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      Alogenosis por biomateriales, nuestra experiencia Translated title: Biomaterials allogenosis, our experience

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          Abstract

          Resumen Introducción y objetivo. Los biomateriales son sustancias o combinación de sustancias de origen natural o sintético diseñadas para interactuar con los sistemas biológicos con el fin de evaluar, tratar, aumentar o sustituir algún tejido, órgano o función del organismo humano. La razón que nos motiva su estudio está en el uso y abuso, no autorizado, para su aplicación en seres humanos y las consecuencias negativas que generan los mal llamados “procedimientos estéticos” en pacientes tratados por personal no médico y no calificado, generando un problema de salud pública en el que los cirujanos plásticos somos interconsultados y debemos dar opciones de solución quirúrgica. Material y método. Estudiamos una población de 250 pacientes de varios niveles socioeconómicos en Venezuela, que entre 2008 y 2016 acudieron a nuestra consulta para diagnóstico, tratamiento y seguimiento clínico y quirúrgico, con el fin de determinar los grupos etarios, sexo y localización anatómica de las lesiones, conocer las consecuencias clínicas y brindar un estudio diagnóstico, y en cada caso, un análisis del tratamiento a seguir según su afectación. Conclusiones. En base a nuestra experiencia, pretendemos contribuir a generar una casuística que brinde información para concienciar sobre el riesgo de salud pública que genera esta patología en los pacientes afectados.

          Translated abstract

          Abstract Background and objective. Biomaterials are substances or a substances combination from natural or synthetic origin, designed to interact with biological systems with the purpose of evaluating, treating, augmentation or substitution of body tissues, organs or body functions. Our concern on this study is due to the wrong and non-authorized use and abuse of substances in so called “aesthetic procedures” which besides of being applied by non qualified health or non medical personnel, have originated a public health problem in which plastic surgeons have been requested to act and to offer surgical solutions. Methods. We conduct an study on a population of 250 patients of various socioeconomic leves in Venezuela, who attended our consultation from 2008 to 2016 for diagnosis, treatment and clinical and surgical follow-up, in order to identify the age groups and according to sex and anatomical location of the lesions, to know the clinical consequences and to provide a diagnostic study and in each particular case an analysis of the treatment to be followed. Conclusions. Based on our experience, we intend to contribute to generate a casuistry that provides information to raise awareness about the public health risk that this pathology generates in affected patients.

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          Most cited references21

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          Liquid injectable silicone: a review of its history, immunology, technical considerations, complications, and potential.

          For over five decades, liquid injectable silicone has been used for soft-tissue augmentation. Its use has engendered polarized reactions from the public and from physicians. Adherents of this product tout its inert chemical structure, ease of use, and low cost. Opponents of silicone cite the many reports of complications, including granulomas, pneumonitis, and disfiguring nodules that are usually the result of large-volume injection and/or industrial grade or adulterated material. Unfortunately, as recently as 2006, reports in The New England Journal of Medicine and The New York Times failed to distinguish between the use of medical grade silicone injected by physicians trained in the microdroplet technique and the use of large volumes of industrial grade products injected by unlicensed or unskilled practitioners. This review separates these two markedly different procedures. In addition, it provides an overview of the chemical structure of liquid injectable silicone, the immunology of silicone reactions within the body, treatment for cosmetic improvement including human immunodeficiency virus lipoatrophy, technical considerations for its injection, complications seen following injections, and some considerations of the future for silicone soft-tissue augmentation.
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            Silicone embolism syndrome: a case report, review of the literature, and comparison with fat embolism syndrome.

            Liquid silicone is an inert material that is utilized for cosmetic procedures by physicians as well as illegally by nonmedical personnel. We present a case report and collated clinical findings of 32 other patients who were hospitalized after illegal silicone injections. Symptoms and signs of the "silicone syndrome" included dyspnea, fever, cough, hemoptysis, chest pain, hypoxia, alveolar hemorrhage, and altered consciousness. Bilateral patchy alveolar infiltrates were present on the chest radiographs, and silicone pulmonary emboli were detected in all the patients. The patients could be divided into two groups based on the initial presentation and clinical outcome. Twenty-seven patients in group 1 presented predominantly with respiratory symptoms, and 93% of patients were discharged home within 3 weeks. Six patients (group 2) presented with severe neurologic findings, and experienced rapid deterioration and 100% mortality. The clinical findings after silicone embolism are very similar to the published reports of fat embolism, including hypoxemia in 92% of patients with silicone embolism (patients with fat embolism, 56 to 96%), dyspnea in 88% of patients (patients with fat embolism, 56 to 75%), fever in 70% of patients (patients with fat embolism, 23 to 67%), alveolar hemorrhage in 64% of patients (patients with fat embolism, 66%), neurologic symptoms in 33% of patients (patients with fat embolism, 22 to 86%), petechiae in 18% of patients (patients with fat embolism, 20 to 50%), chest pain in 15% of patients (patients with fat embolism, 26%), and mortality in 24% of patients (patients with fat embolism, 5 to 20%). The similarities among the mode of injury to the lung, the clinical findings, and the high incidence of alveolar hemorrhage suggest a common pathogenesis of silicone and fat embolism syndromes. We discuss the possibility that the activation of the coagulation system may be important in the development of these clinical syndromes.
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              Host tissue interaction, fate, and risks of degradable and nondegradable gel fillers.

              A constantly increasing number of gel fillers for aesthetic and reconstructive purposes have been introduced during the last 20 years. Most of the new ones are modified versions of the original collagen and hyaluronic acid gels. They have been reconstructed, often by adding cross-bindings to the polymer in order to obtain a more dense molecular structure, which will prolong degradation and filling effect of the gel. Other gel fillers contain particles of organic (poly-lactic acid) or inorganic (calcium hydroxylapatite) material, which have been used in human tissue for other purposes (degradable suture material and bone cement, respectively). The permanent fillers (silicone oil and polyacrylamide gel) have been used for many years, silicone mainly in the US and polyacrylamide gel in most countries outside the US and Canada. Complications occur, and they appear to be more frequent with particulated fillers, polyacrylamide gel and silicone oil. However, these complications differ in nature and depend on the filler type used. This overview presents the different gel filler types, how they interact with host tissue, and what can go wrong. The results and conclusion are based on experimental and clinical observations coupled with a search of the literature. Complications following homogenous hydrogels are caused by infection with bacteria, which have been inserted into the gel during injection. If not treated with relevant antibiotics (but instead steroids or large doses of NSAIDs) the bacteria form a biofilm, which gives rise to a low-grade chronic infection that is resistant to antibiotics. Complications following particulated gels and silicone oil are not known, but bacteria in a biofilm and/or endotoxins released by these is a possibility which deserves further investigations, primarily by using the fluorescence in situ hybridization (FISH) technique.
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                Author and article information

                Journal
                cpil
                Cirugía Plástica Ibero-Latinoamericana
                Cir. plást. iberolatinoam.
                Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) (Madrid, Madrid, Spain )
                0376-7892
                1989-2055
                December 2022
                : 48
                : 4
                : 453-458
                Affiliations
                [1] Barquisimeto orgnameClínica Canabal orgdiv1Servicio de Cirugía Plástica Venezuela
                [2] Barquisimeto orgnameClínica Canabal orgdiv1Servicio de Cirugía Plástica Venezuela
                [3] Maracaibo orgnameFederación Ibero Latinoamericana de Cirugía Plástica Venezuela
                Article
                S0376-78922022000400012 S0376-7892(22)04800400012
                10.4321/s0376-78922022000400012
                d45cdc7e-83c0-44de-8fad-a6f57201b279

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 26 October 2022
                : 01 December 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 21, Pages: 6
                Product

                SciELO Spain

                Categories
                Reconstructiva

                Biomaterials,Biomateriales,Alogenosis,Allogenosis,Rellenos permanentes,Biopolímeros,Permanent fillers,Biopolimers

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