背景:透明质酸酶用作辅助或主要治疗方法,以管理与美容透明质酸(HA)填充剂注射相关的并发症,例如坏死,失明,超敏反应,延迟结节,和不良的美学结果。
目的:系统地绘制现有证据,并确定透明质酸酶在管理与HA注射相关的美学并发症(血管闭塞,失明,结节,延迟的超音速,肉芽肿,不良的审美结果)。
方法:PubMed,Medline,Embase和Cochrane数据库一直使用到2022年5月,以寻找随机临床试验(RCT),临床试验,和回顾性病例对照研究报告使用透明质酸酶治疗HA填充剂注射并发症。
结果:数据库搜索产生了395项研究;在这5项RCT(全部在美国进行)中,选择了(53名受试者),表明透明质酸酶用于去除未复杂的注射HA结节(前臂,上臂,或背部皮肤)。随访时间为14天至4年。注入每个部位的HA填充剂的量在0.2至0.4mL之间变化。对于大多数HA填充剂观察到剂量依赖性反应。无重大不良反应报告。总的来说,为了去除每0.1mLHA填充剂,他们注射了1.25-37.5单位的透明质酸酶(单次注射)。当使用连续3周的透明质酸酶注射时,使用0.375-2.25单位的更低剂量。没有RCT形式的证据,临床试验,以及关于去除/逆转面部皮肤中HA注射的回顾性病例对照研究,或过度更正的管理,炎性结节,或与HA填充剂注射相关的组织缺血/坏死。
结论:根据对前臂的研究,上臂和背部皮肤,透明质酸酶可用于逆转不复杂的HA填充剂注射结节。然而,有必要进行进一步充分的研究,以建立理想的透明质酸酶治疗方案/剂量,以逆转面部区域的HA填充剂注射或治疗与美学HA注射相关的并发症.
方法:本期刊要求作者为每篇文章分配一定程度的证据。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.
BACKGROUND: Hyaluronidase is used as an adjunct or main treatment to manage complications associated with cosmetic hyaluronic acid (HA) filler injections such as necrosis, blindness, hypersensitivity, delayed nodules, and poor aesthetic outcomes.
OBJECTIVE: To systematically map the available evidence and identify the gaps in knowledge on the effectiveness of hyaluronidase use in managing the aesthetic complications associated with HA injections (vascular occlusion, blindness, nodules, delayed hypersensivity, granuloma, poor aesthetic outcome).
METHODS: PubMed, Medline, Embase and Cochrane databases were used up to May 2022, to look for randomized clinical trials (RCTs), clinical trials, and retrospective case-control studies reporting on the use of hyaluronidase for managing the HA filler injection complications.
RESULTS: The database search yielded 395 studies; of those 5 RCTs (all carried out in the USA) were selected (53 subjects), indicating the effectiveness of hyaluronidase for removal of un-complicated injected HA nodules (forearm, upper arm, or back skin). The follow-ups ranged from 14 days to 4 years. The amount of HA filler injected into each site varied from 0.2 to 0.4 mL. A dose dependent response was observed for most HA fillers. No major adverse reactions were reported. Overall, for removal of every 0.1 mL of HA filler they injected 1.25-37.5 units of hyaluronidase (single injections). When 3 consecutive weekly hyaluronidase injection was used much lower doses of 0.375-2.25 unit was utilised. There was no evidence in a form of RCTs, clinical trials, and retrospective case-control studies on the removal/reversal of HA injections in the facial skin, or management of over-corrections, inflammatory nodules, or tissue ischemia/necrosis associated with HA filler injection.
CONCLUSIONS: Based on studies on the forearm, upper arm and back skin, hyaluronidase can be used for the reversal of uncomplicated HA filler injection nodule. However, further adequately powered studies are warranted to establish the ideal treatment protocol/dose of hyaluronidase for reversal of HA filler injections in the facial region or management of complications associated with aesthetic HA injection.
METHODS: This journal requires that authors assign a level of evidence to each article. 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 .