Chronic Inflammatory Tissue Following Failed Silicone Injections

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Patient History

A 52-year-old patient had previously undergone gender affirmation surgery involving silicone oil injections into the hips, buttocks, and thighs. Ten to fifteen years after the surgery,
the patient developed abscesses that required incision and drainage on two separate occasions. Thirty-three years after the initial surgery, the patient presented to the emergency
department with a draining sinus tract on the right buttock and hip (Fig 1) accompanied by malodorous discharge.
Follow-up tests, including a CT scan (Fig 2), MRI, and biopsy, revealed extensive chronic inflammatory tissue changes throughout the injected areas, resulting in progressive necrosis
of the overlying skin on the left buttock (Fig 3) and worsening drainage from the right-sided wounds.

Treatment

The patient underwent extensive serial debridement to remove devitalized soft tissue infiltrated with silicone oil. The resulting right wound measured 1,116 cm2 and the left wound measured 960 cm2. The wounds reached 6 cm in depth (Fig 4, Fig 5). After multiple unsuccessful treatment attempts of other commercially available products, several reconstructive and wound care specialists were consulted. Restrata was ultimately selected as an adjunct to skin grafting due to
benefits resulting from its synthetic composition and resorption profile. Restrata Meshed was applied (Fig 6) with a planned second application at Week 3 due to depth of wound and sensitivity to achieving an acceptable aesthetic outcome. Restrata Meshed was covered with a non-adherent contact layer followed by negative pressure wound therapy (NPWT). After full incorporation of Restrata (Fig 7), a 3:1 split thickness skin graft and autologous skin cell harvesting were applied for definitive closure (Fig 8).

Conclusion

The skin graft healed well with smooth contour and excellent color match (Fig 9A-B, Fig 10A-C). There was some graft loss due to a pressure injury at the ischial regions and intentional draining sinus tracts along the right perirectal area. This case demonstrates a complex wound on a patient where physical, emotional, psychological, and social factors were addressed throughout treatment. This positive outcome enabled the patient to transition to an acute inpatient rehabilitation facility with minimal wound care needs.

SINUS TRACTS

Right buttock and hip at prior incision and drainage

CT SCAN

Injected silicone with associated skin thickening and swelling

SKIN NECROSIS

Left buttock

POST DEBRIDEMENT

Total wound measured 2,076 cm2 in size

POST DEBRIDEMENT

6 cm wound depth

DAY 0

Initial application of Restrata Meshed

WEEK 6

Well-vascularized tissue and decreased wound depth by 4-5 cm

WEEK 8

3:1 STSG applied with autologous skin cells

HEALED SKIN GRAFT

Intentional draining sinus tracts (right perirectal area), pressure injury (ischial regions)

WEEK 24

Smooth contour with excellent color match

Disclaimer: Restrata should not be applied until excessive exudate, bleeding, acute swelling, and infection is controlled. Please refer to the Instructions for Use for a full list of indications, contraindications, precautions, and warnings.

Reference: 1. Latona J, Rattigan D, Kohli A, et al. 661: Successful Wound Management using a Regenerative Electrospun Fiber Matrix. Critical Care Med. 2025; 53(1).

MKG-30244-00

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