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The Histologic Host Response to Liquid Silicone Injections for Prevention of Pressure-Related Ulcers of the Foot

A 38-Year Study

William Dean Wallace, MD ^*, S. W. Balkin, DPM , Leo Kaplan, MD  and Scott Nelson, MD ^*

^* Department of Pathology, UCLA Medical Center, Los Angeles, CA.
Podiatry Section, Department of Orthopedics, University of Southern California Medical Center, Glendale.
Department of Pathology, Cedar Sinai Medical Center, Los Angeles, CA.

Corresponding author: Willam Dean Wallace, MD, Department of Pathology, UCLA Medical Center, A7-149 CHS, 10833 Le Conte Ave, Los Angeles, CA 90095.

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. (J Am Podiatr Med Assoc 94(6): 550–557, 2004)