Loh Kwok Thye David, Phoon Yi Shan, Phua Vanessa, Kapoor Krishan Mohan
David Loh Surgery, Singapore; Anticlock Clinic, Chandigarh, India; and Department of Plastic Surgery, Fortis Hospital, Mohali, India.
Plast Reconstr Surg Glob Open. 2018 Feb 9;6(2):e1639. doi: 10.1097/GOX.0000000000001639. eCollection 2018 Feb.
Facial fillers are becoming increasingly popular as aesthetic procedures to temporarily reduce the depth of wrinkles or to contour faces. However, even in the hands of very experienced injectors, there is always a small possibility of vascular complications like intra-arterial injection of filler substance. We present a case report of a patient who developed features of vascular obstruction in right infraorbital artery and tell-tale signs of impending skin necrosis, after hyaluronic acid filler injection by an experienced injector. The diagnosis of a vascular complication was made quickly with the help of clinical features like blanching, livedo reticularis, and poor capillary refill. Patient was treated promptly with "high-dose pulsed hyaluronidase protocol" comprising three 1,000-unit pulses of hyaluronidase, administered hourly. There was no further increase in size of the involved area after the first dose of hyaluronidase. All of the involved area, along with 1 cm overlapping in uninvolved skin area, was injected during each injection pulse, using a combination of cannula and needle. Complete reperfusion and good capillary filling were achieved after completion of 3 pulses, and these were taken as the end-point of high-dose pulsed hyaluronidase treatment. Immediate skin changes after filler injections, as well as after hyaluronidase injections and during the 3-week recovery period, were documented with photographs and clinical notes. Involved skin was found to have been fully recovered from this vascular episode, thus indicating that complete recovery of the ischemic skin changes secondary to possible intra-arterial injection could be achieved using high-dose pulsed hyaluronidase protocol.
面部填充剂作为一种美容手术，用于暂时减轻皱纹深度或塑造面部轮廓，越来越受欢迎。然而，即使是经验非常丰富的注射者操作，血管并发症的可能性也始终存在，如填充物质的动脉内注射。我们报告一例患者，在经验丰富的注射者注射透明质酸填充剂后，出现右眶下动脉血管阻塞的特征及即将发生皮肤坏死的明显迹象。借助皮肤变白、网状青斑和毛细血管再充盈不佳等临床特征，迅速做出了血管并发症的诊断。患者立即接受了“高剂量脉冲透明质酸酶方案”治疗，该方案包括每小时注射三次1000单位的透明质酸酶脉冲。注射第一剂透明质酸酶后，受累区域面积未进一步增大。在每次注射脉冲期间，使用套管和针头组合，对所有受累区域以及未受累皮肤区域重叠1厘米的范围进行注射。完成3次脉冲注射后实现了完全再灌注和良好的毛细血管充盈，这被视为高剂量脉冲透明质酸酶治疗的终点。通过照片和临床记录记录了填充剂注射后、透明质酸酶注射后以及3周恢复期内皮肤的即时变化。发现受累皮肤已从这次血管事件中完全恢复，这表明使用高剂量脉冲透明质酸酶方案可以实现因可能的动脉内注射继发的缺血性皮肤变化的完全恢复。
