ABSTRACT
This study analyzed the histologic effects of and host response to subdermally injected liquid silicone to augment soft-tissue cushioning of the bony prominences of the foot. A total of 148 postmortem and surgical specimens of pedal skin with attached soft tissue were obtained from 49 patients between July 1, 1974, and November 30, 2002. The longest period that silicone was in vivo was 38 years. The specimens were then processed into paraffin blocks and examined for specific findings. The variables considered included distribution of silicone within the tissue, host response, migration to regional lymph nodes, and viability of the host tissue after treatment. The host response to silicone therapy consisted primarily of delicate-to-robust fibrous deposition and histiocytic phagocytosis, with eventual formation of well-formed elliptic fibrous pads. The response in the foot appears different from that in the breast and other areas of the body previously studied. No examples of granulomas, chronic lymphoplasmacytic inflammation, or granulation tissue formation were seen, with only rare foreign-body giant cells present. Silicone injections in fat pads for the treatment of atrophy and loss of viable tissue show a histologically stable and biologically tolerated host response that is effective, with no evidence of any systemic changes.
Subject(s)
Adipose Tissue/drug effects , Pressure Ulcer/prevention & control , Silicones/pharmacology , Adipose Tissue/pathology , Adult , Aged , Aged, 80 and over , Histology , Humans , Injections , Middle Aged , Silicones/administration & dosage , Silicones/adverse effects , Time FactorsSubject(s)
Foot Ulcer/prevention & control , Hallux , Leprosy/complications , Silicone Oils/therapeutic use , Adult , Female , HumansSubject(s)
Shoes/adverse effects , Social Behavior , Female , Foot Deformities, Acquired/etiology , HumansABSTRACT
Long-term clinical and histologic findings with injectable fluid silicone to reduce mechanical forces over plantar skin are described. The fluid induces a relatively stable soft tissue prosthesis between skin and bone, reducing the frequency of insensitive ulcer recurrence in the foot. On the basis of these favorable findings, studies are warranted to determine the fluid's efficacy in prevention of pressure ulcers.
Subject(s)
Diabetic Neuropathies/complications , Foot Ulcer/drug therapy , Silicones/therapeutic use , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Foot Ulcer/etiology , Foot Ulcer/pathology , Humans , Injections , Male , Middle Aged , Recurrence , Silicones/administration & dosageABSTRACT
Injected fluid silicone serves as a soft prosthetic device and is an effective alternative to surgery in the management of corns and calluses. The material can relieve pain in weightbearing scars, reduce the incidence of recurring neuropathic ulcers, and protect skin at points of bony pressure. Augmenting subcutaneous tissue reduces both the vertical forces that cause direct pressure and the shear stresses imposed on plantar skin during horizontal acceleration or deceleration. The only significant side effect has been fluid migration, which is asymptomatic upon weightbearing and is seen only rarely when small amounts are implanted. Histologic examination of long-term biopsy and necropsy specimens has revealed no adverse tissue response. The safety and efficacy of injectable silicone as a soft-tissue implant in the foot have not been confirmed by the Food and Drug Administration, and pending completion of authorized investigation, the material is not available. Successfully completed studies, federal approval, and proper use could provide relief for millions of people who suffer from these common foot disorders.
Subject(s)
Callosities/therapy , Cicatrix/therapy , Foot Dermatoses/therapy , Prostheses and Implants , Silicones , Aged , Diabetes Complications , Female , Foot Dermatoses/complications , Foot Diseases/complications , Foot Diseases/therapy , Humans , Male , Middle Aged , Silicones/administration & dosage , Silicones/adverse effects , Skin Ulcer/complications , Skin Ulcer/therapyABSTRACT
Between 1964 and 1975, 389 patients were treated with injections of fluid silicone for corns, calluses, healed diabetic ulcers, and painful scars. This paper presents the results achieved in 27 patients with 31 plantar and 3 digital scars treated by injections of silicone to induce protective subdermal cushioning at sites of increased pressure.
Subject(s)
Cicatrix/therapy , Foot , Postoperative Complications/therapy , Silicones/administration & dosage , Toes , Adult , Aged , Callosities/surgery , Female , Foot Diseases/surgery , Humans , Injections , Male , Middle Aged , Warts/surgerySubject(s)
Callosities/therapy , Silicones/therapeutic use , Adult , Aged , Female , Foot Diseases/therapy , Humans , Keratosis/therapy , Male , Middle Aged , Silicones/adverse effectsABSTRACT
Corns and calluses are the most frequently encountered foot complaints. The choices of care range from self trimming and application of over-the-counter remedies to professional treatment, which may include tendon, skin, and bone surgery. A technique using fluid silicone injected subdermally to cushion corns is described. Twenty-nine patients with 71 digital pressure keratoses were injected between 1965 and 1970. Results of treatment of 77% of the corns were rated good to excellent after an average follow-up period of six years, and no serious reactions have been observed. The procedure offers an effective, nondisabling method of treatment, as opposed to lifelong palliation or surgical intervention.