Ultrasound-Guided Targeted vs Regional Flooding: A Comparative Study for Improving the Clinical Outcome in Soft Tissue Filler Vascular Adverse Event Management.
| Title: | Ultrasound-Guided Targeted vs Regional Flooding: A Comparative Study for Improving the Clinical Outcome in Soft Tissue Filler Vascular Adverse Event Management. |
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| Authors: | Schelke LW; Velthuis PJ; Decates T; Kadouch J; Alfertshofer M; Frank K; Cotofana S |
| Source: | Aesthetic surgery journal [Aesthet Surg J] 2023 Jan 09; Vol. 43 (1), pp. 86-96. |
| Publication Type: | Comparative Study; Journal Article |
| Language: | English |
| Journal Info: | Publisher: Oxford University Press Country of Publication: England NLM ID: 9707469 Publication Model: Print Cited Medium: Internet ISSN: 1527-330X (Electronic) Linking ISSN: 1090820X NLM ISO Abbreviation: Aesthet Surg J Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2015-: Oxford : Oxford University Press; Original Publication: St. Louis, MO : Mosby-Year Book, c1997- |
| MeSH Terms: | Dermal Fillers*/adverse effects; Hyaluronic Acid/adverse effects ; Ultrasonography, Interventional/adverse effects ; Humans ; Hyaluronoglucosaminidase ; Retrospective Studies ; Ultrasonography |
| Abstract: | Background: 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".; Objectives: 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.; Methods: 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.; Results: 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.; Conclusions: 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.; (© The Author(s) 2022. Published by Oxford University Press on behalf of The Aesthetic Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.) |
| Substance Nomenclature: | 0 (Dermal Fillers); 9004-61-9 (Hyaluronic Acid); EC 3.2.1.35 (Hyaluronoglucosaminidase) |
| Entry Date(s): | Date Created: 20220811 Date Completed: 20230113 Latest Revision: 20230117 |
| Update Code: | 20260130 |
| DOI: | 10.1093/asj/sjac227 |
| PMID: | 35951759 |
| Database: | MEDLINE |
Comparative Study; Journal Article