The needle should always be advanced slowly over short distances with frequent monitoring by fluoroscopy. The operating practitioner needs to be aware to move his hands out of the path of the x-ray beam when using intermittent fluoroscopy. The needle tip position can be determined by tissue feel (soft tissue vs bone), fluoroscopic visualization [lateral, oblique and AP planes] and using radiopaque contrast. Fluoroscopic localization requires an AP and lateral of the needle or one fluoroscopy view and contact with an identifiable bony landmark. Contacting bone during the procedure offers a unique opportunity to know needle tip position.
In summary, unlike oral dietary supplements, vitamin injections contain the highest quality ingredients at the correct potencies without fillers or contaminants. Following administration, the active ingredients are completely absorbed by the body and do not undergo first-pass metabolism. The nutrients are immediately available for utilization to correct nutritional deficiencies. Because of the depot effect and the fact that more of the nutrients reach target tissues, vitamin injections require less frequent dosing than oral supplements.
To the best of our knowledge, this is the first description of silicone embolization syndrome that occurred after surgical manipulation of the site. It has important management implications for patients with a history of prior silicone injections at a site being considered for surgical intervention. Strategies for managing this potential complication include adding a regimen of daily debridement, aggressive ventilator support, and maintaining close observation in an intensive care unit (ICU) or progressive care unit (PCU) during the high-risk post-operative period. Alternatively, when possible, surgeons may avoid disruption of the siliconoma by trialing medical management of localized inflammation or using alternative procedures such as image-guided wide local excision or liposuction with fat transfer.