VENEX-Vein Centre, Vienna, Austria.
J Eur Acad Dermatol Venereol. 2011 Aug;25(8):983-6. doi: 10.1111/j.1468-3083.2010.03873.x. Epub 2010 Oct 15.
Cutaneous necrosis is one of the most annoying complications of reticular and spider vein sclerotherapy. The precise incidence of the complication is not known, although various sources reported incidence between 0.2% and 1.2%. Among a few mechanisms proposed to explain it, extravasation of the sclerosant into the perivascular tissue has been cited as the major cause.
The aim of the experimental study in rats was to examine the potential of various concentrations and volumes of polidocanol in both liquid and foam forms to cause cutaneous necrosis after superficial subcutaneous injection.
Twenty-four female Sprague Dawley rats were injected subcutaneously different concentrations (0.5%, 1%, 2% and 3%) of polidocanol as well as different preparations of polidocanol (liquid vs. foam) and volumes (0.1-0.5 mL). The animals were sacrificed 10 days after injections and biopsy specimens were obtained.
Cutaneous necrosis was not seen at volumes <0.5 mL regardless of the concentration or form of polidocanol injected. Foam preparation was shown to be less potent in inducing necrosis with a minimal strength being 2% in comparison with the liquid form where 1% was sufficient to produce overt cutaneous necrosis.
This experimental study shows that extravasation of polidocal in usual circumstances of sclerotherapy of spider and reticular veins cannot be a significant cause of cutaneous necrosis rarely observed in this setting. It is particularly true for the foamed polidocanol where 1% strength seems safe if injected extravascularly in volumes up to 0.5 mL.
皮肤坏死是网状和蜘蛛静脉硬化疗法最令人烦恼的并发症之一。尽管各种来源报道的发生率在 0.2%至 1.2%之间，但确切的发生率尚不清楚。在提出的几种解释该并发症的机制中，硬化剂外渗到血管周围组织被认为是主要原因。
本实验研究旨在检查不同浓度和体积的聚多卡醇溶液和泡沫形式在皮下浅层注射后是否会导致皮肤坏死。
24 只雌性 Sprague Dawley 大鼠皮下注射不同浓度（0.5%、1%、2%和 3%）的聚多卡醇以及不同形式的聚多卡醇（液体与泡沫）和体积（0.1-0.5 mL）。注射后 10 天处死动物并获取活检标本。
无论注射的聚多卡醇浓度或形式如何，体积 <0.5 mL 均未出现皮肤坏死。与液体形式相比，泡沫制剂的致坏死能力较弱，最小强度为 2%，而液体形式中 1%即可导致明显的皮肤坏死。
本实验研究表明，在蜘蛛状和网状静脉硬化治疗的常见情况下，聚多卡醇外渗不太可能是这种情况下很少观察到的皮肤坏死的重要原因。对于泡沫形式的聚多卡醇尤其如此，如果在 0.5 mL 体积内血管外注射，1%的浓度似乎是安全的。
