Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Department of Otolaryngology-Head & Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
JAMA Dermatol. 2021 Feb 1;157(2):174-180. doi: 10.1001/jamadermatol.2020.5102.
Soft-tissue augmentation with skin fillers can be delivered with needles or microcannulas, but unwanted vascular occlusions are possible.
To determine whether filler-associated vascular occlusion events of the face occur more often with injections performed with needles than with microcannulas.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included a random sample of board-certified dermatologists deemed eligible based on membership in relevant professional societies and attendance at relevant national professional meetings. Participants completed detailed forms in which they could enter deidentified data and volume statistics pertaining to patients undergoing filler procedures in their practices. Data were collected from August 2018 to August 2019.
Injectable fillers approved by the US Food and Drug Administration delivered via needles or microcannulas.
The primary outcome measure was intravascular occlusion. Occlusion events were graded by severity (no sequelae, scar, and ocular injury or blindness).
A total of 370 dermatologists (mean [SD] years in practice, 22.3 [11.1] years) participated and reported 1.7 million syringes injected. The risk of occlusion with any particular filler type using needle or cannula never exceeded 1 per 5000 syringes injected. Overall, 1 occlusion per 6410 per 1-mL syringe injections was observed with needles and 1 per 40 882 with cannulas (P < .001). Of the 370 participants, 106 (28.6%) reported at least 1 occlusion. Multivariate analysis found that injections with cannula had 77.1% lower odds of occlusion compared with needle injections. Participants injecting fillers for more than 5 years had 70.7% lower odds of occlusion than those who were less experienced. For each additional injection per week, the odds of occlusion decreased by 1%, and 85% of occlusions had no long-term sequelae. Nasolabial folds and lips were most likely to be occluded, with mean severity level of occlusions highest at the glabella.
In this cohort study, filler injections with either needles or cannulas were associated with a very low risk of intravascular occlusion events. Moreover, the vast majority of such events were minor and resolved without scar or other injury. Injections with microcannulas were less often associated with occlusion events than injections with needles. Occlusion risk per syringe appeared decreased after the first few years of clinical practice and was also lower among those who more frequently inject fillers. Whether a needle or cannula is most appropriate for injection may depend on patient factors, anatomic site, and the type of defect being treated.
软组织填充剂的使用可以通过针或微管进行，但可能会发生不必要的血管阻塞。
确定与针相比，使用微管进行注射是否会导致面部填充物相关的血管阻塞事件更常见。
设计、设置和参与者：这是一项回顾性队列研究，包括根据相关专业协会的成员资格和参加相关国家专业会议的情况，认为符合条件的认证皮肤科医生的随机样本。参与者填写详细的表格，可在其中输入与他们在实践中接受填充物治疗的患者有关的匿名数据和体积统计信息。数据收集时间为 2018 年 8 月至 2019 年 8 月。
经美国食品和药物管理局批准的可注射填充物，通过针或微管输送。
主要结局指标是血管内闭塞。闭塞事件按严重程度分级（无后遗症、疤痕和眼部损伤或失明）。
共有 370 名皮肤科医生（从业年限平均为 22.3 年[11.1]年）参与并报告了 170 万支注射器的注射。任何特定填充物类型使用针或套管的闭塞风险从未超过每 5000 支注射器注射 1 次。总体而言，使用针的每 6410 支 1 毫升注射器注射就观察到 1 次闭塞，而使用套管的每 40882 支注射器注射就观察到 1 次闭塞（P<.001）。在 370 名参与者中，有 106 名（28.6%）报告了至少 1 次闭塞。多变量分析发现，与针注射相比，套管注射的闭塞可能性低 77.1%。注射填充物超过 5 年的参与者的闭塞几率比经验较少的参与者低 70.7%。每周每增加一次注射，闭塞的几率就会降低 1%，85%的闭塞没有长期后遗症。鼻唇沟和嘴唇最容易被阻塞，阻塞的平均严重程度最高的部位是眉间。
在这项队列研究中，使用针或套管的填充物注射与血管内闭塞事件的风险非常低有关。此外，大多数此类事件都是轻微的，并且没有疤痕或其他损伤而痊愈。与针注射相比，微管注射引起的闭塞事件较少。在临床实践的最初几年后，每支注射器的闭塞风险似乎会降低，并且那些更频繁注射填充物的人闭塞风险也较低。选择针还是套管进行注射可能取决于患者因素、解剖部位和治疗的缺陷类型。
