Sclerosing Lipogranulomatosis

Department of Surgery, University of North Carolina, Chapel Hill.
Plastic & Reconstructive Surgery (Impact Factor: 2.99). 03/1993; 91(2):352-61. DOI: 10.1097/00006534-199302000-00024
Source: PubMed


For nearly a century, physicians and laypersons have attempted to repair, reconstruct, and embellish the human body in numerous ways by injecting various oils beneath the skin. Soon after Gersuny's first reported subcutaneous injection of oil, the local and systemic complications became apparent. Despite this, the practice of oil injections continues. "Medical grade" silicone injection was investigated in the 1960s to 1980s with varied success and complications. While few physicians practice oil injection therapy, some laypersons continue to subject themselves or their clients to the risk of the disfiguring complications of sclerosing lipogranulomata. Accidental high-pressure injection injury of liquids, so-called grease gun injuries, continues to provide a therapeutic challenge for the hand surgeon. Our case of a man who injected automobile transmission fluid into his scrotum illustrates the classical course and proper management of sclerosing lipogranulomata. A subcutaneous inflammatory and fibrosing reaction occurred with regional lymphadenopathy. The need for complete excision of all involved tissue to treat the condition successfully is illustrated. This case also illustrates the tendency of patients to conceal from their doctors the history of self-injection of foreign bodies. In cases of self-injection, psychological counseling might certainly be appropriate.

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    • "This report suggested that the patient had injected olive oil intravenously causing a massive fat embolism and then presented with a loss of consciousness. The second report by Behar et al. [2] reports on a case of sclerosing lipogranulomata secondary to selfinjection of subcutaneous oil to the scrotum. The successful management of this patient as recommended by the author was complete excision of all involved tissue. "

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    • "Other common sites are the dominant index finger or either middle finger. Injury can be to any region of the body and high pressure injection injuries have been reported to the orbit, neck, leg, foot, abdomen (Weltmer antd Pack, 1988), and scrotum (Behar et al., 1993). Injuries to the digits tend to be serious as the rapid rise in interstitial pressure associated with the rapid infusion of a large volume into a small space may produce compromise in the microcirculation. "
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    ABSTRACT: High pressure injection injuries are infrequent occurrences but their innocuous appearance leads to underestimation of their severity and results in significant morbidity. A good history and early referral of these injuries to a hand surgeon may help in reducing this morbidity. The nature of the substance injected (its volume, viscosity and toxicity), its site of injection and distribution of spread, the pressure of injection and delay to surgical debridement are all believed to be factors that contribute to the outcome of these injuries. Early surgical debridement should be the mainstay of treatment of these injuries. Any decision to treat these injuries nonoperatively should be made by an experienced hand surgeon and is only appropriate in selected cases. Most patients will require postoperative hand therapy, will experience a prolonged time to healing and will be left with long term motor and sensory deficits.
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