[A randomized controlled trial on the effect of early eschar dermabrasion combined with antimicrobial soft silicone foam dressing in the treatment of deep partial-thickness burn wounds in children]

Objective: To explore the effect of early eschar dermabrasion combined with antimicrobial soft silicone foam dressing (hereinafter referred to as foam dressing) in treating the deep partial-thickness burn wounds in children. Methods: This study was a randomized controlled trial. From June 2021 to December 2022, 78 pediatric patients with deep partial-thickness burns who met the inclusion criteria were admitted to the Department of Burns in Guiyang Steel Plant Employees Hospital. According to the random number table, the pediatric patients were divided into two groups, with 38 cases left in combined treatment group (with 20 males and 18 females, aged 26.00 (16.75, 39.75) months) and 39 cases in foam dressing group (with 21 males and 18 females, aged 19.00 (14.00, 31.00) months) after the exclusion of one dropped-out child in follow-up. The pediatric patients in combined treatment group underwent eschar dermabrasion of the wound within 48 hours after injury, the wound was covered with foam dressing after operation, and the dressing was replaced once every 7 days; for the pediatric patients in foam dressing group, the wound was sterilized within 48 hours after injury and covered with foam dressing, and the dressing was replaced once every 2 to 3 days. After the wound healing, the children in both groups were routinely applied with silicone gel twice a day for 3 weeks before started wearing elastic sleeves for more than 18 hours a day, and continuously for over than 6 months. The degree of pain during dressing change was evaluated using the children's pain behavior inventory FLACC. The adverse reactions during the treatment period, number of dressing changes, and wound healing time were observed and recorded. Six months after wound healing, the Vancouver scar scale (VSS) was used to evaluate the condition of the wound scar. Results: When changing dressing, the FLACC score for pain of pediatric patients in combined treatment group was 3.5 (2.0, 5.0), which was significantly lower than 6.0 (5.0, 8.0) in foam dressing group (Z=-5.40, P<0.05). During the treatment period, no adverse reactions such as wound edema, fluid accumulation, or peripheral skin rash allergies occurred in any pediatric patient in both groups. The number of dressing changes of pediatric patients in combined treatment group was 3 (3, 4) times, which was significantly less than 8 (7, 10) times in foam dressing group (Z=-7.58, P<0.05). The wound healing time of pediatric patients in combined treatment group was (19±5) days, which was significantly shorter than (25±6) days in foam dressing group (t=-4.48, P<0.05). Six months after wound healing, the VSS score for scar of pediatric patients in combined treatment group was 5 (2, 8), which was significantly lower than 7 (5, 10) in foam dressing group (Z=-3.05, P<0.05). Conclusions: Compared with using foam dressings alone, early eschar dermabrasion combined with foam dressings can reduce the number of dressing changes, alleviate the pain during dressing changes, and shorten the wound healing time in treating children with deep partial-thickness burns, and effectively alleviate scar hyperplasia by combining with anti-scar treatment post burns.

Microvascular changes on optical coherence tomography angiography after rhegmatogenous retinal detachment vitrectomy with silicone tamponade

Purpose

We aimed to evaluate microvascular changes on optical coherence tomography angiography (OCTA) in patients with rhegmatogenous retinal detachment (RRD) who underwent silicone oil (SO) tamponade and compare changes according to macular involvement.

Methods

This retrospective study included 48 patients with unilateral RRD who underwent vitrectomy and SO tamponade and were stable after SO removal. Control data were obtained from the fellow healthy eye. Ophthalmic examinations, including best corrective visual acuity (BCVA) and OCTA, were conducted. Differences in vascular density (VD) in different sections of the macula and differences in the foveal avascular zone (FAZ) were analyzed between the affected eyes and control eyes. Subgroup analyses according to macular involvement were performed.

Results

Baseline BCVA and duration of SO tamponade were associated with postoperative BCVA (p<0.001, p = 0.03, respectively). The average VD in the deep capillary plexus (DCP) and the VD of the nasal parafoveal area in both the superficial capillary plexus (SCP) and the DCP decreased relative to those in the control eyes (p = 0.026, p = 0.028, and p = 0.031, respectively). The FAZ area in the DCP and in the SCP also increased when compared with that in the controls (p = 0.043, p = 0.002, respectively). In addition, the macular-off RRD group had lower VD in the nasal parafoveal area of the DCP than the macular-on RRD group.

Conclusion

SO tamponade could cause microvascular changes, especially in the nasal parafoveal area. The macular-off RRD group were affected more than the macular-on RRD group.

Wound Healing Treatments After Ablative Laser Skin Resurfacing: A Review

Laser resurfacing has progressed since the 1980s to treat a variety of medical and aesthetic indications with ever-evolving safety parameters. While laser technology has evolved to provide a more favorable safety profile and decrease wound healing time, advances in post-procedure healing agents have also helped to mitigate adverse effects, such as persistent erythema, dyspigmentation, acneiform eruptions, dermatitis, infections, and scarring. We reviewed the evidence of growth factors, stem cells, silicone and silicone polymers, botanical based treatments, fatty acids, probiotics, and closed dressings on post-ablative laser skin resurfacing. All reviewed agents demonstrated some evidence in improving post-procedure outcomes, albeit mixed in many cases. Additionally, these studies contain small numbers of participants, vary in type, strength, and clinical indication for which the resurfacing laser was used, and have differing postprocedural evaluation protocols and assessments. This highlights a need for standardization of clinical studies and the importance of choosing an optimal postprocedural skincare plan depending on every unique clinical scenario. J Drugs Dermatol. 2020;19(11):1050-1055. doi:10.36849/JDD.2020.5386.

Randomised, double-blind, placebo controlled multi-centre study to assess the efficacy, tolerability and safety of Enterosgel® in the treatment of irritable bowel syndrome with diarrhoea (IBS-D) in adults

BACKGROUND

Irritable bowel syndrome (IBS) with diarrhoea (IBS-D) is a common and chronic condition that can significantly impair quality of life. The emergence of new drugs for IBS-D has been slow and there is a need for new treatments, including drug-free treatments, which are easy to use and suitable for different patient groups. Currently available drug-free treatments include Enterosgel®, an intestinal adsorbent approved for use in IBS-D and acute diarrhoea and available over-the-counter in the UK and 30 countries worldwide. The aim of this randomised, double-blind, placebo-controlled, multi-centre study is to test the efficacy and safety of Enterosgel® compared to placebo in symptomatic treatment in IBS-D.

METHODS/DESIGN

We will recruit 430 participants with IBS-D from approximately 30 primary and secondary care sites in England. Participants meeting the required abdominal pain and stool consistency criteria over a 2-week screening period will be randomly allocated to receive blinded treatment (Enterosgel® or placebo) for 8 weeks. This will be followed by an 8-week open-label treatment phase with Enterosgel®. Participants will be allowed to adjust their daily dosage during both phases based on their symptoms. Participants will then return to standard care and those who responded to treatment will receive a follow-up call 8 weeks later. Co-medication with loperamide will be permitted and use recorded. The primary outcome measure is the percentage of participants defined as responders for abdominal pain and stool consistency during at least 4 weeks in the 8-week blinded phase. Secondary outcome measures include stool frequency, stool consistency, abdominal pain, bloating, urgency, adequate relief, questionnaire scores and rescue medication use. Exploratory outcomes will be assessed in subsets of participants including qualitative and quantitative data on faecal microorganisms and biomarkers and gut-related measurements from magnetic resonance imaging data.

DISCUSSION

This is the first large scale randomised controlled trial investigating Enterosgel® in IBS-D. A study design with blinded phase followed by an open-label phase was chosen to encourage participation and study completion. Demonstrating that Enterosgel® is effective and safe in IBS-D could encourage adoption by patients and healthcare professionals and foster future clinical trials assessing its use in related conditions.

TRIAL REGISTRATION

ISRCTN17149988. Prospectively registered on 14 November 2017.

A single-blind, randomised controlled trial of StrataXRT® - A silicone-based film-forming gel dressing for prophylaxis and management of radiation dermatitis in patients with head and neck cancer

AIM

Investigate the effects of StrataXRT® versus 10% Glycerine (Sorbolene cream) for preventing and managing radiation dermatitis in patients with head and neck cancer receiving radical radiotherapy (≥50 Gy) with or without chemotherapy or biotherapy.

METHODS

A single-blind, randomised controlled, superiority trial was conducted. Patients either received StrataXRT® or Sorbolene (usual care). Skin toxicity, pain, itching and skin-related quality of life scores were collected from baseline, and up to four weeks post-treatment.

RESULTS

A total of 197 patients were randomised into the study. Skin toxicity was dependent on the treatment group with StrataXRT® patients experiencing lower mean skin toxicity at the end of the radiation treatment (P = 0.002). At the end of treatment, the StrataXRT® arm had a lower percentage of grade 2 (80%) and grade 3 (28%) skin toxicity compared to the sorbolene arm (91% and 45% respectively). After adjustment for Cetuximab, the StrataXRT® arm had a 12% lower risk of experiencing grade 2 skin toxicity (RRR = 0.876, 95% CI: 0.778-0.987, P = 0.031); and a 36% lower risk of experiencing grade 3 skin toxicity (RRR = 0.648, 95% CI: 0.442-0.947, P = 0.025). Cox regression analysis showed that patients receiving StrataXRT® had a 41.0% and 49.4% reduced risks of developing grade 2 and 3 skin toxicity respectively throughout treatment compared to the Sorbolene arm. There were no differences between groups in patient-reported outcomes. No treatment interruptions and study product related adverse events were reported in either arm.

CONCLUSION

StrataXRT® is effective for preventing, and delaying the development of grade 2 and 3 skin toxicity.

TRIAL REGISTRATION

ACTRN12616000511437.

Silicone-Based Scar Cream for Post Upper Eyelid Blepharoplasty-associated Cicatricial and Hypertrophic Scarring

PURPOSE: Silicone cream has been shown to improve the appearance of postoperative scars. Nevertheless, surgeons may incorporate intralesional wound modulators such as a triamcinolone and/or 5-fluorouracil (5-FU) for scars that do not completely heal well or those that do not completely respond to other treatment options such as silicone cream. This study sought to determine whether a silicone-based topical scar cream that incorporates selective growth factors can help reduce the incidence of postoperative cicatricial and hypertrophic changes in upper eyelid blepharoplasty incisions. METHODS: This is a single-surgeon, retrospective chart review of patients that underwent a cosmetic upper eyelid blepharoplasty. Subjects were divided into two cohorts depending on whether they received postoperative topical scar cream (SKN2017B) twice daily for 3 months versus no topical scar treatment. Using a modified Vancouver Scar Study Scale for treatment criteria, the incidence of focal intralesional injections of triamcinolone and 5-FU to targeted areas of cicatricial and hypertrophic changes was compared between the two groups. RESULTS: 272 eyelids were identified, of those, 132 eyelids received no treatment and 140 were treated with SKN2017B. 43.9% of eyelids that did not receive treatment underwent intralesional injections of triamcinolone and 5-FU, and 22.9% of eyelids treated with SKN2017B underwent intralesional injections of triamcinolone and 5-FU. The difference between the two groups was found to be statistically significant (P less than 0.05). No adverse reactions were reported from either group. CONCLUSION: The use of a topical silicone-based scar cream has been shown to be safe and effective in decreasing the incidence of intralesional injections of triamcinolone and 5-FU for postoperative cicatricial and hypertrophic changes in upper eyelid blepharoplasty incisions. J Drugs Dermatol. 2019;18(5):440-446.

Illicit massive silicone injections always induce chronic and definitive silicone blood diffusion with dermatologic complications

Male-to-female transgender (MtF TG) individuals often report using illegal subcutaneous silicone injections for body feminisation. It leads to silicone dissemination and various dermatologic complications.We report the long-term complications of these feminisation procedures with blood smear examination and dermatologic examination.Between July 2015 and December 2015, 77 MtF TG consulting at Bichat Hospital (Paris, France) were included in this cross-sectional study. Blood smear examinations were performed by a trained haematologist to quantify the presence of silicone vacuoles in monocytes.All patients reported a history of massive amounts of silicone injections (mean 4 L, range 0.5-15 L). Most patients were South American (75/77, 97%). Fifty-nine (59/75, 79%) were HIV-seropositive, mostly with undetectable HIV RNA plasma levels (46/58, 80%). Clinical examinations reported dermatologic complications for all patients: lymphatic or subcutaneous migration of silicone (59%), inflammation (50%), varicose veins (39%), post-inflammatory pigmentation (20%), infection (14%) and abscesses (4%). Blood smear examination showed intracytoplasmic vacuoles containing silicone in monocytes in all patients.We did not chemically prove the silicone nature of the vacuoles. The design of this study does not allow evaluation of short-term complications that should not be minimized.Illicit massive silicone injections always induced chronic and definitive silicone blood diffusion with dermatologic complications. This study highlights the dangers and the inefficiency of clandestine esthetic surgery. There is a need for targeted information campaigns with transgender populations about silicone injections. Otherwise, these practices may persist.

Dressings and topical agents for preventing pressure ulcers

BACKGROUND

Pressure ulcers, localised injuries to the skin or underlying tissue, or both, occur when people cannot reposition themselves to relieve pressure on bony prominences. These wounds are difficult to heal, painful, expensive to manage and have a negative impact on quality of life. Prevention strategies include nutritional support and pressure redistribution. Dressing and topical agents aimed at prevention are also widely used, however, it remains unclear which, if any, are most effective. This is the first update of this review, which was originally published in 2013.

OBJECTIVES

To evaluate the effects of dressings and topical agents on pressure ulcer prevention, in people of any age, without existing pressure ulcers, but considered to be at risk of developing one, in any healthcare setting.

SEARCH METHODS

In March 2017 we searched the Cochrane Wounds Group Specialised Register, CENTRAL, MEDLINE, MEDLINE (In-Process & Other Non-Indexed Citations), Embase, and EBSCO CINAHL Plus. We searched clinical trials registries for ongoing trials, and bibliographies of relevant publications to identify further eligible trials. There was no restriction on language, date of trial or setting. In May 2018 we updated this search; as a result several trials are awaiting classification.

SELECTION CRITERIA

We included randomised controlled trials that enrolled people at risk of pressure ulcers.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials, assessed risk of bias and extracted data.

MAIN RESULTS

The original search identified nine trials; the updated searches identified a further nine trials meeting our inclusion criteria. Of the 18 trials (3629 participants), nine involved dressings; eight involved topical agents; and one included dressings and topical agents. All trials reported the primary outcome of pressure ulcer incidence.Topical agentsThere were five trials comparing fatty acid interventions to different treatments. Two trials compared fatty acid to olive oil. Pooled evidence shows that there is no clear difference in pressure ulcer incidence between groups, fatty acid versus olive oil (2 trials, n=1060; RR 1.28, 95% CI 0.76 to 2.17; low-certainty evidence, downgraded for very serious imprecision; or fatty acid versus standard care (2 trials, n=187; RR 0.70, 95% CI 0.41 to 1.18; low-certainty evidence, downgraded for serious risk of bias and serious imprecision). Trials reported that pressure ulcer incidence was lower with fatty acid-containing-treatment compared with a control compound of trisostearin and perfume (1 trial, n=331; RR 0.42, 95% CI 0.22 to 0.80; low-certainty evidence, downgraded for serious risk of bias and serious imprecision). Pooled evidence shows that there is no clear difference in incidence of adverse events between fatty acids and olive oil (1 trial, n=831; RR 2.22 95% CI 0.20 to 24.37; low-certainty evidence, downgraded for very serious imprecision).Four trials compared further different topical agents with placebo. Dimethyl sulfoxide (DMSO) cream may increase the risk of pressure ulcer incidence compared with placebo (1 trial, n=61; RR 1.99, 95% CI 1.10 to 3.57; low-certainty evidence; downgraded for serious risk of bias and serious imprecision). The other three trials reported no clear difference in pressure ulcer incidence between active topical agents and control/placebo; active lotion (1 trial, n=167; RR 0.73, 95% CI 0.45 to 1.19), Conotrane (1 trial, n=258; RR 0.74, 95% CI 0.52 to 1.07), Prevasore (1 trial, n=120; RR 0.33, 95% CI 0.04 to 3.11) (very low-certainty evidence, downgraded for very serious risk of bias and very serious imprecision). There was limited evidence from one trial to determine whether the application of a topical agent may delay or prevent the development of a pressure ulcer (Dermalex^TM 9.8 days vs placebo 8.7 days). Further, two out of 76 reactions occurred in the Dermalex^TM group compared with none out of 91 in the placebo group (RR 6.14, 95% CI 0.29 to 129.89; very low-certainty evidence; downgraded for very serious risk of bias and very serious imprecision).DressingsSix trials (n = 1247) compared a silicone dressing with no dressing. Silicone dressings may reduce pressure ulcer incidence (any stage) (RR 0.25, 95% CI 0.16 to 0.41; low-certainty evidence; downgraded for very serious risk of bias). In the one trial (n=77) we rated as being at low risk of bias, there was no clear difference in pressure ulcer incidence between silicone dressing and placebo-treated groups (RR 1.95, 95% CI 0.18 to 20.61; low-certainty evidence, downgraded for very serious imprecision).One trial (n=74) reported no clear difference in pressure ulcer incidence when a thin polyurethane dressing was compared with no dressing (RR 1.31, 95% CI 0.83 to 2.07). In the same trial pressure ulcer incidence was reported to be higher in an adhesive foam dressing compared with no dressing (RR 1.65, 95% CI 1.10 to 2.48). We rated evidence from this trial as very low certainty (downgraded for very serious risk of bias and serious imprecision).Four trials compared other dressings with different controls. Trials reported that there was no clear difference in pressure ulcer incidence between the following comparisons: polyurethane film and hydrocolloid dressing (n=160, RR 0.58, 95% CI 0.24 to 1.41); Kang' huier versus routine care n=100; RR 0.42, 95% CI 0.08 to 2.05); 'pressure ulcer preventive dressing' (PPD) versus no dressing (n=74; RR 0.18, 95% CI 0.04 to 0.76) We rated the evidence as very low certainty (downgraded for very serious risk of bias and serious or very serious imprecision).

AUTHORS' CONCLUSIONS

Most of the trials exploring the impact of topical applications on pressure ulcer incidence showed no clear benefit or harm. Use of fatty acid versus a control compound (a cream that does not include fatty acid) may reduce the incidence of pressure ulcers. Silicone dressings may reduce pressure ulcer incidence (any stage). However the low level of evidence certainty means that additional research is required to confirm these results.

Hypercalcemia in a bodybuilder with cosmetic silicone injections

Granulomatous hypercalcemia due to silicone injections is a rare disease with scarce literature. We present a case of a 35-year-old Caucasian male bodybuilder with multiple silicone injections in his upper extremities who developed hypercalcemia and urinary symptoms. He necessitated two sessions of dialysis. A biopsy of the upper arm showed granulomatous tissue. Corticosteroids were administered to relieve symptoms and reverse laboratory abnormalities. Silicone-induced hypercalcemia should be on high alert because of the increasing trend of body contour enhancements with injections, implants and fillers.

Hypercalcemia associated with cosmetic injections: a systematic review

INTRODUCTION

Cosmetic injections with silicone and polymethylmethacrylate are not FDA approved for augmentation of body parts such as breast, buttock or legs, but they have been widely used for decades. Cosmetic injections can cause foreign body granulomas and occasionally severe and life-threatening hypercalcemia. We aimed to systematically analyze the published literature on cosmetic injection-associated hypercalcemia.

METHODS

We searched relevant articles on hypercalcemia associated with various cosmetic injections and extracted relevant data on demographics, cosmetic injections used, severity of hypercalcemia, management and outcomes.

RESULTS

We identified 23 eligible patients from 20 articles. Mean age was 49.83 ± 14.70 years with a female preponderance (78.26% including transgender females). Silicone was most commonly used, followed by polymethylmethacrylate and paraffin oil (43.48, 30.43, and 8.70% respectively). The buttock was the most common site followed by the breast (69.57% and 39.13% respectively). Hypercalcemia developed at mean duration of 7.96 ± 7.19 years from the initial procedure. Mean ionized calcium at presentation was 2.19 ± 0.61 mmol/L and mean corrected calcium at presentation was 3.43 ± 0.31 mmol/L. 1,25-Dihydroxyvitamin D (1,25(OH)₂D or calcitriol) was elevated while 25-hydroxyvitamin D (25(OH)D) and PTH were low in majority of cases. Hypercalcemia was managed conservatively with hydration, corticosteroids and bisphosphonates in majority of cases. Surgery was attempted in 2 cases but was unsuccessful. Renal failure was the most common complication (82.35% cases) and 2 patients died.

CONCLUSION

Hypercalcemia from cosmetic injections can be severe and life threatening and can present years after the initial procedure. Cosmetic injection-associated granuloma should be considered a cause of hypercalcemia, especially in middle-aged females presenting with non-PTH-mediated, non-malignant hypercalcemia, which is often associated with elevated calcitriol; however, it should be noted that calcitriol level may be normal as well.

Seeding of Corneal Wounds by Epithelial Cell Transfer from Micropatterned PDMS Contact Lenses

Persistent corneal wounds result from numerous eye disorders, and to date, available treatments often fail to accelerate reepithelialization, the key initial step in wound healing. To speed reepithelialization, we explored a cell-transfer transplant method utilizing polydimethylsiloxane (PDMS) contact lenses to deliver epithelial cells derived from limbal explants directly within a corneal wound. Human primary epithelial cells and an immortalized corneal epithelial cell line (HCE-SV40) grew well on PDMS contact lenses and their morphology and growth rates where similar to cells grown on tissue culture polystyrene. To initially study cell transfer from PDMS, HCE-SV40 cells were seeded onto PDMS with or without micropatterned posts. After a day in culture, HCE-SV40 cells attached to the unpatterned PDMS uniformly, whereas on micropatterned PDMS they appeared to attach primarily between posts. The cell-covered PDMS contacts were then placed cell-side down onto tissue culture plastic and, after 1, 2, or 3 days, the PDMS contact was removed and the transferred cells were trypsinized and counted. Micropatterned PDMS contact lenses with 100-μm-diameter posts and a post height of 40 μm transferred three times as many cells as unpatterned PDMS. Cell transfer to a wounded cornea was tested in a pig cornea organ culture model deepithelialized by alkali treatment. Post micropatterned PDMS contact lenses were seeded with labeled HCE-SV40 cells at a density 50,000 cells/cm2 and applied to the wounded pig corneas. After 24, 48, or 96 h of application, PDMS contact lenses were removed, corneas fixed with formaldehyde, and sectioned. After 48 h, epithelial cells transferred from post micropatterned contact lenses to provide 35% epithelial coverage of denuded pig corneas; after 96 h coverage was 65%. We conclude that cell transfer from epithelial-coated PDMS contact lenses micropatterned with posts provides a promising approach to reepithelialize corneal surfaces.

Intracranial Migration of Silicone Delaying Life Saving Surgical Management: A Mimicker of Hemorrhage

We present a case in which intraocular silicone injection for complex retinal detachment resulted in migration and distribution of silicone along the intracranial visual pathway, and ultimately throughout the ventricular system. Misinterpretation of this material as intracranial hemorrhage on outside computed tomography imaging delayed emergent repair of a Type A aortic dissection until the diagnosis was made on repeat imaging. A discussion of this case and salient computed tomography and magnetic resonance imaging characteristics of silicone is provided.

Polydimethylsiloxane Particles for Permanent Injection Laryngoplasty

Objectives:

Polydimethylsiloxane (PDMS) particles are a nonresorbable material that allows for permanent vocal fold augmentation. This study investigated morbidity and voice quality in patients treated for unilateral vocal fold paralysis by injection of PDMS particles.

Methods:

Fourteen patients who had neurogenic unilateral vocal fold paralysis of different causes were included in this prospective study. Each patient underwent videostroboscopic assessment before and after operation. Friedrich's dysphonia index (DI), a score system combining subjective and objective parameters, was used to describe voice quality. A DI of 0 reflects a normal voice, and a DI of 3 stands for complete aphonia. The PDMS particles were injected into the paraglottic space by microlaryngoscopy under general anesthesia.

Results:

The median follow-up was 4.1 months. There was no complication attributable to the injection of PDMS particles. The mean DI was 2.8 before operation. After the operation, voice quality improved significantly in each patient, as reflected by a mean postinjection DI of 1.4.

Conclusions:

Particles of PDMS provide a relatively safe and minimally invasive option for permanent vocal fold augmentation. The functional results in terms of voice improvement are comparable to those obtained with other techniques, including thyroplasty. In the European Community, PDMS particles are officially approved for use in the human larynx.

The efficacy and safety of urethral injection therapy for urinary incontinence in women: a systematic review

To evaluate the efficacy and safety of different bulking agents for treating urinary incontinence in women, a systematic review including only randomized controlled trials was performed. The subjects were women with urinary incontinence. The primary outcomes were clinical and urodynamic parameters. The results were presented as a weighted mean difference for non-continuous variables and as relative risk for continuous variables, both with 95% confidence intervals. Initially, 942 studies were identified. However, only fourteen eligible trials fulfilled the prerequisites. Altogether, the review included 1814 patients in trials of eight different types of bulking agents, and all studies were described and analyzed. The measured outcomes were evaluated using a large variety of instruments. The most common complications of the bulking agents were urinary retention and urinary tract infection. Additionally, there were certain major complications, such as one case of death after use of autologous fat. However, the lack of adequate studies, the heterogeneous populations studied, the wide variety of materials used and the lack of long-term follow-up limit guidance of practice. To determine which substance is the most suitable, there is a need for more randomized clinical trials that compare existing bulking agents based on standardized clinical outcomes.

Results of silicone oil injection into the vitreous

The long-therm follow-up of eyes after injection of silicone oil into the vitreous is reported.l The clinical findings, the results of the subjective examination of the retinal function as well as the ERG and the histological findings of the meanwhile enucleated eyes are very discouraging.

Morphea-like complications to illicit gluteal silicone injections

We present a case of a 39-year-old Hispanic woman who was referred to our clinic for treatment of several indurated plaques on her buttocks that developed one year prior to presentation, after she received injections of an unknown substance for augmentation. Biopsy of one nodule revealed silicone in the dermis.

Fast ultra-fine self-nanoemulsifying drug delivery system for improving in vitro gastric dissolution of poor water soluble drug

Meloxicam (MLX) has poor water solubility which leads to slow absorption following oral administration; hence, immediate release tablet is unsuitable in the treatment of acute pain. The aim of this study was to prepare a novel fast ultra-fine self-nanoemulsifying drug delivery system (UF-SNEDDS) of MLX for oral administration to facilitate drug release process in the stomach as well as comparing its in vitro dissolution with commercial Mobic and Mobitil tablets. MLX solubility in oils, mixed glycerides and surfactants with different HLB values was investigated. Based on MLX solubility profiles, eight UF-SNEDDSs composed of MLX, Cremophor RH 40 as oily phase, Capmul MCM-C8 or Tween 80 as surfactant and PEG 400 as co-solvent were prepared and evaluated for their spontaneous formation of emulsion, droplet size, turbidity and in vitro dissolution. The prepared novel MLX formulations showed a significant very low droplets size (up to 25 nm), thermodynamically stable and spontaneously formed nanoemulsion. MLX UF-SNEDDS formulations showed significant high percentage of drug dissolution (up to 70%) in simulated gastric fluid, compared with Mobic and Mobitil. In conclusion, due to higher drug release from MLX UF-SNEDDS formulations they could enhance its absorption and hence its bioavailability.

Design and Characterization of Silicone and Surfactant Based Systems for Topical Drug Delivery

Nanotechnology offers advantages for new drug delivery design by providing drug targeting while minimizing the side effects. Polyoxyethylene 20 cetyl alcohol (CETETH-20) is a surfactant that may form nanostructured systems, such as liquid crystals, when in contact with water/oil, which are structurally similar to biological membranes and may improve skin interaction. The aim of this study was to develop and characterize CETETH 20-based nanostructured systems by combining CETETH-20 with water and different oily phases, including PEG-12-dimethicone for topical drug administration. The systems were characterized by polarized light microscopy (PLM), small-angle X-ray scattering (SAXS), rheology, texture profile analyses (TPA), in vitro cytotoxicity and histopathological analyses of rabbits' skin. Lamellar, hexagonal and cubic phases were identified and their viscoelastic moduli varied according to each phase. The stiffness of the cubic phase was 3-fold higher and twice more adhesive than the hexagonal phase. The formulations did not affect the normal macrophages cells, neither promoted skin irritation. They were spontaneously obtained by simply mixing the components, which corroborates for an ease scaled-up. These results suggest that systems composed of CETETH 20, PEG-12-dimethicone and water are a promising new approach for designing nanostructured topical drug delivery systems.

Gluteal silicone injections leading to extensive filler migration with induration and arthralgia

Silicone injections have been used for cosmetic soft tissue augmentation for over five decades with documented consequences both systemic and dermatologic. We present a case of extensive filler migration causing bilateral lower extremity woody induration in a 53 year old Hispanic woman. She presented with a multi-year history of progressive joint stiffening at the knees, accompanied by induration and pain of the bilateral lower extremities. The patient had received two injections of an unknown substance placed into her bilateral gluteals 11 years prior. MRI indicated an infiltrative process of both lower extremities and pathology was consistent with migration of injected tissue augmentation material, most likely silicone. Due to the extent of involvement the patient was started on a trial of doxycycline 100 mg PO BID.

[Role of enterosorbents in treatment of complicated varicose disease]

Results of treatment of 43 patients, suffering varicose disease, complicated by trophic disorders, were analyzed. To the patients a complex was prescribed, including sorpents, angioprotectors, locally - ointments. There were operated 14 patients.

Liposuction and lipofilling for treatment of symptomatic silicone toxicosis of the gluteal region

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.

Island osteoperiosteal flap vitality when isolated from basal bone by silicone interposition: an experimental study in rabbit tibia

PURPOSE

This study sought to confirm, through histologic evaluation, the vitality and viability of the island osteoperiosteal flap (i-flap) in a rabbit tibia model.

MATERIALS AND METHODS

In four rabbits, an osteotomy was performed on the tibial aspect of the right leg. A bone flap was raised, but the periosteal attachment was kept intact. The free-floating i-flap was separated from the rest of the bone by a silicone sheet. The rabbits were to be sacrificed after 1, 2, 4, and 8 weeks and histologic samples examined.

RESULTS

All surgeries were accomplished successfully; however, three animals showed fractured tibiae within a few days after surgery and were sacrificed immediately after the fractures were discovered. The fourth rabbit was sacrificed at 4 weeks. Histologic specimens showed vital new bone in the i-flap area and signs of remodeling in the transition zone and the original basal bone.

CONCLUSION

The i-flap remained vital. This suggests potential for use in bone augmentation strategies, particularly for the alveolar split procedure.

The utility of soft tissue fillers in clinical dermatology: treatment of fine wrinkles and skin defects

This review discusses treatment strategies for wrinkles and skin defects through an in-depth overview of current soft tissue fillers utilized within the fields of dermatology and plastic surgery. From the review, it is evident that the utilization of different materials for various skin abnormalities is extremely wide in scope. Many clinicians have adopted their own preferences based on not only the knowledge provided by their experience but also the respective profiles of each individual filler, including their efficacy, practicality and safety. With the ongoing emergence of commercially available products designed for soft tissue augmentation, the market will continue to present new and improved treatment options. Although the search for the perfect or most ideal filler is far from over, this review demonstrates that there are a number of commercially available products that are more than acceptable to both patients and clinicians in the treatment of wrinkles and other skin defects.

Use of silicone tubes to repair canalicular lacerations via a novel method

PURPOSE

To develop a novel method to repair canalicular lacerations using silicone tubes.

METHODS

A total of 47 adult patients (47 eyes) with canalicular lacerations were collected from the outpatient department from November 2010 to December 2012. The age ranged from 16 to 53 years. Among the 47 eyes, 37 had lower canalicular lacerations, 6 had upper canalicular lacerations, and 4 had bicanalicular lacerations. A soft probe was made using a stainless steel acupuncture needle, which was inserted into the lumen of the proximal part of the catheter to increase its rigidity. The probe was then inserted into the lacrimal sac and nasolacrimal duct. After retrieval of the catheters, the two ends of the silicone tube were securely tied (end to end) to the catheters. The silicon tube outside the nostril formed a U-shape. The catheters were then pulled upward until the silicone tube was completely located in the canalicular system. The catheters were cut off of the silicone tube near the site of the connection. The two ends of the silicone tube were cut short, -2mm out of the lacrimal punctum, and tied securely, end to end. The length of the tube between the upper and lower punctum was adjusted to ensure that no tension was present in the medial cathus, and the suture was removed through the nostril. The silicone tube was removed 3-10 months after this novel canalicular intubation procedure (NCI).

RESULTS

All cases were anatomically rehabilitated after surgery. The silicone tube was removed after implanted in 3-10 months (mean 4.5 +/- 1.3 months), the average follow-up time was 11.8 months after removal. In total, 45 eyes in all 47 eyes (95.74%) were free from obstruction. Among them, 41 eyes (91.11%) achieved complete success (completely disappearance of epiphora after tube removal), 4 eyes (8.89%) achieved partial success (irritation occurs under stimulation conditions, such as wind or cold conditions), 4 eyes showed postoperative tearing, with three eyes having inferior lacrimal duct laceration, and one eye with superior canalicular laceration. Apart from two cases (4.26%) suffering inferior punctum splitting, no other associated issues occurred with the silicone tube or iatrogenic injury and lacrimal complications.

CONCLUSION

For adult patients with canalicular laceration, the NCI was an effective, atraumatic surgery, which has fewer complications than traditional canalicular suture.

[Twenty-three cases of recurrent dacryocystitis treated with modified silicone mold implantation]

OBJECTIVE

To observe the surgical therapeutic effects of dacryorhinocystotomy under nasal endoscope combined with the application of modified silicone mold implantation for postoperative recurrent dacryocystitis.

METHOD

The research method is to conduct the dacryorhinocystotomy under nasal endoscope to 23 cases(24 eyes) of recurrent dacryocystitis, in the process of which modified silicone mold is implanted under the nasal mucosa.

RESULT

During a follow-up of 6-12 months to the 23 cases (24 eyes), 18 eyes were cured, 6 eyes were getting setter and there was no recurrence.

CONCLUSION

It's concluded that the modified silicone mold implantation can avoid the recurrent atresia of the aperture created by the dacryorhinocystotomy, which proves that the combination with the modified silicone mold implantation in dacryorhinocystotomy is an effective treatment method of curing recurrent dacryocystitis.

Perianal injectable bulking agents as treatment for faecal incontinence in adults

BACKGROUND

Faecal incontinence is a complex and distressing condition with significant medical and social implications. Injection of perianal bulking agents has been used to treat the symptoms of passive faecal incontinence. However, various agents have been used without a standardised technique and the supposed benefit of the treatment is largely anecdotal with a limited clinical research base.

OBJECTIVES

To determine the effectiveness of perianal injection of bulking agents for the treatment of faecal incontinence in adults.

SEARCH METHODS

We searched the Cochrane Incontinence Group Specialised Register of trials (25 May 2012), ZETOC (3 May 2012), clinical trials registries (3 May 2012) and the reference lists of relevant articles.

SELECTION CRITERIA

All randomised or quasi-randomised controlled trials comparing the use of injectable bulking agents for faecal incontinence with any alternative treatments or placebo were reviewed to evaluate the therapeutic effects. Case-control and cohort studies were also reviewed to assess risks and complications associated with the treatments.

DATA COLLECTION AND ANALYSIS

Two review authors (YM and CN) assessed the methodological quality of eligible trials and independently extracted data from the included trials using a range of pre-specified outcome measures.

MAIN RESULTS

Five eligible randomised trials with a total of 382 patients were identified. Four of the trials were at an uncertain or high risk of bias.Most trials reported a short term benefit from injections regardless of the material used, including placebo saline injection. One study demonstrated dextranomer in stabilised hyaluronic acid (NASHA Dx) to be more effective than sham injection but with more adverse effects. Dextranomer in stabilised hyaluronic acid (NASHA Dx) was better than sham injections at six months (65/136, 48% versus 48/70, 69% participants not improved, defined as less than 50% reduction in incontinence episodes, RR 0.70, 95% CI 0.55 to 0.88; with more incontinence free days (3.1 days compared with 1.7 in the sham treatment group, MD 1.40 days, 95% CI 0.33 to 2.47). Another study comparing silicone material (PTQ™) to saline injections was too small to demonstrate a clinical benefit compared to the control injection of normal saline.A silicone biomaterial (PTQ™) was shown to provide some advantages and was safer in treating faecal incontinence than carbon-coated beads (Durasphere®) in the short term.Similarly, there were short term benefits from injections delivered under ultrasound guidance compared with digital guidance.No long term evidence on outcomes was available and further conclusions were not warranted from the available data. None of the studies reported patient evaluation of outcomes and thus it is difficult to gauge whether the improvement in incontinence scores matched practical symptom improvements that mattered to the patients.

AUTHORS' CONCLUSIONS

One large randomised controlled trial has shown that this form of treatment using dextranomer in stabilised hyaluronic acid (NASHA Dx) improves continence for a little over half of patients in the short term. However, the number of identified trials was limited and most had methodological weaknesses.

Penis augmentation by application of silicone material: complications and surgical treatment

BACKGROUND

Complications resulting from enlargement of the penis by applications of unknown types of silicone and mineral oils are well described. Surgical removal of the tissue altered by inflammation leads to the development of defects of various sizes, often circular from the glans penis to the scrotum. The options of subsequent surgical treatment described in literature are not very extensive. Most defects are managed with skin grafting, rarely V-Y advancement or bilateral scrotal flaps.

METHODS

We present a 36-year-old patient after application of unknown silicone material into the penis for cosmetic enlargement. After the application developed severe inflammation with ulceration and necrosis around the penis. Conservative treatment was not effective, therefore, the infiltrated skin with subcutaneous tissue of the entire penis was surgically removed. The resulting defect was covered by implantation of the penis under the skin of the scrotum.

RESULT

There were no complications in the postoperative course, pain that was present before the surgery immediately subsided. Skin suture healed completely within 14 days. Three months after the surgery the patient returned to normal sexual life.

CONCLUSIONS

Implantation of the penis under the skin of the scrotum is a fast, safe and effective method that can treat most of the circular skin defects of the penis. Scrotal skin is thin, soft, elastic and creates abundant and good cover around the entire penis.

Development of a specially tailored local drug delivery system for the prevention of fibrosis after insertion of cochlear implants into the inner ear

A cochlear implant (CI)-associated local drug delivery system based on dexamethasone (DMS) was developed with the purpose to inhibit the growth of fibrotic tissue which influences the signal transmission from the CI to the neurons of the inner ear. For the realization of a targeted DMS delivery the following concepts were combined: modification of the silicone-based electrode carrier by incorporation of DMS and a DMS-containing polymeric coating chemically attached on the surface of the electrode carrier. It was demonstrated that the coated CI showed a high coating stability in a simulated implantation procedure. The in vitro drug release studies in a quasi-stationary model revealed a faster DMS release in the initial phase originating from the DMS-containing coatings and then a lower and sustained DMS release originating from the DMS-loaded silicone carrier. The performed in vitro biocompatibility study confirmed that the released DMS was non-toxic for cultured spiral ganglion cells.

Spherical headed silicone intubation in the treatment of 26 cases (31 eyes) of chronic dacryocystitis under nasal endoscopy

PURPOSE

To observe the clinical efficacy of spherical headed silicone implantation in the treatment of chronic dacryocystitis under nasal endoscopy.

METHODS

Twenty six patients (31 eyes) with chronic dacryocystitis were subjected to spherical headed silicone implantation under topical anesthesia (lacrimal passage and nasal mucosal surface). Lacrimal passage irrigation was performed daily throughout the first postoperative week , and once each month thereafter.

RESULTS

All spherical headed silicone tube placements were successfully performed. The operative time ranged from 6 to 11 minutes. Symptoms of epiphora were immediately ameliorated post-operatively, and irrigation demonstrated patency of the lacrimal system in all patients. All patients were followed from 7 to 24 months, during which symptoms of tearing were improved. The lacrimal ducts of 27 eyes (87.7%) were normal. The lacrimal ducts of 4 others (12.3%) were still blocked. Lacrimal passage irrigation was open and secretion disappeared in 28 eyes (90.3%). Tearing was observed in 3 eyes (9.68%).

CONCLUSION

Spherical headed silicone tube implantation under nasal endoscopy is successful in relieving symptoms of tearing.

[Improvement of fecal incontinence with silicone implants in patients with internal anal sphincter injury: First report in North America]

The injection of bulking agents has been described as a useful treatment of urinary and fecal incontinence. Among them, silicone implants have shown benefits in patients with internal anal sphincter (IAS) injury. We describe two patients with a history of hemorrhoidectomy and IAS injuries, which underwent placement of silicone implants. The implants were inserted into the intersphincteric space and the IAS under ultrasound guidance. The Wexner continente score fell from 17 and 19 before treatment, to 6 and 8 at six months follow up, respectively. Patients had no postoperative complications or implants migration. In our patients, injection of silicone implants improved fecal continence score, without postoperative complications or implants migration at six month follow up.

HIV prevalence, risk behavior, hormone use and surgical history among transgender persons in Thailand

While Male-to-female transgender persons (TG) are believed to often engage in sex work and have high HIV infection risk, little is known about demographics, surgical and hormone use history, risk behaviors and HIV prevalence. Between March and October 2005, 474 TG from Bangkok, Chiangmai, and Phuket were surveyed using venue-day-time sampling. Of 474 participants, overall HIV prevalence was 13.5%. Most participants had completed at least secondary or vocational education (79.2%), gender self-identified as female (89.0%), had received money, gifts or valuables for sex (60.8%), and reported hormone use (88.6%). Surgical history was taken from 325 participants. Of these, 68.6% reported some form of surgery and 11.1% had undergone penile-vaginal reconstructive surgery. In multivariate analysis, being recruited from a park/street; older age, anal sex role identification as "versatile" and anal sex debut before age 13 were independently associated with HIV prevalence. The development, implementation and evaluation of culturally appropriate sexual health interventions for Thai TG is urgently needed.

Effects of combined intralesional 5-Fluorouracil and topical silicone in prevention of keloids: a double blind randomized clinical trial study

Keloids are aesthetically disfiguring and severely disabling. The optimal treatment remains undefined. This clinical study, evaluate the efficacy and side effects of combined topical silicone and 5-Fluorouracil on the prevention of keloids. In this double blind randomized clinical trial, fifty patients with keloids were randomly allocated in two groups. The control group were treated by perilesional surgical excision of keloids combined with topical silicone and the trial group were treated with adjuvant treatment of intralesional 5-Fluorouracil. All patients were examined and assessment was done by an independent observer. the data collected were analyzed by SPSS statistical software with using tables and χ square tests. 75% of the cases in the trial group were keloid free 21% have keloid partially improvement and 4% have keloid recurrence, compared to patients in the control group respectively: 43%, 35% and 22%, findings suggest that efficacy of 5-Fluorouracil combined with topical silicone used for the prevention of keloid is comparable to other modality. The lack of any serious side effects and the evidence of recurrence at one year of follow-up make this an effective tool for the prevention of keloids.

[The impact of silicone spray on scar formation. A single-center placebo-controlled double-blind trial]

For more than two decades silicone has successfully been employed in the treatment and prevention of hypertrophic scars and keloids as a painless noninvasive modality with few side effects. In the present trial, after 3 months of treatment the Patient Scar Assessment Scale demonstrated that patient satisfaction with the silicone application was significantly higher compared to placebo. When treatment was stopped after 3 months, the topical silicone spray did not exhibit any lasting long-term impact on the objective results of scar formation. Due to the significant differences in patient satisfaction once treatment has ended and since the administration is safe and simple, any final decision on treatment indication should be tailored to the patient and include the psychological well-being of the patient as well as the temporary improvement in scar formation during treatment.

Perianal injectable bulking agents as treatment for faecal incontinence in adults

BACKGROUND

Faecal incontinence is a complex and distressing condition with significant medical and social implications. Injection of perianal bulking agents has been used to treat the symptoms of passive faecal incontinence. However, various different agents have been used without a standardised technique and the supposed benefit of the treatment is largely pragmatic with a limited clinical research base.

OBJECTIVES

To determine the effectiveness of perianal injection of bulking agents for the treatment of faecal incontinence in adults.

SEARCH STRATEGY

We searched the Cochrane Incontinence Group Specialised Register of trials (searched 10 June 2009), ZETOC (searched 18 July 2009), clinical trials registries (searched 18 July 2009) and the reference lists of relevant articles.

SELECTION CRITERIA

All randomised or quasi-randomised controlled trials comparing use of injectable bulking agents for faecal incontinence with any alternative treatments or placebo were reviewed to evaluate the therapeutic effects. Case-control and cohort studies were also reviewed to assess risks and complications associated with the treatment.

DATA COLLECTION AND ANALYSIS

Two reviewers assessed the methodological quality of eligible trials and independently extracted data from included trials using a range of pre-specified outcome measures.

MAIN RESULTS

Four eligible randomised trials were identified with a total of 176 patients. All trials but one were at an uncertain or high risk of bias. Most trials reported a short term benefit from injections regardless of the material used as outcome measures improved over time. A silicone biomaterial (PTQ), was shown to provide some advantages and was safer in treating faecal incontinence than carbon-coated beads (Durasphere(R)) in the short term. Similarly, there were short term benefits from injections delivered under ultrasound guidance compared with digital guidance. However, PTQ did not demonstrate obvious clinical benefit compared to control injection of normal saline. No long term evidence on outcomes was available and further conclusions were not warranted from the available data.

AUTHORS' CONCLUSIONS

A definitive conclusion cannot be drawn regarding the effectiveness of perianal injection of bulking agents for faecal incontinence due to the limited number of identified trials together with methodological weaknesses. Within the available data, however, we found no reliable evidence for effectiveness of one treatment over another in improving faecal incontinence. Larger well-designed trials with adequate numbers of subjects using reliable validated outcome measures are needed to allow definitive assessment of the treatment for both effectiveness and safety.

A comparative study evaluating the tolerability and efficacy of two topical therapies for the treatment of keloids and hypertrophic scars

BACKGROUND

Onion extract gel (OE) and 0.5% hydrocortisone, silicone and vitamin E lotion (HSE) are two over-the-counter preparations used to enhance the cosmesis of keloids and hypertrophic scars.

OBJECTIVE

To determine the tolerability and efficacy of OE versus HSE versus placebo in subjects with keloids and hypertrophic scars.

METHODS

Thirty subjects (> or =18 years) with keloids or hypertrophic scars were randomly assigned to one of three study preparations for 16 weeks. Scar volume was measured at baseline and weeks 4, 8, 12 and 16. Subjects and blinded investigators assessed scar parameters (induration, erythema, pigmentation alteration, pain, itching, tenderness and cosmetic appearance) and patient satisfaction at each visit using a visual analog scale (VAS). Data analysis included: mean percentage change (MPC) for subjects completing the study (n = 15); the mixed model test to determine differences between the groups over time; and the Kruskal-Wallis test for the analysis of differences in subjects' satisfaction within the three groups over 16 weeks for subjects who completed at least one follow-up visit (n = 21).

RESULTS

All three preparations were well tolerated with the exception of a mild acneiform-like eruption in one OE patient. Significant improvements were obtained with OE in volume, length, width and induration and with HSE in volume, length, induration, erythema and pigmentation alteration. There was a trend showing that a higher percentage of subjects were satisfied with OE than with HSE or placebo. The Mix Model Analysis (MMA) showed significant improvements with OE over placebo in investigator cosmetic assessment, lesion induration, pigmentation and tenderness and with HSE over placebo in investigator cosmetic assessment, lesion induration, pigmentation and erythema. Improvements in erythema and pigmentation were significantly greater in HSE than in OE.

CONCLUSION

Both OE and HSE were more effective than placebo in the management of hypertrophic scars and keloids.

The science and art of dermal fillers for soft-tissue augmentation

Our expanding understanding of the physiological and immunological conditions of the skin and, in particular, the aging face, has prompted a growing field of aesthetic technology. Restorative procedures are taking advantage of improved and refined biotechnology, which continues to evolve at a rapid pace. Whereas surgical correction of skin laxity was the norm in years past, there are now many topical options available to encourage healthy, youthful skin, and an ever-growing, increasingly perfected depot of minimally invasive, injectable dermal volumizers and stimulators, collectively referred to as dermal fillers. The growth indicators for this market are as striking as the science. However, successful use of dermal fillers is not only a function of the quality of science leading to improved biocompatibility but also the "art" of client selection, filler application and vigilant follow up. Even the "ideal" filler is subject to unique interactions with both the practitioner and the patient. This article presents a review of the safety and efficacy of the most commonly used dermal fillers with emphasis on those approved for facial aesthetics. The subtleties of improved filler technologies that impact tissue acceptance and reaction, measures of effectiveness and a comparison of wrinkle-reduction outcomes, the nature and incidence of acute and chronic tissue reaction, and a discussion of recommended or preferred filler applications are presented.

Reversible vs. nonreversible fillers in facial aesthetics: concerns and considerations

Soft-tissue augmentation of the face is an increasingly popular cosmetic procedure. In recent years, the number of available filling agents has also increased dramatically, improving the range of options available to physicians and patients. Understanding the different characteristics, capabilities, risks, and limitations of the available dermal and subdermal fillers can help physicians improve patient outcomes and reduce the risk of complications. The most popular fillers are those made from cross-linked hyaluronic acid (HA). A major and unique advantage of HA fillers is that they can be quickly and easily reversed by the injection of hyaluronidase into areas in which elimination of the filler is desired, either because there is excess HA in the area or to accelerate the resolution of an adverse reaction to treatment or to the product. In general, a lower incidence of complications (especially late-occurring or long-lasting effects) has been reported with HA fillers compared with the semi-permanent and permanent fillers. The implantation of nonreversible fillers requires more and different expertise on the part of the physician than does injection of HA fillers, and may produce effects and complications that are more difficult or impossible to manage even by the use of corrective surgery. Most practitioners use HA fillers as the foundation of their filler practices because they have found that HA fillers produce excellent aesthetic outcomes with high patient satisfaction, and a low incidence and severity of complications. Only limited subsets of physicians and patients have been able to justify the higher complexity and risks associated with the use of nonreversible fillers.

Case report and literature review: acute pneumonitis and alveolar hemorrhage after subcutaneous injection of liquid silicone

Lay (non-medical) injection of silicone may lead to serious clinical consequences. Most reports of illicit cosmetic procedures have dealt with failed, lay attempts at breast augmentation. Although these procedures have resulted in severe pneumonitis and alveolar hemorrhage, reports of similar complication after lay attempts at buttock augmentation have been sparse. We describe one of these rare cases and review the literature on clinicopathologic sequelae of lay attempts at cosmetic procedures using commercially available silicone preparations.

Chondrotinase ABC enhances axonal regeneration across nerve gaps

We evaluated the effects of chondroitinase ABC on axonal regeneration across peripheral nerve gaps. We compared axonal regeneration after 15-mm tibial nerve resection and repair with a silicone tube filled with type I collagen gel (negative control group), with a silicone tube filled with type I collagen gel containing chondroitinase ABC at three different concentrations (2.5 units/mL, 5 units/mL, 10 units/mL) (chondroitinase ABC groups), and with an autologous nerve segment (nerve autograft group). Electrophysiological and histological assessments were carried out 12 weeks after surgery. In the electrophysiological study, compound muscle action potentials (CMAPs) and nerve conduction velocities (NCVs) were recorded in all groups except the negative control group. Although both CMAPs and NCVs were highest in the nerve autograft group, there were no significant differences among the three chondroitinase ABC groups in either parameter. Histological findings were consistent with electrophysiological results. Based on these findings, we conclude that topical injection of chondroitinase ABC can significantly increase the critical length of nerve gap repair by tubulization or artificial nerve placement.