Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University Munich, Germany.
Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada.
Aesthet Surg J. 2021 Apr 12;41(5):NP226-NP236. doi: 10.1093/asj/sjaa350.
The most severe complications following soft tissue filler injections result from the intraarterial administration of the filler product. Although hyaluronic acid-based filler can be trans-arterially dissolved with hyaluronidase, no information is available on calcium hydroxylapatite (CaHA)-based fillers.
The authors sought to test whether CaHA-based fillers can be trans-arterially dissolved by sodium thiosulfate (STS) when evaluated in cadaveric and in vitro models.
Human cadaveric facial arterial segments were each filled with 0.2 cc of commercially available CaHA product and submerged for 24 hours in 4 different STS-containing solutions: 10 cc STS (300 mg/cc) (pure, 1:1 dilution, 1:2 dilution), 0.9% saline and 10 cc STS (300 mg/cc), and 300 IU (bovine) hyaluronidase in a 1:1 ratio.
Intraarterial CaHA was detected in human facial artery segments after 24 hours independent of the STS concentration employed. Submerging the arterial segments in STS (300 mg/cc) and 300 IU (bovine) hyaluronidase (1:1 ratio) also did not dissolve the intraarterial CaHA product. Gray scale analyses did show, however, that increasing concentrations of STS resulted in increased disintegration of CaHA in an in vitro experimental setting.
The results of this study indicate that STS is limited in its potential to dissolve intraarterial CaHA of cadaveric human facial arteries, despite the fact that it appears effective when in direct contact with the CaHA. Adverse events caused by intraarterial administration of CaHA-based fillers still lack a suitable antidote.
软组织填充剂注射后最严重的并发症是由于填充物产品的动脉内给药。尽管基于透明质酸的填充剂可以用透明质酸酶经动脉内溶解，但尚无关于基于钙羟磷灰石（CaHA）的填充剂的信息。
作者试图在尸体和体外模型中测试 CaHA 基填充剂是否可以通过硫代硫酸钠（STS）经动脉内溶解。
将 0.2 cc 商用 CaHA 产品分别注入人体尸体面部动脉段，并将其在 4 种不同的 STS 溶液中浸泡 24 小时：10 cc STS（300 mg/cc）（纯品，1:1 稀释，1:2 稀释）、0.9%生理盐水和 10 cc STS（300 mg/cc），以及 300 IU（牛）透明质酸酶以 1:1 的比例。
24 小时后，独立于 STS 浓度，在人体面部动脉段中检测到动脉内 CaHA。将动脉段浸泡在 STS（300 mg/cc）和 300 IU（牛）透明质酸酶（1:1 比例）中也不能溶解动脉内的 CaHA 产品。然而，灰度分析表明，STS 浓度的增加导致体外实验环境中 CaHA 的崩解增加。
本研究结果表明，尽管 STS 与 CaHA 直接接触时似乎有效，但它在溶解尸体人类面部动脉内的 CaHA 方面的潜力有限。基于 CaHA 的填充剂经动脉内给药引起的不良事件仍然缺乏合适的解毒剂。
