Sclerosing lipogranulomatosis: a case report of scrotal injection of automobile transmission fluid and literature review of subcutaneous injection of oils.

For nearly a century, physicians and laypersons have attempted to repair, reconstruct, and embellish the human body in numerous ways by injecting various oils beneath the skin. Soon after Gersuny's first reported subcutaneous injection of oil, the local and systemic complications became apparent. Despite this, the practice of oil injections continues. "Medical grade" silicone injection was investigated in the 1960s to 1980s with varied success and complications. While few physicians practice oil injection therapy, some laypersons continue to subject themselves or their clients to the risk of the disfiguring complications of sclerosing lipogranulomata. Accidental high-pressure injection injury of liquids, so-called grease gun injuries, continues to provide a therapeutic challenge for the hand surgeon. Our case of a man who injected automobile transmission fluid into his scrotum illustrates the classical course and proper management of sclerosing lipogranulomata. A subcutaneous inflammatory and fibrosing reaction occurred with regional lymphadenopathy. The need for complete excision of all involved tissue to treat the condition successfully is illustrated. This case also illustrates the tendency of patients to conceal from their doctors the history of self-injection of foreign bodies. In cases of self-injection, psychological counseling might certainly be appropriate.

Major stump trauma following below-knee amputation. Outcome and recommendations for therapy.

Injury to the stump of a below-knee amputation (BKA) may require revision to a higher level of amputation. We undertook a retrospective review of BKAs performed during a 14-year period. Twenty-three patients suffered trauma to their stumps. Most (80%) trauma resulted from a fall. The severity of the trauma was graded on a three-part scale. Operative reclosure was attempted in 8 cases with 2 successes. Closure by secondary intent was successful in 7 of the 12 attempts. A total of 11 patients had revision to above-knee amputation (AKA) as the final outcome. The severity of trauma correlated inversely with the likelihood of eventual stump salvage. We conclude that primary reclosure or closure by secondary intent should be considered, since in 53% of attempts this results in knee preservation. Analysis of noninvasive vascular testing prior to the BKA was not helpful in predicting successful salvage of traumatized stumps.