Late Onset of Lower Limb Infection Caused by Gluteal Augmentation with Polyalkylimide Gel (PAIG), A Case Report

Abstract

Background: Soft tissue augmentations with liquid injectibles is a common method for the treatment of lipodystrophy in HIV positive patients. Especially PAIG injections in small volumes have been used for this purpose and have been an established treatment. We report an unusual case of a complication 15 years after bilateral gluteoplasty by PAIG injection. PAIG as a volume replacement for aesthetic procedures as well as for the treatment of facial lipodystrophy has been used for a long time. A broad experience has been gained and few complications have been reported so far therefore it is an established and reliable procedure. Today’s plastic surgeon has a wide range of liquid injectibles and alternate procedures to choose from. Volume augmentation by hyaluronic acid, collagen and especially autologous fat grafting are more common in Europe and North America. Material and methods: We present a case report of a patient treated in our department for lower limb infection due to a long term complication after bilateral gluteoplasty by polyalkylimde injection. Verbal consent was obtained from the patient. Results: We report an unusual case of a complication 15 years after bilateral gluteoplasty by PAIG injection. Our case reports a descending abscess on the left inferior member in a male patient of Asian descent. Typical silicone associated granulomas were absent. Histopathology revealed foreign body tissue reaction untypical for silicone. A second survey of the patient’s history indicated previous PAIG injections for gluteoplasty. A radical surgical approach was crucial for the cure. Conclusion: Our case shows that plastic surgeons have to be aware of alternate augmentation methods and procedures in patients of foreign descent especially Asia and its associated potential complications. Those might include unusual materials like PAIG or silicone and respective different injection areas, as well. Treating those patients means to consider material migration with unusual clinical presentation of the complication. Consideration of cultural particularities and thoroughly empathetic and perceptive history taking is a crucial condition for the correct diagnosis and consecutive therapy