title: A Serious Complication of Illicit Silicone Injections: Latent Silicone Embolization Syndrome after Incision and Drainage of Local Injection Site.
abstract: BACKGROUND
  Silicone embolization syndrome, a serious adverse effect of illicit silicone injections by laypersons, occurs when silicone particles enter the circulation and shower the lungs and other vital organs.
  
  
  METHODS
  We review the literature on silicone embolization syndrome and describe a unique case of the syndrome that developed after a latent period of several months, upon surgical debridement of an injection site abscess.
  
  
  RESULTS
  In the scientific literature, silicone embolization syndrome has been well described and multiple presentations have been delineated. Immediate presentation with a rapidly fatal course occurs in cases of erroneous intra-vascular injection, in which large volumes of silicone occlude pulmonary arteries and cause cor pulmonale. Insidious presentation of progressive respiratory distress and systemic inflammatory response syndrome occurs in cases of peri-vascular injection, caused by gradual vascular infiltration by smaller silicone emboli that shower pulmonary capillaries diffusely, causing alveolar hemorrhage and inflammation. Rarely, latent cases have presented months to years later upon trauma to the original site, which disrupts the sequestered siliconoma, allowing re-exposure to the immune system and the opportunity for vascular infiltration.
  
  
  CONCLUSIONS
  To the best of our knowledge, this is the first description of silicone embolization syndrome that occurred after surgical manipulation of the site. It has important management implications for patients with a history of prior silicone injections at a site being considered for surgical intervention. Strategies for managing this potential complication include adding a regimen of daily debridement, aggressive ventilator support, and maintaining close observation in an intensive care unit (ICU) or progressive care unit (PCU) during the high-risk post-operative period. Alternatively, when possible, surgeons may avoid disruption of the siliconoma by trialing medical management of localized inflammation or using alternative procedures such as image-guided wide local excision or liposuction with fat transfer.
authors.affiliation: 1 University of Central Florida College of Medicine , Orlando, Florida.
authors.forename: Erin K
authors.initials: EK
authors.lastname: Purdy-Payne
authors.affiliation: 1 University of Central Florida College of Medicine , Orlando, Florida.
authors.forename: Jillian
authors.initials: J
authors.lastname: Green
authors.affiliation: 2 Department of General Surgery, Florida Hospital Orlando , Orlando, Florida.
authors.forename: Scott
authors.initials: S
authors.lastname: Zenoni
authors.affiliation: 2 Department of General Surgery, Florida Hospital Orlando , Orlando, Florida.
authors.forename: Alexander N
authors.initials: AN
authors.lastname: Evans
authors.affiliation: 2 Department of General Surgery, Florida Hospital Orlando , Orlando, Florida.
authors.forename: Tracy R
authors.initials: TR
authors.lastname: Bilski
mesh_terms: D000328:Adult; D004617:Embolism / Q000209:etiology / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous / Q000009:adverse effects*; D012828:Silicones / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D012828:Silicones