(661) Successful Wound Management Using a Regenerative Electrospun Fiber Matrix

Introduction: Body contouring is an increasingly desired cosmetic alteration amongst transgender individuals. Due to poor reimbursement by insurance, some individuals undergo unregulated procedures such as the illicit injection of silicone oils mixed with other unknown substances directly into subcutaneous tissue. This can result in infection, inflammation, and painful silicone-induced granulomas (or siliconomas). Often, these complications can be managed symptomatically, but surgical excision may be required for source control in cases of necrosis and sepsis. There is no general consensus for the surgical management of issues that arise from free silicone injection due to a number of factors, such as complication severity and variability of volume, composition, and migration of injected materials.

Description: A 52 year old male-to-female transgender patient presented to the ED with spontaneously draining malodorous wounds characterized by induration and calor of the surrounding skin. She received silicone oil injections to her hips, thighs, and buttocks as part of feminizing gender-affirming genital surgery 33 years ago. A work-up with CT scan and biopsy was performed to rule out underlying abscess and malignancy. The patient subsequently developed sepsis with an acute kidney injury and required admission for IV antibiotics and fluid resuscitation. Definitive treatment included serial radical debridement to surgically excise the silicone invested subcutaneous tissue resulting in a wound measuring over 2000 square centimeters and depth of 6 cm. A synthetic electrospun fiber matrix (SEFM) was utilized which resulted in a decrease in wound depth by 4 cm. In combination with widely meshed skin grafting and an application of autologous skin cell suspension, complete wound closure was achieved.

Discussion: The latency time for the local complications from injected oils to develop can be decades. When the complications are necrosis and sepsis, surgical excision provides source control but results in a disfiguring wound. The previously dreaded and disfiguring outcomes of radical surgical excision may be ameliorated by combining adjuncts such as skin substitutes or novel regenerative technologies in the reconstructive phase of wound management.