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McGraw JR, Jaimez IA, Card E, Holland M, Azoury SC, Kovach SJ. Bilateral gluteal reconstruction with deep inferior epigastric perforator flaps and saphenofemoral arteriovenous loops. Microsurgery 2024; 44:e31120. [PMID: 37795640 DOI: 10.1002/micr.31120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/29/2023] [Accepted: 09/14/2023] [Indexed: 10/06/2023]
Abstract
The use of liquid silicone injections for soft tissue augmentation harbors numerous risks and is not approved by the FDA. Still, such injections are frequently performed by unlicensed providers, often in the gluteal region, and can lead to infection, soft-tissue breakdown, scarring, and disfigurement. The purpose of this case report was to demonstrate the use of immediate, abdominally based free flaps for reconstruction in a patient with bilateral total gluteal defects and limited inflow options in the setting of remote silicone injections. The patient is a 45-year-old female who developed chronically infected injected silicone in the bilateral buttocks leading to draining abscesses and soft tissue breakdown. The patient required radical debridement and excision of the bilateral buttocks to remove all foreign material. After intermediate skin grafting of the residual wounds, the patient then was deemed a candidate for bilateral free flap reconstruction of the buttocks. On exploration of the bilateral defects, both 20 cm × 10 cm in size, the gluteal vessels were non-usable, and preoperative CTA additionally had revealed no suitable posteriorly based perforators. Therefore, bilateral arteriovenous (AV) loops, measuring 30 cm in length, were then constructed utilizing the greater saphenous veins anastomosed to the femoral arteries which were then tunneled to the defect. The soft tissue defects were concurrently reconstructed with bilateral deep inferior epigastric perforator (DIEP) flaps measuring 16 cm × 12 cm. The postoperative course was complicated by small seromas in each groin requiring drain placement by interventional radiology on postoperative day 16. Otherwise, the patient's buttocks healed well, and functionally, the patient had regained the ability to sit and was satisfied with the aesthetic appearance of the reconstruction as of last follow-up at 10 months. Abdominally based free flap reconstruction with AV loops, in this case, provided for successful reconstruction of otherwise challenging soft-tissue defects with limited inflow options.
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Affiliation(s)
- J Reed McGraw
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ivan A Jaimez
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elizabeth Card
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael Holland
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Saïd C Azoury
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephen J Kovach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Agostini T, Perello R. Siliconomas of the lower limb: Tumour-like excision and reconstruction. Indian J Plast Surg 2019; 49:384-389. [PMID: 28216820 PMCID: PMC5288915 DOI: 10.4103/0970-0358.197228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Silicone oil injection can cause several complications including pain, cellulitis, abscesses, skin compromise, migration, embolism and multiorgan failure. Oil-infested tissue excision remains the solely treatment to prevent such complications. Objectives: The authors evaluate tumor-like excision of the oil-infested tissue as a treatment for patients experiencing silicone injections in the lower limbs, to both preserve aesthetic appearance and solve further risk of complication from silicone. Methods: Between January 2004 and January 2011 a total of 12 consecutive, nonrandomized female patients underwent surgical management of siliconoma of the lower limb. The mean age was 41-years, range from 22 to 61 years and all patients didn’t referred comorbidities. Eight siliconomas were located on the leg and 4 were on the thigh. The mean area of siliconoma was 35 cm2, range from 25 to 60 cm2. Each patient was evaluated by ultrasonography and EchocolorDoppler of the soft tissue and in order to achieve a “staging” of siliconoma. Results: Healing was uneventful in all cases. Three patients (25%) suffering hypertrophic scarring underwent further injection of corticosteroids to improve hypertrophic scars quality. Two patients (16.6%) required a further session of structural fat grafting to improve thigh's profile. All patients were satisfied with the cosmetic results and indispositions requiring medical therapy disappeared. Conclusions: Tumor-like excision and immediate reconstruction appears to be a safe and consistent surgical option that preserves aesthetic appearance for patients victims of illegal oil silicone injection of the lower limbs.
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Affiliation(s)
- Tommaso Agostini
- Department of Plastic and Reconstructive Surgery, Centro Chirurgico San Paolo, Pistoia, Italy
| | - Raffaella Perello
- Department of Plastic and Reconstructive Surgery, Centro Chirurgico San Paolo, Pistoia, Italy
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Sharobaro VI, Manturova NE, Ivanov YV, Avdeev AE, Zabozlaev FG, Telnova AV. [Injected non-absorbable fillers in large volumes]. Khirurgiia (Mosk) 2019:42-51. [PMID: 31120446 DOI: 10.17116/hirurgia201904142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIM To present treatment strategy for large volumes of injectable non-absorbable 'shell-less' soft tissue fillers (vaseline, synthol, silicone etc.). MATERIAL AND METHODS The authors present an experience of surgical treatment of 8 patients who underwent injections of medical vaseline (breast augmentation, n=5) and synthol (muscles enlargement, n=3) and review of the current literature devoted to this problem. RESULTS Injection of large amounts (over 50 ml) of non-absorbable fillers into soft tissues is unacceptable and leads to numerous complications. Oil-based 'shell-less' fillers cannot be removed by minimally invasive techniques (puncture, mini-incisions, etc.) due to multiple diffuse lesions in the form of oleogranulomas (cysts of different size) and surrounding widespread inflammation and fibrosis of tissues. Surgery is the only adequate method. However, this approach is followed by scars and often tissue contour deformation. Migration of these fillers to other anatomical areas (from the neck to the lower extremities) significantly complicates the situation, treatment and results. In case of categorical refusal of patients from surgical treatment and no complaints, they should be properly informed about possible consequences and complications and dynamic medical supervision is necessary. Intraoperative ultrasound examination is useful for the control of radical removal of pathological areas. Timely removal of non-absorbable fillers allows to avoid serious complications and to achieve good aesthetic results.
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Affiliation(s)
- V I Sharobaro
- Federal Research Clinical Center of Specialized Types of Medical Care and Medical Technologies, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - N E Manturova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Yu V Ivanov
- Federal Research Clinical Center of Specialized Types of Medical Care and Medical Technologies, Moscow, Russia
| | - A E Avdeev
- Institute of Beauty on Arbat, Moscow, Russia
| | - F G Zabozlaev
- Federal Research Clinical Center of Specialized Types of Medical Care and Medical Technologies, Moscow, Russia
| | - A V Telnova
- Federal Research Clinical Center of Specialized Types of Medical Care and Medical Technologies, Moscow, Russia
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Tremp M, di Summa PG, Oranges CM, Schaefer DJ, Kalbermatten DF. Reconstruction of gluteal deformities: a systematic review and experience of four cases. J Plast Surg Hand Surg 2016; 51:313-322. [PMID: 27928936 DOI: 10.1080/2000656x.2016.1263203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The reconstruction of gluteal deformities remains a major challenge. The aim of this article is to provide a systematic review of the literature concerned, and to present a case series with representative defects from various zones. METHODS A review of the literature was performed using PubMed, EMBASE, and The Cochrane Library, in accordance with the PRISMA statement. Quality of evidence was rated according to GRADE. Patients with various buttock deformities were included and, depending on the defect, the reconstructive techniques applied consisted of lipoinjection, local fasciocutaneous flap, or pedicled gracilis muscle flap. Complications, patient's pain assessment, impairment in everyday-life activities, aesthetic outcome, objective assessment of sensitivity, and recurrence were considered. RESULTS A total of 498 records were identified in the literature search. Of those, 12 studies met the PICOS (participants, interventions, comparators, outcomes, and study design) criteria. Overall, 41 patients were analysed, the evidence of which was of low quality. In this study, four patients (three female and one male) with a mean age of 44 ± 15 years were operated on between 2010-2014. The mean operation time was 83 ± 30 minutes. One patient required revision due to persistent seroma and recurrence, and one patient required neurolysis and gracilis denervation due to neuroma and scarring. After a mean follow-up of 40 ± 21 months, the results were functionally and cosmetically satisfactory. CONCLUSIONS Reconstruction of buttock deformities using an integrated approach can lead to a long-lasting, functionally and aesthetically satisfactory result. However, evidence is limited due to the lack of good-quality studies.
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Affiliation(s)
- Mathias Tremp
- a Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery , University Hospital Basel , Basel , Switzerland
| | - Pietro Giovanni di Summa
- b Division of Plastic, Reconstructive, Aesthetic, and Hand Surgery, CHUV , University Hospital of Lausanne , Lausanne , Switzerland
| | - Carlo M Oranges
- a Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery , University Hospital Basel , Basel , Switzerland
| | - Dirk J Schaefer
- a Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery , University Hospital Basel , Basel , Switzerland
| | - Daniel Felix Kalbermatten
- a Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery , University Hospital Basel , Basel , Switzerland.,b Division of Plastic, Reconstructive, Aesthetic, and Hand Surgery, CHUV , University Hospital of Lausanne , Lausanne , Switzerland
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Lungu E, Thibault-Lemyre A, Dominguez JM, Trudel D, Bureau NJ. A case of recurrent leg necrotic ulcers secondary to silicone migration in a transgender patient: radiographic, ultrasound and MRI findings. BJR Case Rep 2016; 2:20150309. [PMID: 30364371 PMCID: PMC6195932 DOI: 10.1259/bjrcr.20150309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/10/2015] [Indexed: 11/06/2022] Open
Abstract
Injection of massive quantities of liquid silicone into body parts for cosmetic purposes is a popular practice among the transgender population. Although a myriad of short-term complications associated with this procedure have been described, few reports of chronic and persistent ailments exist. We present the case of a male-to-female transgender with recurrent necrotic leg ulcers associated with migration of the silicone material injected in the buttocks 25 years ago. We review the imaging findings as well as the clinical and pathological aspects of this presentation, with an emphasis on the necessity of a high degree of suspicion for silicone-associated complications in a transgender patient presenting with leg wounds. We highlight the importance of the characteristic sonographic snowstorm artefact generated by free silicone material in soft tissues in the diagnosis of this entity.
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Affiliation(s)
- Eugen Lungu
- Faculty of Medicine, Université de Montréal, Montréal, Canada
| | | | | | - Dominique Trudel
- Department of Pathology, Centre Hospitalier de l´Université de Montréal, Montréal, Canada
| | - Nathalie J Bureau
- Radiology Department, Centre Hospitalier de l´Université de Montréal, Montréal, Canada
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Silicone-induced Granuloma After Buttock Augmentation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e624. [PMID: 27014553 PMCID: PMC4778895 DOI: 10.1097/gox.0000000000000618] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/13/2016] [Indexed: 11/26/2022]
Abstract
Liquid silicone is inexpensive, minimally antigenic, and likely noncarcinogenic. Its simplicity of use has made it popular as a soft-tissue filler in some parts of the world for patients seeking rapid soft-tissue augmentation of the face, breast, and buttocks. However, multiple reports describe the complications of silicone injections such as cellulitis, abscess, ulceration, and foreign body migration. We present an unusual complication of granulomatous reaction secondary to silicone injection for buttock augmentation, with a literature review of this entity and treatment options. Our patient was a 54-year-old woman who underwent bilateral buttock augmentation in the Dominican Republic using percutaneous injection of liquid silicone. She presented to our facility 1 year after this procedure with pain and inflammation of both buttocks. She was diagnosed with multiple silicone granulomas. Her symptoms completely resolved with a 3-week course of minocycline. Granulomatous reactions to silicone may occur months to years after the silicone injection. The incidence of such complications may be increased when nonmedical-grade silicone is used, and hence, when these procedures are performed in developing countries. Tetracycline antibiotics, especially minocycline, may be used to achieve sustained remission.
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Pseudocyst of the Neck After Facial Augmentation With Liquid Silicone Injection. J Craniofac Surg 2014; 25:e474-5. [DOI: 10.1097/scs.0000000000001125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Salgado CJ, Sinha VR, Desai U. Liposuction and lipofilling for treatment of symptomatic silicone toxicosis of the gluteal region. Aesthet Surg J 2014; 34:571-7. [PMID: 24676144 DOI: 10.1177/1090820x14527107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Silicone injection can cause numerous posttreatment complications-including debilitating pain, cellulitis, abscesses, overlying skin compromise, and siliconomas distorting overlying tissues-that can be difficult to manage. OBJECTIVES The authors evaluate liposuction as a treatment for patients experiencing complications from silicone injections to the gluteal region, to both preserve aesthetic appearance and minimize further risk of complication from these procedures. METHODS Eight patients (7 women and 1 man) who presented consecutively to us between 2010 and 2013 with complications from silicone injections to their gluteal region were enrolled in this study. Each patient was evaluated by computed tomography scan and a 0 to 6 visual analog scale for pain. Emergency room (ER) visits, previous hospital admissions, and cellulitis requiring antibiotics in the 12 months prior to treatment were recorded. Patients were treated with ultrasonic and standard liposuction followed by lipotransfer into the gluteal musculature. A Student t test was used for statistical comparison of pre- and postoperative values. RESULTS Average patient age was 36 years (range, 25-43 years). All patients initially presented with intense pain as assessed by a visual analog scale; by the 12th week postoperatively, the entire cohort experienced remission in pain. At 1 year postoperatively, no patients had infections (vs 75% preoperatively; P = .028), visited the ER (vs 50% preoperatively; P = .058), or were hospitalized (vs an average of 1.5 hospitalizations per patient preoperatively; P = .066). CONCLUSIONS Liposuction with immediate intramuscular fat transfer for buttock augmentation appears to be a safe surgical option that preserves aesthetic appearance for patients with gluteal silicone toxicosis.
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Affiliation(s)
- Christopher J Salgado
- DeWitt Daughtry Family Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, University of Miami Miller School of Medicine, Florida
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de la Fuente TP, Sandoval E, Hermoso CC, Pardo LG. Mycobacterium tuberculosis silicone gluteus abscesses with bone involvement. Aesthetic Plast Surg 2014; 38:485-7. [PMID: 24584858 DOI: 10.1007/s00266-014-0281-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 01/19/2014] [Indexed: 11/26/2022]
Affiliation(s)
- T Pérez de la Fuente
- Department of Plastic and Reconstructive Surgery, Fundación Jiménez Díaz, Avd/Reyes Católicos 2, 28040, Madrid, Spain,
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Frank SJ, Flusberg M, Friedman S, Sternschein M, Wolf EL, Stein MW. Aesthetic surgery of the buttocks: imaging appearance. Skeletal Radiol 2014; 43:133-9. [PMID: 24240204 DOI: 10.1007/s00256-013-1753-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 09/25/2013] [Accepted: 10/07/2013] [Indexed: 02/02/2023]
Abstract
Familiarity with the imaging appearance and potential complications of buttocks aesthetic surgery is important for radiologists. In this review, we illustrate the spectrum of imaging features after buttocks implants, liposuction, fat injections and silicone injections. Complications such as fat necrosis, abscess, and silicone migration are also presented.
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Affiliation(s)
- Susan J Frank
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA
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Carella S, Romanzi A, Ciotti M, Onesti MG. Skin ulcer: a long-term complication after massive liquid silicone oil infiltration. Aesthetic Plast Surg 2013; 37:1220-4. [PMID: 24045933 DOI: 10.1007/s00266-013-0212-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 08/27/2013] [Indexed: 11/29/2022]
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 .
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Affiliation(s)
- Sara Carella
- Department of Plastic and Reconstructive Surgery, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy,
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Mutaf procedure: expanding the indications. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-011-0624-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Schäfer CN, Hvolris J, Karlsmark T, Plambech M. Muscle enhancement using intramuscular injections of oil in bodybuilding: review on epidemiology, complications, clinical evaluation and treatment. Eur Surg 2011. [DOI: 10.1007/s10353-011-0033-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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