Abstract：
BACKGROUND: As a new-generation collagen stimulator, polycaprolactone (PCL) containing filler has been extensively applied in facial dermal fillers and other medical aesthetic fields. However, inadvertent intravascular injection of PCL may result in complications such as tissue edema, flap necrosis, and even blindness. To date, there is no effective treatment for PCL-induced intravascular embolism.
OBJECTIVE: The aim of this study was to identify a viable resolution for the embolism resulting from intravascular administration of PCL-containing fillers.
METHODS: Two different animal experiments were performed: (1) PCL-induced rat inferior epigastric arteries embolism, followed by gross observation, histological evaluation, and cytokines analysis from serum; and (2) PCL-induced rabbit auricular artery embolism, immediately treated with heparin and nitroglycerin. The ears were then evaluated by gross observation, Laser speckle imaging, in vivo imaging system (IVIS) imaging, and histological evaluation. Saline and hyaluronic acids (HA) were used as controls, hyaluronidase was used as a positive drug.
RESULTS: In a rat model of inferior epigastric arteries embolism, both intravascular injection of HA and PCL resulted in flap necrosis, indicating that the filler-induced intravascular embolism can lead to serious complications. In a rabbit model of auricular artery embolism, the combination treatment of heparin and nitroglycerin resulted in a relative blood reperfusion recovery of 80% in the ischemic area of the PCL group on day 7 post-operation, which was comparable to that of the HA group treated with hyaluronidase. Histological analysis revealed that the administration of heparin and nitroglycerin significantly attenuated intravascular thrombosis formation and inflammatory cell aggregation.
CONCLUSIONS: The combination of heparin and nitroglycerin effectively restores blood flow reperfusion in the intravascular embolization caused by PCL filler injection, alleviates local tissue edema and flap necrosis. These findings offer a novel approach for future clinical management of intravascular embolization with PCL-containing filler injection.
METHODS: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .
OBJECTIVE: The aim of this study was to identify a viable resolution for the embolism resulting from intravascular administration of PCL-containing fillers.
METHODS: Two different animal experiments were performed: (1) PCL-induced rat inferior epigastric arteries embolism, followed by gross observation, histological evaluation, and cytokines analysis from serum; and (2) PCL-induced rabbit auricular artery embolism, immediately treated with heparin and nitroglycerin. The ears were then evaluated by gross observation, Laser speckle imaging, in vivo imaging system (IVIS) imaging, and histological evaluation. Saline and hyaluronic acids (HA) were used as controls, hyaluronidase was used as a positive drug.
RESULTS: In a rat model of inferior epigastric arteries embolism, both intravascular injection of HA and PCL resulted in flap necrosis, indicating that the filler-induced intravascular embolism can lead to serious complications. In a rabbit model of auricular artery embolism, the combination treatment of heparin and nitroglycerin resulted in a relative blood reperfusion recovery of 80% in the ischemic area of the PCL group on day 7 post-operation, which was comparable to that of the HA group treated with hyaluronidase. Histological analysis revealed that the administration of heparin and nitroglycerin significantly attenuated intravascular thrombosis formation and inflammatory cell aggregation.
CONCLUSIONS: The combination of heparin and nitroglycerin effectively restores blood flow reperfusion in the intravascular embolization caused by PCL filler injection, alleviates local tissue edema and flap necrosis. These findings offer a novel approach for future clinical management of intravascular embolization with PCL-containing filler injection.
METHODS: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .
摘要：
背景：作为新一代胶原蛋白刺激器，聚己内酯（PCL）填充剂已广泛应用于面部真皮填充剂和其他医疗美学领域。然而,PCL的意外血管内注射可能导致并发症，如组织水肿，皮瓣坏死，甚至失明。迄今为止,对于PCL诱导的血管内栓塞尚无有效的治疗方法。
目的：本研究的目的是确定血管内施用含PCL的填充剂导致的栓塞的可行解决方案。
方法：进行了两种不同的动物实验：（1）PCL诱导的大鼠腹壁下动脉栓塞，接下来是粗略的观察，组织学评估，和血清细胞因子分析；（2）PCL诱导的兔耳动脉栓塞，立即用肝素和硝酸甘油治疗。然后通过粗略观察评估耳朵，激光散斑成像,体内成像系统（IVIS）成像，和组织学评估。盐水和透明质酸（HA）用作对照，透明质酸酶被用作阳性药物。
结果：在大鼠腹壁下动脉栓塞模型中，血管内注射HA和PCL均导致皮瓣坏死，表明填充剂引起的血管内栓塞可导致严重的并发症。在兔耳动脉栓塞模型中,肝素和硝酸甘油的联合治疗在术后第7天导致PCL组缺血区域的相对血液再灌注恢复80％，这与用透明质酸酶处理的HA组相当。组织学分析表明，肝素和硝酸甘油的给药可显着减轻血管内血栓形成和炎症细胞聚集。
结论：肝素和硝酸甘油联合使用可有效恢复PCL填充剂所致血管内栓塞的血流再灌注，减轻局部组织水肿和皮瓣坏死。这些发现为将来使用含PCL的填充剂注射进行血管内栓塞的临床管理提供了新方法。
方法：本期刊要求作者为每个提交的证据分配一个级别，该级别的证据适用于循证医学排名。这不包括评论文章，书评,和有关基础科学的手稿，动物研究,尸体研究，和实验研究。对于这些循证医学评级的完整描述，请参阅目录或在线作者说明www。springer.com/00266.
目的：本研究的目的是确定血管内施用含PCL的填充剂导致的栓塞的可行解决方案。
方法：进行了两种不同的动物实验：（1）PCL诱导的大鼠腹壁下动脉栓塞，接下来是粗略的观察，组织学评估，和血清细胞因子分析；（2）PCL诱导的兔耳动脉栓塞，立即用肝素和硝酸甘油治疗。然后通过粗略观察评估耳朵，激光散斑成像,体内成像系统（IVIS）成像，和组织学评估。盐水和透明质酸（HA）用作对照，透明质酸酶被用作阳性药物。
结果：在大鼠腹壁下动脉栓塞模型中，血管内注射HA和PCL均导致皮瓣坏死，表明填充剂引起的血管内栓塞可导致严重的并发症。在兔耳动脉栓塞模型中,肝素和硝酸甘油的联合治疗在术后第7天导致PCL组缺血区域的相对血液再灌注恢复80％，这与用透明质酸酶处理的HA组相当。组织学分析表明，肝素和硝酸甘油的给药可显着减轻血管内血栓形成和炎症细胞聚集。
结论：肝素和硝酸甘油联合使用可有效恢复PCL填充剂所致血管内栓塞的血流再灌注，减轻局部组织水肿和皮瓣坏死。这些发现为将来使用含PCL的填充剂注射进行血管内栓塞的临床管理提供了新方法。
方法：本期刊要求作者为每个提交的证据分配一个级别，该级别的证据适用于循证医学排名。这不包括评论文章，书评,和有关基础科学的手稿，动物研究,尸体研究，和实验研究。对于这些循证医学评级的完整描述，请参阅目录或在线作者说明www。springer.com/00266.
