Intravenous Hyaluronidase with Urokinase as Treatment for Arterial Hyaluronic Acid Embolism.

Abstract

Although injection of hyaluronidase into surrounding tissues was proposed to treat arterial hyaluronic acid embolism, its application is still rather limited. The authors' goal was to investigate whether intravenous use of hyaluronidase can help resolve hyaluronic acid-induced arterial embolism. Inferior epigastric arteries, nourishing inferior abdominal skin of rats, were injected with 0.02 ml of hyaluronic acid to create the animal model. The rats were divided randomly into four groups and given different solutions intravenously: hyaluronidase plus urokinase (group A), hyaluronidase (group B), urokinase (group C), or saline (group D). Progression of tissue necrosis in all groups was recorded for 1 week. The flap survival rate and mean percentage of surviving flap area were analyzed. The animal model closely imitated actual hyaluronic acid arterial obstruction cases. Flap necrosis occurrence rates of each group were 10 percent in group A, 70 percent in group B, 80 percent in group C, and 90 percent in group D. The mean surviving flap areas of each group were 92.45 percent (group A), 47.67 percent (group B), 41.41 percent (group C), and 33.19 percent (group D). When hyaluronidase and urokinase were used together, the flap necrosis rate decreased significantly compared with that of the control group (p < 0.05). Even in cases of necrosis, group A had a higher average surviving flap area than did the other groups. Combined use of hyaluronidase and urokinase can help increase the flap survival rate when administered intravenously in intraarterial hyaluronic acid occlusion cases. Both red thrombus and hyaluronic acid emboli must be dissolved for flap reperfusion. This method shows a promising effect for future application.