• 1

    Balkin SW, Kaplan L: Injectable silicone and the diabetic foot: a 25 year report. .The Foot 2::83. ,1991. .

  • 2

    Duffy DM: The silicone conundrum: a battle of anecdotes. .Dermatol Surg 28::590. ,2002. .

  • 3

    Balkin SW: “Injectable Silicone and the Foot,” in Neale’s Disorders of the Foot: Diagnosis and Management, 6th Ed, ed by D Lorimer et al, p 471, Churchill Livingstone, New York. ,2002. .

  • 4

    van Schie CHM, Whalley A, Vileikyte L, et al: Efficacy of injected liquid silicone in the diabetic foot to reduce risk factors for ulceration. .Diabetes Care 23::634. ,2000. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    van Schie CHM, Whalley A, Armstrong, DG, et al: The effect of silicone injections in the diabetic foot on peak plantar pressure and plantar tissue thickness: a 2-year follow-up. .Arch Phys Med Rehabil 83::919. ,2002. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Jahss MH, Michelson JD, Desai P, et al: Investigations into the fat pads of the sole of the foot: anatomy and histology. .Foot Ankle 13::233. ,1992. .

  • 7

    Balkin SW, Kaplan L: Silicone injection management of diabetic foot ulcers: a possible model for prevention of pressure ulcers. .Decubitus 4::38. ,1991. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Travis WD, Balogh K, Abraham JL: Silicone granulomas: report of three cases and review of the literature. .Hum Pathol 16::19. ,1985. .

  • 9

    McNearney T, Hague A, Wen J, et al: Inguinal lymph node foreign body granulomas after placement of a silicone rubber (Silflex) implant of the first metatarsophalangeal joint. .J Rheumatol 23::1449. ,1996. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Peoc'h M, Duprez D, Grice G, et al: Silicone lymphadenopathy mimicking a lymphoma in a patient with a metatarsophalangeal joint prosthesis. .J Clin Pathol 53::549. ,2000. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Busch H: Silicone toxicology. .Semin Arthritis Rheum 24: (suppl 1):11. ,1994. .

  • 12

    Randall T: Less maligned, but cut from the same cloth, other silicone implants also have adverse effects. .JAMA 268::12. ,1992. .

  • 13

    Sammarco GJ, Tabatowski K: Silicone lymphadenopathy associated with failed prosthesis of the hallux: a case report and literature review. .Foot Ankle 13::273. ,1992. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Okamoto K, Hirai S, Yoshida T, et al: Asteroid bodies in silicone-induced granuloma are ubiquitinated. .Acta Pathol Jpn 42::688. ,1992. .

  • 15

    Murakata LA, Rangwala AF: Silicone lymphadenopathy with concomitant malignant lymphoma. .J Rheumatol 16::1480. ,1989. .

  • 16

    Lin RP, DiLeonardo M, Jacoby RA: Silicone lymphadenopathy: a case report and review of the literature. .Am J Dermatopathol 15::82. ,1993. .

  • 17

    Benjamin E, Ahmed A: Silicone lymphadenopathy: a report of two cases, one with concomitant malignant lymphoma. .Diagn Histopathol 5::130. ,1982. .

    • Search Google Scholar
    • Export Citation
  • 18

    Digby J: Malignant lymphoma with intranodal silicone rubber particles following metacarpophalangeal joint replacements. .Hand 14::326. ,1982. .

  • 19

    Fowler MR, Nathan CA, Abreo F: Synovial metaplasia, a specialized form of repair. .Arch Pathol Lab Med 126::727. ,2002. .

  • 20

    Sanger JR, Matloub HS, Yousif NJ, et al: Silicone gel infiltration of a peripheral nerve and constrictive neuropathy following rupture of a breast prosthesis. .Plast Reconstr Surg 89::949. ,1992. .

    • PubMed
    • Search Google Scholar
    • Export Citation

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

A 38-Year Study

William Dean Wallace Department of Pathology, UCLA Medical Center, Los Angeles, CA.

Search for other papers by William Dean Wallace in
Current site
Google Scholar
PubMed
Close
 MD
,
S. W. Balkin Podiatry Section, Department of Orthopedics, University of Southern California Medical Center, Glendale.

Search for other papers by S. W. Balkin in
Current site
Google Scholar
PubMed
Close
 DPM
,
Leo Kaplan Department of Pathology, Cedar Sinai Medical Center, Los Angeles, CA.

Search for other papers by Leo Kaplan in
Current site
Google Scholar
PubMed
Close
 MD
, and
Scott Nelson Department of Pathology, UCLA Medical Center, Los Angeles, CA.

Search for other papers by Scott Nelson in
Current site
Google Scholar
PubMed
Close
 MD
Restricted access

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)

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