Shalmon Dana, Cohen Joel L, Landau Marina, Verner Ines, Sprecher Eli, Artzi Ofir
Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
AboutSkin Dermatology and AboutSkin Research, Greenwood and Lone Tree, CO, USA.
Clin Cosmet Investig Dermatol. 2020 May 7;13:345-349. doi: 10.2147/CCID.S247315. eCollection 2020.
Over the past few decades, soft tissue augmentation is ever-increasing, specifically hyaluronic acid (HA)-based filler injections. As the number of these procedures have risen, so have the adverse reactions. Delayed-type inflammatory reactions (DIRs) secondary to tissue fillers are typically classified according to the time of appearance post-procedure and have various presentations including nodules, abscesses, edema, and discoloration. Currently, the treatment of these complications varies among physicians.
The aim of this study was to assess the knowledge and experience of practitioners in Israel who inject HA-based tissue fillers with respect to the management of late-onset procedural complications.
A survey regarding management and treatment of late-onset inflammatory reactions was sent to 1120 physicians and dentists in Israel who practice tissue filler injections.
Three hundred thirty-four out of the 1120 practitioners replied to the questionnaire. The majority of respondents were dentists (group A) comprising 31% of all respondents. Group B accounted for 31% of injectors and consisted of dermatologists (19%) and plastic surgeons (12%), and group C (38%) accounted for all other practitioners; 48.2% of all injectors indicated that they have not previously encountered a DIR, whereas 11.4% responded that they have encountered more than 5 DIRs. In order to assess treatment management, we presented the injectors with a simulatory case of a woman with a late-onset complication. Most injectors referred the patient to the emergency department. When asked to establish a treatment plan, the majority of practitioners prescribed short-term oral steroids, ie, prednisone (35.3%). A limited number of patients were treated with intra-lesional hyaluronidase (31.4%) injection as only 34% of injectors kept hyaluronidase at their clinic.
The varied approach regarding the management of delayed type reactions to HA-based filler injections, reflected in our study, illustrates the existing ambivalence in the current literature regarding the management and therapy of late-onset complications.
在过去几十年中，软组织填充术日益增多，尤其是基于透明质酸（HA）的填充剂注射。随着此类手术数量的增加，不良反应也随之增多。组织填充剂继发的迟发型炎症反应（DIRs）通常根据术后出现时间进行分类，有多种表现形式，包括结节、脓肿、水肿和变色。目前，这些并发症的治疗方法在医生之间各不相同。
本研究的目的是评估以色列注射基于HA的组织填充剂的从业者在处理迟发性手术并发症方面的知识和经验。
向以色列1120名从事组织填充剂注射的医生和牙医发送了一份关于迟发性炎症反应管理和治疗的调查问卷。
1120名从业者中有334人回复了问卷。大多数受访者是牙医（A组），占所有受访者的31%。B组占注射者的31%，由皮肤科医生（19%）和整形外科医生（12%）组成，C组（38%）包括所有其他从业者；48.2%的注射者表示他们以前从未遇到过DIR，而11.4%的人回答他们遇到过5次以上的DIR。为了评估治疗管理，我们向注射者展示了一个迟发性并发症女性的模拟病例。大多数注射者将患者转诊至急诊科。当被要求制定治疗方案时，大多数从业者开具短期口服类固醇，即泼尼松（35.3%）。只有少数患者接受了病灶内透明质酸酶注射（31.4%），因为只有34%的注射者在诊所备有透明质酸酶。
我们的研究反映出，对于基于HA的填充剂注射迟发型反应的管理方法各不相同，这说明了当前文献中关于迟发性并发症管理和治疗存在的矛盾态度。
