Background The result of illicit polymer injection is chronic inflammation with foreign-body granuloma (FBG) formation. Treatment can be divided into medical and surgical. Some patients develop severe complications with need surgical treatment. This study aims to describe patients who underwent surgical removal of the FBGs and autoimmune/inflammatory syndrome induced by adjuvants (ASIA); additionally, we evaluated the quality of life after surgery.Methods In this retrospective single-center study, the authors examined data of patients who underwent surgical removal of FBG caused by illicit polymer injection for cosmetic purposes and confirmed ASIA from 2015 to 2020 by three different surgical approaches. Descriptive summary statistics were reported on patient demographics, presenting symptoms and clinical examination features, treatment strategies, histopathology reports and quality of life.Results The cohort included 11 female patients with FBGs and ASIA. The most affected anatomical zones were the combination of gluteal region, thighs and legs (40%); and thighs with legs (20%). Main presentation was: skin hyperpigmentation (90.9%), skin induration (63.6%), chronic fatigue (63.6%), and ulcers (36.4%). Surgical modalities consisted of: ultrasonic-assisted liposuction in four patients (36.4%); open en bloc excision and primary closure in four patients (36.4%); and open en bloc excision and microsurgical reconstruction in three patients (27.2%). The postoperative quality of life visual analog scale score was 83.9.Conclusions ASIA treatment represents a challenge for the plastic surgeon. Adequate surgical treatment emphasizing, when possible, the total or near-total resection of the FBG must be performed to improve ASIA evolution.
Introduction:The incidence of dermatological malignancies increases with age and a considerable percentage of older adults will require radical surgeries and adjuvant treatments, microsurgery allows repair and coverage of major defects with success rates of up to 90%.Case Report: We present the case of an elderly patient with an ulcer in the left clavicular region without evidence of healing. Histological and imaging studies were performed, a basal cell carcinoma subtype morphea was found. A wide excision and axillary lymph node dissection were performed, subsequently covering the defect with a free flap. There is an 11-year follow-up. Conclusion:Complications in microsurgical reconstructions are more associated with comorbidities than with the age of the patient. The same success rates can be obtained in elderly patients.
Non-FDA approved foreign substances injected in areas such as the hips and buttocks for aesthetic purposes have resulted in significant complications including secondary lymphedema. We sought to demonstrate lymphoscintigraphic abnormalities in a group of patients with lower extremity edema following infiltration of foreign substances in buttocks and hips to confirm secondary lymphedema. This retrospective and observational study examined 10 lower extremities for lymphoscintigraphic abnormalities from patients with history of infiltration of foreign substances and subsequent complaints about lower extremity edema. Clinical evaluation, lymphedema index, lymphoscintigraphy, and Transport Index (TI) were evaluated. The average lymphedema index documented in each limb was 236.45 categorizing most of our patients in a lower limb lymphedema stage I. The average TI was 15.7 points (8.6 - 22.8 points) demonstrating that all patients show abnormal lymphoscintigraphy (LSG) patterns. LSG findings confirm the diagnosis of lower extremity lymphedema secondary to injection of foreign substances in the buttocks and hips in the group of patients studied.
Presentamos el caso clínico de un paciente varón de 6 años de edad con antecedente de caída desde su propia altura un mes antes de su valoración en consulta, en donde se identifica una tumoración pulsátil en región hipotenar de mano derecha, no dolorosa y no fija a planos profundos. El ultrasonido doppler informa de una tumoración con pared definida, heterogénea, con flujo sanguíneo a través de la misma. En base a los antecedentes y a los resultados del ultrasonido se decide intervenir quirúrgicamente para evitar posibles complicaciones, encontrando un aneurisma de la arteria cubital de 3 x 3 cm de diámetro, no trombosado, que resecamos, practicando reconstrucción mediante injerto venoso término-terminal. El paciente evolucionó sin complicaciones.
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