Johnson-Arbor Kelly
MedStar Georgetown University Hospital; 3800 Reservoir Road NW; Washington, DC 20007; USA.
Undersea Hyperb Med. 2024 Fourth Quarter;51(4):403-406.
Arterial vascular occlusion is a rare complication of dermal filler injection. This case report describes the successful use of hyperbaric oxygen therapy in a patient with vascular occlusion after a permanent dermal filler was injected.
A 51-year-old woman underwent an injection of non-resorbable polymethylmethacrylate microspheres into her nasolabial folds. Several hours later, she experienced dusky discoloration of the right nasolabial fold and surrounding livedo skin changes, consistent with vascular occlusion. Treatment with warm compresses and topical nitroglycerin was initiated, and the patient was referred for hyperbaric oxygen therapy. The tissue discoloration improved significantly after the administration of six hyperbaric treatments.
While hyaluronidase is recognized as a treatment option for vascular occlusion associated with using temporary fillers containing hyaluronic acid, it may also be beneficial for patients who experience vascular occlusion after administration of permanent fillers. Hyperbaric oxygen therapy, which results in hyperoxygenation of ischemic tissue and mitigation of the associated inflammatory response, may also benefit patients who experience vascular occlusion after permanent filler injection.
Administration of hyaluronidase and hyperbaric oxygenation should be considered for patients who develop arterial occlusions after dermal filler placement, regardless of the type of injected filler.
动脉血管阻塞是真皮填充剂注射的一种罕见并发症。本病例报告描述了高压氧疗法在一名注射永久性真皮填充剂后发生血管阻塞的患者中的成功应用。
一名51岁女性在鼻唇沟注射了不可吸收的聚甲基丙烯酸甲酯微球。数小时后，她右侧鼻唇沟出现暗褐色变色，周围皮肤出现网状青斑改变，符合血管阻塞表现。开始采用热敷和局部应用硝酸甘油治疗，并将患者转诊接受高压氧治疗。在进行6次高压治疗后，组织变色明显改善。
虽然透明质酸酶被认为是治疗与使用含透明质酸的临时填充剂相关的血管阻塞的一种选择，但对于在注射永久性填充剂后发生血管阻塞的患者可能也有益处。高压氧疗法可使缺血组织过度氧合并减轻相关炎症反应，对于永久性填充剂注射后发生血管阻塞的患者可能也有益处。
无论注射的填充剂类型如何，对于真皮填充剂植入后发生动脉阻塞的患者，均应考虑给予透明质酸酶和高压氧治疗。
