Removal of polyacrylamide gels from lower extremity soft tissues: a retrospective analysis of 25-year experience

Objective. To evaluate the effectiveness of various methods of polyacrylamide gels (PAAG) removal from soft tissues of lower extremities. Material and methods. The authors present a 25-year experience of PAAG removal in 138 female patients. In 125 cases, PAAG was localized in soft tissues of lower legs, in 47 — thighs, in 9 — gluteal region. In 31 patients, PAAG was removed from multiple anatomical regions at intervals 8—26 months. These ones were analyzed as separate cases. Open method of gel removal was used in 18 cases, closed method with active aspiration — 55, closed method with pulsating cavity technique — in 96 cases. Results. Open method had no advantages and resulted unaesthetic scarring in 39% of cases. Closed aspiration method was followed by residual free PAAG in 71% of cases that required repeated surgeries in 49% of cases. Pulsating-cavity method yielded better results: residual free PAAG — 20% of cases (p<0.001), redo surgery rate — 5% (p<0.001). However, tissue hyperhydration exacerbated pre-existing lymphatic and venous insufficiency and led to fluid collections. This required punctures in 22% of cases. Conclusion. Preserving the compromised soft tissues in PAAG removal is justified to minimize the risk of secondary defects. Closed removal techniques offer aesthetic advantages over open approaches. PAAG removal requires careful individualized approach regarding potential complications and risks. Pulsating-cavity method may significantly improve postoperative outcomes, although condition of lymphatic and venous systems should be considered. © 2025 Elsevier B.V., All rights reserved.