Edit Bio-Alcamid treatment

<p>In fact, it is a complex material, with a difficult injection process and considerable potential for immediate and long-term hazard if not treated properly. It is a very unforgiving product if mishandled.</p> <p>Bio-Alcamid™ is described by the manufacturer as a hydrogel, a mix of polyalkylimide (96%) and water (4%). Amongst its stated characteristics are primarily ease of removal; being chemically inert; and not migrating. Unfortunately, in practice, in a small number of patients this has proven not to be the case.</p> <p>Jones et al, writing in Dermatologic Surgery (Volume 33, Issue s2, Pages S193-S198) describe five cases of a late-appearing abscess (in patients with HIV where Bio-Alcamid™ had been placed for large facial volume replacement) some considerable time after placement which then required incision and drainage and antibiotics.</p> <p>A review by Pacini S, et al. (Bio-Alcamid™: a novelty for reconstructive and cosmetic surgery. Ital J Anat Embryol 2002;107:209–14.) of 2000 cases showed a late abscess complication rate of 12/2000 cases, a rate of less than 1%. All five cases showed contamination with streptococcus. My personal experience with a range of HIV-positive patients some of who are severely immunosuppressed with marker CD4 counts of less than 100 and some who are co-infected with hepatitis C has shown a similar infection rate although my laboratory sample have failed to yield any organisms except a coliform in one instance.</p> <p>Migration of the product can be a potential problem although data is relatively scarce. Certainly the contention that Bio-Alcamid™ will not migrate is in my opinion and experience false and this leads to a deeply disturbing result in a group of patients for whom cosmetic appearance and improvement are exquisitely important. Raman Malhotra and Adam Ross at the Queen Victoria Hospital, East Grinstead have recently published a retrospective series of 4 patients referred to them where they conclude “Bio-Alcamid™ use can potentially result in long-term orbitofacial complications including infection, abscess formation, recurrent swelling, migration and inflammatory nodules, particularly if manipulation, massage or removal using bimanual expression is attempted”. As a result, they caution specifically against over vigorous manipulation and/or repeated attempts to remove by expressing the product.</p>

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