TY - JOUR
AR - SCR-2018-3-103
TI - Modified Charles Procedure for Tissue Destruction after Gluteal Silicone Injection in a Transgender Woman
AU - Andrew B , Siref
AU - Edward C , Ray
AU - Philip , Brazio
AU - Smita , Mascharak
AU - Thomas M , Hagopian
JO - Surgical Case Reports
PY - 2018
DA - Wed 10, Oct 2018
SN - 2613-5965
DO - http://dx.doi.org/10.31487/j.SCR.2018.03.003
UR - https://www.sciencerepository.org/charles-procedure-for-tissue-destruction-after-silicone-injection_SCR-3-103 
KW - Liquid injectable silicone, Complications, Transgender, Gender-affirming surgery, Charles procedure
AB - A 49- year-old male-to-female transgender patient presented to the Emergency Department with
inflammation and soft tissue necrosis of the right leg. She had undergone injection of liquid silicone into
her buttocks and hips for cosmetic purposes five years prior, causing several episodes of infection and longstanding open wounds over the buttocks and both lower extremities. Limited debridement, antibiotics, and
local wound care did not halt the slow progression of tissue loss. Radical dermofasciectomy of the right leg
was performed, followed by split thickness skin grafting from the back. The grafts healed well and the
patient regained full leg function.
Large volume injection of industrial-grade liquid silicone is an unfortunately common practice, often used
by unlicensed racketeers in feminization procedures. Devastating complications may occur well away from
the zone of injection. As gender affirming procedures become more prevalent, so does the potential for
complications associated with the inappropriate use of liquid silicone injection. Early recognition of these
complications can allow the institution of appropriately aggressive therapy. In a scenario of widespread
infectious and inflammatory damage to soft tissues of the limb, wide dermofasciectomy with split thickness
skin grafting should be considered as an option for limb salvage.