, Singapore, Singapore.
Dermatology Service, Department of General Medicine, Sengkang General Hospital, Singapore, Singapore.
Aesthetic Plast Surg. 2024 Oct;48(19):3971-3978. doi: 10.1007/s00266-024-04334-1. Epub 2024 Aug 30.
Hyaluronidase remains the mainstay treatment for skin necrosis due to vascular occlusion after hyaluronic acid (HA) dermal fillers. There is wide variability in protocols for the administration of hyaluronidase. Most protocols, however, lack strong evidence regarding hyaluronidase dosages.
We conducted a systematic review and pilot meta-analysis, searching four international databases from inception until December 2023 for clinical studies reporting on two or more patients receiving hyaluronidase for skin necrosis after hyaluronic acid fillers. Random-effects (DerSimonian and Laird) meta-analyses were conducted. The primary outcome was the pooled proportion of complete scar resolution. We rated intra-study risk of bias using the Joanna Briggs Institute checklists and assessed the certainty of evidence using the GRADE approach.
We included 15 studies totaling 223 patients. The pooled proportion of complete scar resolution after hyaluronidase administration was 77.8% (95%-CI: 65.5% to 86.6%, p = 0.093, low certainty). Patients treated with high doses of hyaluronidase (>500 international units [IUs]) had lower rates of resolution of 69.6% (95%-CI: 41.2% to 88.3%) compared to those treated with low doses (500IU or less) that had 88.1% rate of resolution (95%-CI: 86.0% to 96.2%), though not statistically significant (p= 0.18). The use of adjunct therapies did not have a statistically significant effect on outcomes.
A higher proportion of patients receiving low doses (500IU or less) (88.1%) had complete scar resolution compared to patients receiving high doses (69.7%), though not statistically significant (p=0.18). Future studies should provide more granular details on their protocols to benefit the formulation of evidence-based guidelines in future.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
CRD42024538661.
透明质酸（HA）填充剂导致血管阻塞后出现皮肤坏死，透明质酸酶仍然是其主要治疗方法。然而，透明质酸酶给药方案存在很大差异。大多数方案在透明质酸酶剂量方面缺乏强有力的证据。
我们进行了系统评价和试点荟萃分析，从四个国际数据库中检索了从成立到 2023 年 12 月发表的报告了两例或两例以上接受透明质酸酶治疗 HA 填充物后皮肤坏死的患者的临床研究。采用随机效应（DerSimonian 和 Laird）荟萃分析。主要结局是完全瘢痕消退的汇总比例。我们使用 Joanna Briggs 研究所检查表评估研究内的偏倚风险，并使用 GRADE 方法评估证据的确定性。
我们纳入了 15 项研究，共 223 名患者。透明质酸酶给药后完全瘢痕消退的汇总比例为 77.8%（95%CI：65.5%至 86.6%，p=0.093，低确定性）。接受高剂量透明质酸酶（>500 国际单位 [IU]）治疗的患者，其缓解率为 69.6%（95%CI：41.2%至 88.3%），低于接受低剂量（500IU 或更少）治疗的患者（88.1%的缓解率，95%CI：86.0%至 96.2%），但无统计学意义（p=0.18）。辅助治疗的使用对结局没有统计学意义的影响。
接受低剂量（500IU 或更少）治疗的患者中，有更高比例（88.1%）的患者完全瘢痕消退，而接受高剂量治疗的患者为 69.7%，但无统计学意义（p=0.18）。未来的研究应该提供更详细的方案细节，以便为未来制定基于证据的指南提供参考。
证据水平 I：本刊要求作者为每篇文章指定一个证据水平。有关这些循证医学评级的详细描述，请参阅目录或在线作者指南 www.springer.com/00266 。
CRD42024538661。
