Impending Necrosis Research Articles

THE USE OF HYALURONIC ACID FOR CORRECTING FACE DEFORMITIES

The use of injectable hyaluronic acid (HA) fillers has become increasingly widespread in facial contouring and rejuvenation. We report our experiences to emphasize the role of HA fillers as tools in addition to aesthetic treatments in cases of post-surgical facial sequelae. HA fillers are generally used for aesthetic rejuvenation, but a new potential horizon could be their application in traumatic, reconstructive and craniofacial surgeries. This study was carried out retrospectively through a bibliographic survey of books, public health manuals and scientific articles in Portuguese and English published in the databases of VHL (Virtual Health Library), SciELO (Scientific Electronic Library Online) and PUBMED. The search for references was developed by looking for publications referring to the period of the last 10 years. Visual analogue scale (VAS) assessment was performed to assess patient satisfaction. No major complications (ie impending necrosis or visual loss) were reported. Bruising and swelling have been reported for 48 hours after lip injection. In the immediate VAS assessment, 67% of the patients were “extremely satisfied” and 33% “satisfied”. In those 33%, VAS scores changed to “extremely satisfied” at 6–9 weeks and 3–6 months of VAS assessment (contextually for improvement in flexibility, elasticity, and aesthetic appearance of the tissue). The results indicate that this minimally invasive approach achieves a high level of aesthetic enhancement, improving patient satisfaction. The concept of HA filler applications may be a frontier that may be applicable to other areas of reconstructive facial plastic surgery.

Commentary on "Soft Tissue Dermal Filler-Associated Necrosis and Impending Necrosis: A Systematic Review of the Literature".

Commentary on "Soft Tissue Dermal Filler-Associated Necrosis and Impending Necrosis: A Systematic Review of the Literature".

Soft Tissue Dermal Filler-Associated Necrosis and Impending Necrosis: A Systematic Review of the Literature.

Cosmetic soft tissue fillers are a popular minimally invasive procedure. Necrosis is a rare yet devastating complication of soft tissue fillers. To date, the relationship between soft tissue fillers and necrosis has not been fully described. To systematically compile published cases of soft tissue fillers resulting in necrosis and collect data regarding the injection, treatment, and outcome. Using PRISMA protocol, a comprehensive search for soft tissue filler necrosis was performed using no time constraints, resulting in 97 articles encompassing 192 cases of soft tissue filler necrosis containing individual-level data. Of the cases analyzed, 66.1% had progressed to necrosis, whereas 33.9% of patients had impending necrosis. Necrosis most commonly resulted from injection of the nasolabial fold (32.4%, n = 88). The filler material most commonly used was hyaluronic acid (71.9%, n = 138). Hyaluronidase was used most frequently as an initial treatment agent (19.1%, n = 88). Forty-three patients (22.4%) with necrosis had a prior minor procedure or surgery. This systematic review is an extensive overview of necrosis as a complication of soft tissue fillers. It serves as a reference tool for any clinician who injects soft tissue fillers and any provider who encounters soft tissue filler necrosis.

HYALURONIC ACID FILLER INJECTION FOR COSMETIC PURPOSE: SKIN NECROSIS COMPLICATION AND TREATMENT - CASES REPORTS

Background: Hyaluronic acid (HA) fillers for aesthetic are generally considered safe and the use of dermal fillers for soft tissue augmentation has become a very popular technique in aesthetic practices. Dermal fillers temporarily remove the appearance of rhytids and reduce the depth of skin folds. This is one of the most effective method for facial improvement used in Viet Nam nowadays. However, complications such as skin necrosis, blind... may happen and hence any filler injection practitioner need to be aware of such side effects, contraindications and precaution to be adopted while using fillers. Even with the most experienced of injectors, adverse effects can and do occur ranging from mild bruising to severe injection necrosis. Aims: HA filler injectors should be able to prevent and treat the severe complication of skin necrosis and detect impending necrosis after injection of a augmentation filler. Materials and Methods: Cases report of 3 patients who were HA filler injection for nose augmentation and had suffered from skin necrosis. These patients were followed for 3-6 months from time of injection of hyaluronic acid filler to complete healing of wound. Results: Complete wound healing were achieved with early recognition and institution of treatment, surgical procedures applied in some severe cases. The functional of the noses are remained but most of the patients have bad scar on the nose. Discussion: We review cases report of injection necrosis and methods used to prevent and treat this complication. Conclusion: Early recognition of vascular necrosis with specific protocol for treatment after injection necrosis with hyaluronic acid fillers improves the outcome of wound healing.

Non-Surgical Touch-Up with Hyaluronic Acid Fillers Following Facial Reconstructive Surgery

The use of hyaluronic acid (HA) injectable fillers has become increasingly widespread in facial recontouring and rejuvenation. We report our experiences to emphasize the role of HA fillers as tools beyond aesthetic treatments in cases of post-surgical facial sequelae. HA fillers are generally used for aesthetic rejuvenation, but one potential new horizon could be their application in trauma, reconstructive, and craniofacial surgery. This study was conducted retrospectively, evaluating medical reports of patients treated at the Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, Naples, for lip incompetence, trauma, oncological, reconstructive, and craniosynostosis surgery sequelae. Visual analog scale (VAS) evaluation was performed to assess patient satisfaction. No major complications (i.e., impending necrosis or visual loss) were reported. Bruising and swelling was reported for 48 h after lip injection. At the immediate VAS evaluation, 67% of the patients were “extremely satisfied” and 33% “satisfied”. In those 33%, VAS scores changed to “extremely satisfied” at 6–9 weeks and 3–6 months of VAS evaluation (contextually to improvement in tissue flexibility, elasticity, and aesthetic appearance). Results indicate that this minimally invasive approach achieves a high level of aesthetic enhancement, improving patient satisfaction. The concept of HA filler applications could be a frontier that may be applicable to other areas of reconstructive facial plastic surgery.

Prevention of impending scalp necrosis by topical nitroglycerine in hair transplant surgery.

Recipient site necrosis is a rare but potentially devastating complication of hair restoration surgery. Appropriate case selection and procedure performed by expert surgical team are although mandatory but not enough to prevent such event, particularly in megasessions. Timely recognition of impending necrosis is very important to consider preventive measures. We aim to evaluate the use of topical nitroglycerine in preventing the incidence of impending necrosis in hair restoration surgery. A retrospective observational study was designed to determine the efficacy of nitroglycerine spray in consecutive cases of hair transplant troubled with dusky skin vulnerable to necrosis. 1580 cases that underwent hair transplant were enrolled and topical nitroglycerine was used in 88 patients vulnerable to necrosis. A management algorithm was also proposed from clinical observations and literature review to avoid vascular injury that may lead to necrosis. 83 cases (94.32%) were rescued by topical nitroglycerine and five developed necrosis eventually. Five cases who had considerable black hue and treated successfully with above treatment were reported in detail. Our experience with the use of nitroglycerine spray on the cyanotic area aided in the prevention of impending necrosis due to its vasodilatory effects on arterioles.

A 65-Year-Old Male with a Large Plaque of Retiform Purpura with Impending Necrosis on the Right Lower Abdomen

Abstract not available.

Nitroglycerin, or Not, When Treating Impending Filler Necrosis.

Dermal necrosis is a rare yet serious risk associated with cosmetic filler injections, and although current consensus recommends the use of hyaluronidase injections in cases of hyaluronic acid filler, the efficacy of topical nitroglycerin as a treatment has not yet been fully investigated. To review the literature on tissue necrosis resulting from soft tissue augmentation and to highlight the use of topical nitroglycerin as a first-line treatment. A review of the literature was performed with no time limitations resulting in 35 articles and 66 patients who experienced tissue necrosis secondary to injectable fillers. Articles were reviewed for pertinent information and presented. Only 7 of the 66 reported cases (10%) used topical nitroglycerin as a treatment. Six of 7 (85%) were successful in halting the impending necrosis. Fifty-nine patients received alternative treatments, with hyaluronidase injection being the most common. Few reports of novel treatments for necrosis included the use of topical growth factors and injection of adipose-derived stem cells. Topical nitroglycerin is a potentially effective and underused treatment for tissue necrosis from soft tissue augmentation, but because data are very limited, topical nitroglycerin should be used in conjunction with hyaluronidase injections in cases of hyaluronic acid filler dermal necrosis.

The use of GTN paste in impending necrosis following soft-tissue augmentation

One of the actions of Glyceryl trinitrate (GTN), otherwise known as nitroglycerin, is initiating the relaxation of smooth muscle cells in blood vessels to promote blood flow to various parts of the body. GTN comes in a number of forms and has a range of indications; however, unfortunately GTN has some common side effects, which in some cases may limit therapy. These side effects include flushing, headache and postural hypotension. One significant, yet controversial, off-license use for GTN paste is for the adjunctive treatment of necrosis or impending necrosis following the use of dermal fillers for soft tissue augmentation. In the event of occlusion or damage and impending necrosis, the goal is to promote blood flow to the area as quickly as possible and treatment should always be immediate. Emergency treatment of the area with hyaluronidase should be initiated first, with adjunct treatments to improve blood supply to the area following shortly.

Application of Nipple-Areolar Complex Impending Necrosis with Light-Emitting Diode Treatment for Immediate Breast Reconstruction after Nipple-Sparing Mastectomy

Application of Nipple-Areolar Complex Impending Necrosis with Light-Emitting Diode Treatment for Immediate Breast Reconstruction after Nipple-Sparing Mastectomy

Treatment of Hyaluronic Acid Filler–Induced Impending Necrosis With Hyaluronidase: Consensus Recommendations

Injection-induced necrosis is a rare but dreaded consequence of soft tissue augmentation with filler agents. It usually occurs as a result of injection of filler directly into an artery, but can also result from compression or injury. We provide recommendations on the use of hyaluronidase when vascular compromise is suspected. Consensus recommendations were developed by thorough discussion and debate amongst the authors at a roundtable meeting on Wednesday June 18, 2014 in Las Vegas, NV as well as significant ongoing written and verbal communications amongst the authors in the months prior to journal submission. All authors are experienced tertiary care providers. A prompt diagnosis and immediate treatment with high doses of hyaluronidase (at least 200 U) are critically important. It is not felt necessary to do a skin test in cases of impending necrosis. Some experts recommend dilution with saline to increase dispersion or lidocaine to aid vasodilation. Additional hyaluronidase should be injected if improvement is not seen within 60 minutes. A warm compress also aids vasodilation, and massage has been shown to help. Some experts advocate the use of nitroglycerin paste, although this area is controversial. Introducing an oral aspirin regimen should help prevent further clot formation due to vascular compromise. In our experience, patients who are diagnosed promptly and treated within 24 hours will usually have the best outcomes.

Managing dermal filler complications part 4: impending necrosis

As the number of soft tissue filler injections increases, the incidence of adverse events associated with these treatments will inevitably rise. Impending necrosis is a serious complication; if it is not treated correctly and in good time, there may be grave consequences. Although impending necrosis is one of the most feared complications among aesthetic practitioners, its incidence is difficult to quantify. This is possibly owing to an adverse event of this kind not being reported, combined with the element of taboo associated with dermal filler complications. However, even with the most experienced of injectors, adverse effects can and do occur, ranging from mild bruising to severe injection necrosis. It is paramount that aesthetic practitioners are able to recognise and treat the severe complication of impending necrosis for the safety of their patients and to protect themselves from litigation.

Bitemporal scalp, lip and tongue necrosis in giant cell arteritis: A rare presentation

A 74-year-old man was presented with fever, bilateral throbbing temporoparietal headache, jaw claudication, and bilateral loss of vision. On examination, he had bilateral scalp necrosis with impending necrosis of lip and tongue. Temporal artery biopsy was done, and it was compatible with active temporal arteritis. This is one of the rare presentations of giant cell arteritis where there is simultaneous necrosis of scalp, lip, and tongue, and to the best of our knowledge, it is the first case reported from India.

An exaggerated altered immune response following treatment with an HA dermal filler

Facial soft tissue augmentation with a hyaluronic acid (HA) based dermal filler is a medical procedure that is normally well tolerated by patients. Side effects are usually predictable, mild and transient, including bruising, erythema, pain and swelling. These are minor local injection site reactions that will typically resolve within a number of days. However, despite the impressive safety profile of HA based dermal fillers, there is the potential for a myriad of complications to occur. Baumann (2009) has cited several HA dermal filler complications that range from infection, abscess formation, nodule formation, granulomatous reactions and altered immune responses to the most feared complication of all: occlusion or compression of a vessel(s) resulting in impending necrosis, skin ulceration or cutaneous necrosis. This case report will document a series of adverse events that were experienced by a 54-year-old patient who was injected with a HA-based dermal filler to the upper and lower vermillion borders of the lips, the marionette region of the lower face, and the malar and submalar region of the mid-face. Following treatment, the patient suffered months of recurring symptoms, including persistent immune system reactivity, eczematous changes to the skin and marked hypertrophic changes to the upper eyelids. To date, intermittent symptoms continue to occur with full resolution of symptoms yet to be achieved. To respect and protect patient confidentiality, the patient will not be referred to by her name.

Extensive necrosis after injection of hyaluronic acid filler: case report and review of the literature

Use of dermal fillers for soft tissue augmentation has become an integral part of aesthetic practices. Dermal fillers temporarily remove the appearance of rhytids and reduce the depth of skin folds. Even with the most experienced of injectors, adverse effects can and do occur ranging from mild bruising to severe injection necrosis. Physicians should be able to treat the severe complication of vascular necrosis and detect impending necrosis after injection of a dermal filler, especially with hyaluronic acid fillers. Case report of a patient who was followed for 6 months from time of injection of hyaluronic acid filler to complete healing of wound. Complete wound healing was achieved with early recognition and institution of treatment. We review a case report of injection necrosis and methods used to prevent and treat this complication. Early recognition of vascular necrosis with specific protocol for treatment after injection necrosis with hyaluronic acid fillers improves the outcome of wound healing.

The Risk of Alar Necrosis Associated with Dermal Filler Injection

Injection of dermal fillers is one of the most commonly performed cosmetic procedures. Serious complications from fillers are rare but potentially devastating to patients and physicians. Skin necrosis, such as nasal alar necrosis, is one of the most feared serious complications of dermal fillers, but there is a paucity of literature on the incidence of such events, as well as potential treatment options. We present a review of the literature and three cases of nasal alar necrosis after dermal filler injection. Nasal alar necrosis associated with dermal filler injection is a rare event. Proper technique and recognition of risk factors may reduce the incidence of this complication. Physicians should be aware of early intervention and treatment options should impending necrosis become apparent.

Late Salvage of the Ischemic Finger After Crush Injury Using Flow-Through Flaps: Case Report

The progressive evolution and late salvage of a posttraumatic digit with poor vascularization has not been discussed in the literature. We report the cases of 3 patients whose fingers were rescued at referral 5 to 16 days after the traumatic event by restoring the arterial inflow by means of flow-through free flaps. All 3 fingers were compromised vascularly with patchy necrosis and absence of Doppler signal distal to the injury. All were salvaged. In our experience, in the setting of a posttraumatic digit with poor vascularization, it is possible to reverse impending necrosis by late revascularization. Frank infection or mummification is considered an irreversible state and a contraindication to salvage.

Successful Management of an Unusual Presentation of Impending Necrosis Following a Hyaluronic Acid Injection Embolus and a Proposed Algorithm for Management with Hyaluronidase

HIRSCH, RANELLA J. MD, FAAD*; COHEN, JOEL L. MD, FAAD†; CARRUTHERS, JEAN D.A. MD, FRCS‡ Author Information

Successful Management of an Unusual Presentation of Impending Necrosis Following a Hyaluronic Acid Injection Embolus and a Proposed Algorithm for Management with Hyaluronidase

Successful Management of an Unusual Presentation of Impending Necrosis Following a Hyaluronic Acid Injection Embolus and a Proposed Algorithm for Management with Hyaluronidase

Hysteroscopic Differences in the Gestational Sac in Asymptomatic Blighted Ovum and Viable Pregnancy at Early Gestation

Summary Objective To assess differences in the surface anatomy of the gestational sac and endometrium in cases of blighted ovum and viable pregnancies using flexible hysteroscopy. Methods This was an observational case-control study. Seventeen patients with asymptomatic blighted ovum at gestational ages of 8-13 weeks and 32 women with viable pregnancy at 6-12 weeks of gestation were recruited. Subjects at 8-10 weeks of gestation in both groups were matched for comparison. The gross surface anatomy of the gestational sac and the endometrium was assessed and compared between the two groups. Results In the viable pregnancy group, the gestational sac was either round (84.4%, 27/32) or ellipsoid and slightly creased (15.6%, 5/32). In the blighted ovum group, the sac appeared collapsed and wrinkled (58.8%, 10/17), small for gestational age (11.8%, 2/17), a combination of the two (17.6%, 3/17), or round and normal (11.8%, 2/17). In general, the sac in subjects with blighted ovum tended to have various degrees of loss in surface tension, collapse in shape, decrease in sac size, and dark blue color at the sac dome compared with the sac in viable pregnancies. Conclusions The anatomic alterations of the gestational sac reflect impending sac necrosis and abortion in early-stage pregnancy loss. There were no morphologic differences between the two groups in the pattern of capillary distribution on the endometrium or the implantation base.