Traitement durable des lipoatrophies faciales VIH et autres par implants malaires SAM GoreTex ® et hydrogel de polyacrylamide (Eutrophill ®). À propos de 90 cas consécutifs

Abstract

HIV-related lipoatrophy (HIV LA) stands out with regard to its recent discovery, increasing incidence, multiple etiologies, relatively low morbidity, apparently irreversible effects, and unequivocal clinical features. The underlying cause of HIVLA is still controversial but there is an increasing demand of correction. We describe a technique using soft malar implants and acrylamid gel injections separately or in combination. Expanded polytetrafluoroethylene (Gore SAM ®) malar implants are used for augmentation of the most sunken areas below the eye; they should be placed subperiostealy and more medially than conventional implants. After trying sheets and custom made implants, preshaped GoreTex ® Sam implants are now used systematicaly. Eutrophill ® is a 2.5% polyacrylamide hydrogel obtained by polymerization of acrylamide monomers with an official half-life of 5 years. The soluable chains are more or less slowly released by enzymatic degradation and subsequently cleared via interstitial tissue without further metabolism or degradation. Injection should be performed continuously and evenly from one side to the other in the deepest part of the sunken area at the subcutaneous level only. A total of 90 consecutive patients were treated using implants alone in 11 cases, injections alone in 68 cases, and both implants and injections in 11 cases. Drawbacks were very few except three cases of chronic inflammation (dental conflict) with sheets and custom made implants which were never observed since the use of preshaped forms, and some very light bulgings with acrylamid injections which usually desapear in a few months. Mean follow-up was 17 months for injections and 29 for implants.