Schelke Leonie W, Velthuis Peter J, Decates Tom, Kadouch Jonathan, Alfertshofer Michael, Frank Konstantin, Cotofana Sebastian
Aesthet Surg J. 2023 Jan 9;43(1):86-96. doi: 10.1093/asj/sjac227.
Adverse vascular event management following hyaluronic acid-based aesthetic injections relies on the administration of hyaluronidase which is capable of enzymatically degrading the injected product and improving clinical symptoms. Two protocols are currently available to manage such complications: "ultrasound-guided targeted" and "flooding".
The aim of this study was to compare the 2 protocols in terms of the volume of hyaluronidase utilized, and the onset and degree of clinical improvement.
A comparative case series of 39 patients was retrospectively evaluated. The patients were initially treated with the "flooding" protocol and then treated with the "ultrasound-guided targeted" protocol due to no or little improvement.
The "ultrasound-guided targeted" protocol utilized a mean [standard deviation] total of 122.5 [34] IU of hyaluronidase, whereas the "flooding" protocol utilized 1519.4 [1137] IU, which represents a statistically significant reduced amount of injected hyaluronidase (P = 0.028). There was no clinical improvement in 92.3% and only little improvement in 7.7% of the treated patients following the first applied "flooding" protocol, but there was a 100% immediate improvement when subsequently treated with the "ultrasound-guided targeted" protocol. Ultrasound imaging revealed that the application of hyaluronidase restored normal blood flow both in the perivascular space and in the superficially located subdermal soft tissues.
Despite its limitations in study design, this retrospectively evaluated case series revealed that the "ultrasound-guided targeted" protocol utilized less hyaluronidase and restored clinically visible symptoms faster. The effect of this protocol is best explained by the perforasome concept which will need to be investigated further in future studies.
基于透明质酸的美容注射后的不良血管事件管理依赖于透明质酸酶的注射，该酶能够通过酶解作用降解注射产品并改善临床症状。目前有两种方案可用于处理此类并发症：“超声引导下靶向注射”和“大面积注射”。
本研究旨在比较这两种方案在透明质酸酶使用量、临床改善的起始时间和程度方面的差异。
对39例患者的比较病例系列进行回顾性评估。患者最初采用“大面积注射”方案治疗，由于改善不明显或无改善，随后采用“超声引导下靶向注射”方案治疗。
“超声引导下靶向注射”方案平均[标准差]共使用122.5[34]IU透明质酸酶，而“大面积注射”方案使用1519.4[1137]IU，这表明注射的透明质酸酶量在统计学上显著减少（P = 0.028）。在首次应用“大面积注射”方案后，92.3%的治疗患者无临床改善，7.7%的患者仅有轻微改善，但随后采用“超声引导下靶向注射”方案治疗时，100%的患者立即得到改善。超声成像显示，透明质酸酶的应用恢复了血管周围间隙和浅表皮下软组织的正常血流。
尽管本研究设计存在局限性，但该回顾性评估的病例系列显示，“超声引导下靶向注射”方案使用的透明质酸酶较少，且能更快恢复临床可见症状。该方案的效果最好用穿孔体概念来解释，这需要在未来的研究中进一步探讨。
