From the Departments of Plastic, Reconstructive and Aesthetic Surger.
Histology, Gazi University Hospital, Ankara, Turkey.
Ann Plast Surg. 2021 Dec 1;87(6):e137-e144. doi: 10.1097/SAP.0000000000002962.
The most feared complication of the hyaluronic acid injections in the periorbital region is embolism of the central retinal artery. The present study aimed to compare the effectiveness of hyaluronidase administered intravenously (systemically) alone or in combination with streptokinase with that of intra-arterial revascularization. Thirty rats were divided into 5 groups. The bilateral oblique groin flap of the rats was raised; the right side was the experiment group, and the left side was the sham control. The right superficial epigastric artery was occluded with a hyaluronic acid injection. After occlusion, no additional procedures were performed in group 1, whereas group 2 received systemic hyaluronidase, group 3 received intra-arterial hyaluronidase, group 4 received systemic hyaluronidase and streptokinase, and group 5 received intra-arterial hyaluronidase and streptokinase. On the seventh day, the rats were killed, flap necrosis rate was calculated, and histological examination was performed. There was no significant difference in the necrosis rates of the rats in groups 2, 3, 4, and 5 (P > 0.05). In histological evaluation, the histological view closest to normal arterial structure was observed in group 4. Immunohistochemical analysis revealed that the ischemia scores of systemic therapy were significantly lower than those of intra-arterial therapy. These results have shown that hyaluronidase and streptokinase administered systemically is as effective as intra-arterial revascularization and does not cause arterial wall degeneration. It has been shown that systemic administration of hyaluronidase and streptokinase is as successful as intra-arterial revascularization in the treatment of arterial embolism with hyaluronic acid.
在眶周区域注射透明质酸最令人担心的并发症是视网膜中央动脉栓塞。本研究旨在比较单独静脉内（全身）给予透明质酸酶或与链激酶联合应用与动脉再通的效果。将 30 只大鼠分为 5 组。抬高大鼠双侧斜腹股沟皮瓣；右侧为实验组，左侧为假手术对照组。用透明质酸注射闭塞右侧腹壁浅动脉。闭塞后，第 1 组不进行任何其他操作，第 2 组给予全身透明质酸酶，第 3 组给予动脉内透明质酸酶，第 4 组给予全身透明质酸酶和链激酶，第 5 组给予动脉内透明质酸酶和链激酶。第 7 天处死大鼠，计算皮瓣坏死率，并进行组织学检查。第 2、3、4 和 5 组大鼠的坏死率无显著差异（P > 0.05）。组织学评价显示，第 4 组的组织学观察结果最接近正常动脉结构。免疫组化分析显示，全身治疗的缺血评分明显低于动脉内治疗。这些结果表明，全身给予透明质酸酶和链激酶与动脉内再通一样有效，且不会引起动脉壁退化。已经证明，在治疗透明质酸引起的动脉栓塞时，全身给予透明质酸酶和链激酶与动脉内再通一样成功。
