.

Safety of silicone liquid in the postoperative management of Dupuytren's contracture

BACKGROUND

Recently the New Zealand Department of Health expressed concerns about the safety of applying silicones to open wounds and banned their use. For 30 years silicone liquid has been used for the management and rehabilitation of the injured hand. It has been reported that the application of silicone fluids to the skin and ordinary handling over a period of years of various methyl and phenyl polymers by laboratory workers caused no skin disorders or sensitization, nor was absorption observed. There are no reports in the literature of the safety of the use of silicones applied to open wounds.

METHODS

In the present study, 116 hands that had been mobilized in silicone liquid following surgery for Dupuytren's contracture over the last 12 years were reviewed. In the cases of 64 hands, the patients could be traced and contacted, and 47 patients (hands) agreed to attend for a clinical review. The hands were examined for areas of inflammation, granuloma formation and abnormal scar formation.

RESULTS

No patient showed any evidence of adverse effects from the use of silicone liquid.

CONCLUSIONS

There is no evidence that the use of silicone liquid, in contact with open wounds of the hands, for the mobilization of the hand following surgery for Dupuytren's contracture has any of the adverse effects reported as being associated with implanted silicone prostheses.