Vascular Complication in Aesthetic Medicine Treated with Hyperbaric Oxygenation

Najbardziej niebezpieczne reakcje niepożądane po iniekcjach kwasu hialuronowego w medycynie estetycznej, to powikłania naczyniowe czyli Zespół Nicolau. W artykule przedstawiono powikłanie naczyniowe w okolicy górnej części fałdu nosowo-wargowego lewego po podaniu podskórnie kwasu hialuronowego w ilości 0, 5 ml. W czasie iniekcji wystąpiło zblednięcie, a już po godzinie sinica siateczkowata (livedo racemosa). Po tygodniu pojawiło się owrzodzenie. Dopiero dziesiątego dnia od iniekcji kwasu hialuronowego podano hialuronidazę. Po zastosowaniu 15 ekspozycji hiperbarii tlenowej nastąpiło całkowite wyleczenie owrzodzenia.The most hazardous adverse reactions following hyaluronic acid injections in aesthetic medicine involve vascular complications, known as the Nicolau Syndrome. This article presents a vascular complication in the area of the upper part of the nasolabial fold following subcutaneous administration of 0.5 ml of hyaluronic acid. At the time of the injection, paling occurred, which was followed by livedo racemosa appearing an hour later. Upon the lapse of a week, an ulceration appeared. It was not until the tenth day after the hyaluronic acid injection that hyaluronidase was administered. After 15 hyperbaric oxygen exposures, the ulcer was completely healed

Vascular complication in aesthetic medicine treated with hyperbaric oxygenation

Najbardziej niebezpieczne reakcje niepożądane po iniekcjach kwasu hialuronowego w medycynie estetycznej, to powikłania naczyniowe czyli Zespół Nicolau. W artykule przedstawiono powikłanie naczyniowe w okolicy górnej części fałdu nosowo-wargowego lewego po podaniu podskórnie kwasu hialuronowego w ilości 0, 5 ml. W czasie iniekcji wystąpiło zblednięcie, a już po godzinie sinica siateczkowata (livedo racemosa). Po tygodniu pojawiło się owrzodzenie. Dopiero dziesiątego dnia od iniekcji kwasu hialuronowego podano hialuronidazę. Po zastosowaniu 15 ekspozycji hiperbarii tlenowej nastąpiło całkowite wyleczenie owrzodzenia.The most hazardous adverse reactions following hyaluronic acid injections in aesthetic medicine involve vascular complications, known as the Nicolau Syndrome. This article presents a vascular complication in the area of the upper part of the nasolabial fold following subcutaneous administration of 0.5 ml of hyaluronic acid. At the time of the injection, paling occurred, which was followed by livedo racemosa appearing an hour later. Upon the lapse of a week, an ulceration appeared. It was not until the tenth day after the hyaluronic acid injection that hyaluronidase was administered. After 15 hyperbaric oxygen exposures, the ulcer was completely healed

The impact of lifestyle upon the probability of late bacterial infection after soft-tissue filler augmentation

Wojciech Marusza,1 Romuald Olszanski,2 Janusz Sierdzinski,3 Kamila Szyller,1 Tomasz Ostrowski,4 Joanna Gruber-Miazga,1 Irina Netsvyetayeva51Academy of Face Sculpting, Warsaw, Poland; 2Military Institute of Health Services, Warsaw, Poland; 3Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Warsaw, Poland; 4Department of General and Endocrine Surgery, Medical University of Warsaw, Warsaw, Poland; 5Department of Microbiology, Medical University of Warsaw, Warsaw, PolandPurpose: Little is known about the influence of lifestyle-related factors upon the risk of late bacterial infection (LBI) emerging at the site of soft-tissue filler augmentation. The aim of this study was to analyze the impact of some such factors on the risk of LBI by comparing their respective prevalence between two groups of previously healthy women: a group in which infection occurred at a site of cross-linked hyaluronic acid (HA) augmentation and a second group which did not have such an infection.Patients and methods: The infection group featured 25 women who developed LBI at a site of cross-linked HA augmentation; the control group featured 92 women who did not experience complications during a 24-month period of observation after the same procedure. Data was analyzed statistically using Chi-square tests and logistic regression.Results: The two groups did not differ significantly in terms of age. However, the frequency of antibiotic therapy, household pet ownership, occupation, hormone replacement therapy or contraception use, and attendance at a swimming pool, sauna, or gym attendance were found to vary with statistical significance, P<0.05.Conclusions: Women in the control group practiced a more active lifestyle. Antibiotic therapy in the year preceding cross-linked HA augmentation was a factor which rendered a patient predisposed towards the development of LBI. Pet ownership was more prominent among women who did not suffer LBI than within the group in which soft tissue filler-related complications had occurred.Keywords: late bacterial infection, bacterial biofilm, lifestyle, hyaluronic acid, soft tissue filler

Erratum

Marusza W, Mlynarczyk G, Olszanski R, Netsvyetayeva I, Obrowski M, Iannitti T, Palmieri B. Probable biofilm formation in the cheek as a complication of soft tissue filler resulting from improper endodontic treatment of tooth 16. Int J Nanomedicine. 2012;7:1441–1447.Dr Obrowski’s affiliation was published incorrectly in the original article. The correct affiliation for Dr Obrowski is as follows:Private Practice (General, Aesthetic and Oriental Medicine), Cork, IrelandRead the original article

Treatment of late bacterial infections resulting from soft-tissue filler injections

Wojciech Marusza,1 Romuald Olszanski,2 Janusz Sierdzinski,3 Tomasz Ostrowski,4 Kamila Szyller,1 Grazyna Mlynarczyk,5 Irina Netsvyetayeva5 1Academy of Face Sculpting, Warsaw, Poland; 2Military Institute of Health Services, Warsaw, Poland; 3Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Warsaw, Poland; 4Department of General and Endocrine Surgery, Medical University of Warsaw, Warsaw, Poland; 5Department of Microbiology, Medical University of Warsaw, Warsaw, Poland Purpose: Late bacterial infections (LBIs) after esthetic facial augmentation using hyaluronic acid (HA) fillers are relatively rare yet severe complications that are difficult to treat. No adequate treatment standards have hitherto been formulated. We have bridged this gap by formulating a treatment scheme based on the principles of treating foreign-body implantation-related infections and treating bacterial growth in the form of biofilm. The objective of this study was to evaluate the efficacy of a comprehensive scheme for treating LBI complications after facial augmentation using cross-linked HA fillers. Methods: A total of 22 patients with LBI symptoms at a site of cross-linked HA injection underwent treatment and observation. The comprehensive treatment scheme formulated by Marusza and Netsvyetayeva (M&N scheme) comprised draining the lesion, dissolution of cross-linked HA with hyaluronidase, broad-spectrum antibiotic combination therapy, and use of probiotics. While 17 patients underwent the M&N scheme, the remaining five were treated with other schemes. Statistical analysis of the data was performed using Mann–Whitney U and χ2 nonparametric tests with SAS 9.4 software. Results: All 17 patients who underwent the M&N scheme experienced resolution of symptoms, with no recurrence of infection at the HA-injection sites. Conclusion: To treat LBI at a site of cross-linked HA administration, the principles applicable to infections resulting from implantation of a foreign body must be followed. The treatment period should be sufficiently long for complete resolution of symptoms. The efficacy of treatment is considered proven if 2 months have elapsed without recurrence since the symptoms resolved. The M&N scheme is recommended for use as the first therapeutic option for treating LBI related to soft-tissue fillers. Keywords: bacterial biofilm, hyaluronic acid, soft-tissue filler complications, biofilm treatmen

Skin bacterial flora as a potential risk factor predisposing to late bacterial infection after cross-linked hyaluronic acid gel augmentation

Irina Netsvyetayeva,1 Wojciech Marusza,2 Romuald Olszanski,3 Kamila Szyller,2 Aneta Krolak-Ulinska,2 Ewa Swoboda-Kopec,1 Janusz Sierdzinski,4 Zachary Szymonski,5 Grazyna Mlynarczyk1 1Department of Microbiology, Medical University of Warsaw, Poland; 2Academy of Face Sculpturing, Warsaw, Poland; 3Military Institute of Health Services, Warsaw, Poland; 4Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Poland; 5Department of Zoology, Magdalen College, University of Oxford, Oxford, UK Introduction: Cross-linked hyaluronic acid (HA) gel is widely used in esthetic medicine. Late bacterial infection (LBI) is a rare, but severe complication after HA augmentation. The aim of this study was to determine whether patients who underwent the HA injection procedure and developed LBI had qualitatively different bacterial flora on the skin compared to patients who underwent the procedure without any complications. Methods: The study group comprised 10 previously healthy women with recently diagnosed, untreated LBI after HA augmentation. The control group comprised 17 healthy women who had a similar amount of HA injected with no complications. To assess the difference between the two groups, their skin flora was cultured from nasal swabs, both before and after antibiotic treatment in the study group. Results: A significant increase in the incidence of Staphylococcus epidermidis was detected in the control group (P=0.000) compared to the study group. The study group showed a significantly higher incidence of Staphylococcus aureus (P=0.005), Klebsiella pneumoniae (P=0.006), Klebsiella oxytoca (P=0.048), and Staphylococcus haemolyticus (P=0.048) compared to the control group. Conclusion: The bacterial flora on the skin differed in patients with LBI from the control group. The control group’s bacterial skin flora was dominated by S. epidermidis. Patients with LBI had a bacterial skin flora dominated by potentially pathogenic bacteria. Keywords: hyaluronic acid, late bacterial infection, bacterial biofilm, skin bacterial flora, S. epidermidis, S. aureus, Klebsiella spp