【 文献重点摘要 】

Accidental intra-arterial filler injection may cause significant tissue injury and necrosis. Hyaluronic acid (HA) fillers, currently the most popular, are the focus of this article, which highlights complications and their symptoms, risk factors, and possible treatment strategies. Although ischemic events do happen and are therefore important to discuss, they seem to be exceptionally rare and represent a small percentage of complications in individual clinical practices. However, the true incidence of this complication is unknown because of underreporting by clinicians. Typical clinical findings include skin blanching, livedo reticularis, slow capillary refill, and dusky blue-red discoloration, followed a few days later by blister formation and finally tissue slough. Mainstays of treatment (apart from avoidance by meticulous technique) are prompt recognition, immediate treatment with hyaluronidase, topical nitropaste under occlusion, oral acetylsalicylic acid (aspirin), warm compresses, and vigorous massage. Secondary lines of treatment may involve intra-arterial hyaluronidase, hyperbaric oxygen therapy, and ancillary vasodilating agents such as prostaglandin E1. Emergency preparedness (a “filler crash cart”) is emphasized, since early intervention is likely to significantly reduce morbidity. A clinical summary chart is provided, organized by complication presentation.

Keywords: soft tissue filler, HA filler, hyaluronic acid, hyaluronidase (HYAL), hyaluronic acid complications, dermal fillers, embolia cutis medicamentosa, Nicolau syndrome, Freudenthal syndrome, vascular complications, intravascular injections, cosmetic medicine

动脉内意外注射填充物可能会导致严重的组织损伤和坏死。透明质酸(HA)填充物是目前最流行的填充物，本文重点介绍了并发症及其症状、危险因素和可能的治疗策略。虽然缺血事件确实会发生，因此值得讨论，但它们似乎非常罕见，在个别临床实践中只占一小部分并发症。然而，由于临床医生的报告不足，这种并发症的真实发生率尚不清楚。典型的临床表现包括皮肤漂白，网状活体，毛细血管缓慢充盈，暗淡的蓝红色变色，几天后出现水疱，最后组织脱落。治疗的主要方法(除了通过细致的技术避免)是迅速识别，立即使用透明质酸酶治疗，在闭塞的情况下局部使用硝酸糊剂，口服乙酰水杨酸(阿司匹林)，热敷和大力按摩。次要治疗路线可能涉及动脉内透明质酸酶、高压氧治疗和辅助血管扩张剂，如前列腺素E1。强调应急准备(“加注急救车”)，因为早期干预可能会显著降低发病率。提供临床总结图，按并发症表现进行组织。

关键词：软组织填充物；HA填充物；透明质酸；透明质酸酶；透明质酸并发症；真皮填充物；皮肤药物性栓子；尼古拉综合征；弗洛伊登塔尔综合征；血管并发症；血管内注射；美容医学