title: Skin ulcer: a long-term complication after massive liquid silicone oil infiltration.
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.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  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 .
authors.affiliation: Department of Plastic and Reconstructive Surgery, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy, saracarella@hotmail.it.
authors.forename: Sara
authors.initials: S
authors.lastname: Carella
authors.forename: Andrea
authors.initials: A
authors.lastname: Romanzi
authors.forename: Mariangela
authors.initials: M
authors.lastname: Ciotti
authors.forename: Maria Giuseppina
authors.initials: MG
authors.lastname: Onesti
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D046289:Body Modification, Non-Therapeutic / Q000009:adverse effects; D002081:Buttocks; D003646:Debridement / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007279:Injections, Subcutaneous; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D018570:Risk Assessment; D012827:Silicone Oils / Q000009:adverse effects* / Q000494:pharmacology; D017592:Skin Care / Q000379:methods*; D012883:Skin Ulcer / Q000139:chemically induced* / Q000473:pathology / Q000628:therapy*; D063106:Transgender Persons; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D008297:Male
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D012827:Silicone Oils