Arch Hand Microsurg.  2024 Sep;29(3):163-172. 10.12790/ahm.23.0056.

Paraffinoma of the hands: a case report

• Choi J
• Hwang H
• Kwon ST
• Kim BJ

• KMID: 2558740
• DOI: http://doi.org/10.12790/ahm.23.0056

Abstract

Paraffin injection has been widely used to improve body contouring or to augment various body parts, although it has now been abandoned owing to serious complications. Paraffin injection may lead to complications after a long latency period, ranging from several years to several decades. Here, we present the rare case of a 77-year-old woman who suffered from recurrent wound problems after a bilateral paraffin injection into her hands 40 years ago. Initially, conservative debridement was carried out due to the patient’s reluctance to undergo extensive surgery and cost concerns. However, this resulted in recurrent wound dehiscence and infection. After serial debridement procedures, a skin graft was performed on her right hand. The patient complained of a depressed contour and numbness at the skin graft site, and tightness and discomfort of her right hand during flexion of the metacarpophalangeal joint. Three years later, the patient presented with a highly similar wound on her left hand. Thorough excision of the soft tissue infiltrated by paraffin was performed, followed by reconstruction using a sensate free anterolateral thigh flap. The patient responded well postoperatively without complications, displaying a fair range of motion without discomfort, sensory restoration of the flap, and satisfaction with the contour of the dorsum. This case report highlights the importance of complete excision of soft tissues infiltrated by paraffin for definitive treatment. Among the various reconstruction options, a sensate free flap is a good choice for achieving favorable functional and esthetic outcomes in hand reconstruction after radical excision of a paraffinoma.

Keyword

Foreign bodies; Hand deformities; Perforator flap; Skin transplantation

Figure

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  Fig. 1. Initial clinical photographs. The patient presented with a 1-cm ulcerative lesion without any active discharge, along with swelling, mild redness, and firm changes on the entire dorsum of her right hand.

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  Fig. 2. Initial magnetic resonance imaging revealed diffuse soft tissue thickening with multiple microcystic fatty components in the dorsum of the right hand, located on the outer side of the extensor digitorum communis tendon.

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  Fig. 3. Due to the patient’s reluctance to undergo radical excision and reconstruction with a free flap, a conservative debridement leaving a skin flap was performed. The extirpated paraffinoma (A), intraoperative photograph (B), and a postoperative photograph after primary closure (C) are shown.

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  Fig. 4. The results from a histopathological examination (H&E stain; A, x40 and B, x100) showed vacuolated foreign materials in the fibroadipose tissue with hyaline sclerosis, consistent with a diagnosis of paraffinoma. Macrophages and fibroblasts surround paraffin oil drops.

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  Fig. 5. Clinical photographs during serial debridement. (A–D) The clinical photographs before a full-thickness skin graft (E) and a clinical photograph immediately after the full-thickness skin graft (F).

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  Fig. 6. Three years later, a similar wound was observed on her left hand. The patient presented with a 2-cm ulcer with swelling, redness, and firm changes on the dorsum of her left hand.

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  Fig. 7. Preoperative (A) and intraoperative (B) photographs. A thorough excision of the soft tissue infiltrated by paraffin was performed. The extensor digitorum communis tendons were preserved, and the affected paratenon was excised.

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  Fig. 8. (A) An anterolateral thigh fasciocutaneous flap was elevated with a lateral femoral cutaneous nerve. (B, C) The immediate postoperative photographs show a good hand dorsum contour.

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  Fig. 9. Clinical photographs taken 3 weeks after the operation.

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  Fig. 10. (A) The estimated thickness of the superficial circumflex iliac artery perforator flap elevated along the superficial fascial plane was 7 to 7.4 mm. (B) The estimated thickness of the anterolateral thigh flap elevated along the subfascial plane was 6.1 to 6.6 mm.

Reference

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