Skin Necrosis from Intra-articular Hyaluronic Acid Injection

Kim, Whan B.; Alhusayen, Raed

doi:10.2310/7750.2014.14081

Cited by 17 publications

(21 citation statements)

References 12 publications

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“…Plastic surgeons nowadays are working on improved injection techniques and rescue solutions once embolism occurred. [33][34][35] Our injected 3D MA-HA cryogel had a diameter of 5 mm, which is far larger than the diameter of subcutaneous blood vessels, thus minimizing the risk of inadvertent blood vessel embolization.…”

Section: 27mentioning

confidence: 99%

Injectable Shape-Memorizing Three-Dimensional Hyaluronic Acid Cryogels for Skin Sculpting and Soft Tissue Reconstruction

Cheng

Shih

et al. 2017

Tissue Engineering Part A

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Introduction: Hyaluronic acid (HA)-based fillers are used for various cosmetic procedures. However, due to filler migration and degradation, reinjections of the fillers are often required. Methacrylated HA (MA-HA) can be made into injectable shape-memorizing fillers (three-dimensional [3D] MA-HA) aimed to address these issues. In this study, shape retention, firmness, and biocompatibility of 3D MA-HA injected subcutaneously in mice were evaluated. Materials and Methods: Fifteen mice, each receiving two subcutaneous injections in their back, were divided into four groups receiving HA, MA-HA, 3D MA-HA, or saline, respectively. Digital imaging, scanning electron microscope (SEM) and in vivo imaging system (IVIS), durometry, and histology were utilized to evaluate in vitro/ vivo degradation and migration, material firmness, and the angiogenic (CD31) and immunogenic (CD45) response of the host tissue toward the injected materials. Results: Digital imaging, SEM, and IVIS revealed that 3D MA-HA fillers maintained their predetermined shape for at least 30 days in vitro and in vivo. Little volume effects were noted in the saline and other control groups. There were no differences in skin firmness between the groups or over time. Histology showed intact skin architecture in all groups. Three-dimensional MA-HA maintained its macroporous structure with significant angiogenesis at the 3D MA-HA/skin interfaces and throughout the 3D MA-HA. There was no significant inflammatory response to any of the injected materials. Conclusion: 3D MA-HA showed remarkable tissue compatibility, compliance, and shape predictability, as well as retention, and thus might be suitable for various skin sculpting and soft tissue reconstruction purposes.

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Section: 27mentioning

confidence: 99%

Injectable Shape-Memorizing Three-Dimensional Hyaluronic Acid Cryogels for Skin Sculpting and Soft Tissue Reconstruction

Cheng

Shih

et al. 2017

Tissue Engineering Part A

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“…However, persistent and irreversible damage to bone and cartilage remains [33]. Skin necrosis is a rare complication [34]. TA is a commonly used intra-articular drug that significantly reduces the secretion of interleukin-1 and tumour necrosis factor alpha from synovial tissue and inhibits the proliferation of capillaries and fibroblasts.…”

Section: Discussionmentioning

confidence: 99%

Bevacizumab tested for treatment of knee osteoarthritis via inhibition of synovial vascular hyperplasia in rabbits

Lin

Wang

et al. 2019

Journal of Orthopaedic Translation

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Background/objectiveOsteoarthritis (OA) is the most common joint disorder. Angiogenesis and synovial hyperplasia are important factors in the development of OA. Previous studies demonstrated that bevacizumab, an antibody against vascular endothelial growth factor in angiogenesis for cancer treatment, might be a potential candidate for the treatment of OA. However, experimental studies were lacking in whether bevacizumab would be able to attenuate the severity of OA. In this study, we used normal New Zealand rabbits and a rabbit knee immobilization model of OA, to investigate the toxicity and efficacy of bevacizumab.MethodsIn the safety test of bevacizumab, sixteen rabbits were randomly divided into 2 groups: control group and bevacizumab group (n = 8 per group). We evaluated the blood chemistry and histology of normal rabbit joints after bevacizumab treatment. In the efficacy test of bevacizumab, thirty-two rabbits were used for establishing OA model and then randomly divided into 4 groups: bevacizumab group, sodium hyaluronate (SH) group, triamcinolone acetonide (TA) group and control group (n = 8 per group). We used histological evaluations and immunohistochemistry to examine the responses to bevacizumab treatment in a rabbit model of knee immobilization-induced OA.ResultsBevacizumab treatment did not show any adverse effects histologically on normal joints. Blood tests and Mankin's score of cartilage revealed no significant difference between the bevacizumab and control groups (p > 0.05). The bevacizumab, SH, and TA groups attenuated articular cartilage degeneration and showed less synovial hyperplasia compared to the control group macroscopically and histologically, while the effect of the bevacizumab group was most obvious (p < 0.05). Immunohistochemistry revealed significantly lower vascular endothelial growth factor (VEGF) expression in the synovium and matrix metalloproteinase-1 (MMP-1) in the cartilage in the bevacizumab, SH, and TA groups compared to the control group (p < 0.05), while the expression of VEGF and MMP-1 in the bevacizumab group was the lowest among the four groups (p < 0.05).ConclusionsIntra-articular injection of 4-mg bevacizumab in rabbit knees did not show adverse effects. The bevacizumab treatment prevented joint inflammation in terms of inhibition of reduced angiogenesis, inhibited synovial proliferation, and reduced VEGF and MMP-1 expression. Compared with SH and TA, bevacizumab protected the cartilage and produced a better therapeutic effect on primary knee OA in rabbits, which imply that bevacizumab, an anticancer drug, may become a potentially effective drug for the treatment of OA.The translational potential of this articleOur study confirmed the therapeutic effect of bevacizumab on rabbit primary knee OA. This study demonstrated that bevacizumab may have clinical implications and contribute to the development of new OA treatments.

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“…Skin biopsy demonstrated HA embolism in dermal vessels as the etiological factor. Only two similar cases are available in the literature, 4,5 but this is the first patient with associated neuropathy. It is reasonable to admit that neural damage is related to the involvement of vasa nervorum by HA embolism, similar to that demonstrated in skin vessels.…”

Section: Figurementioning

confidence: 96%

“…Some serious problems, including severe acute inflammatory reactions, infections, allergic reactions, and anaphylaxis, have been reported 2,3 . Skin necrosis is an extremely unusual complication, described in only two patients 4,5 …”

Section: Figurementioning

confidence: 99%

Dermal embolization associated with peroneal mononeuropathy: an unusual complication after hyaluronic acid intra‐articular injections

et al. 2020

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Skin Necrosis from Intra-articular Hyaluronic Acid Injection

Abstract: Although tissue necrosis is a rare complication, physicians need to be aware of this possibility as a complication of HA IA injections in the treatment of osteoarthritis and should be mindful of potential treatment options to manage this adverse event.

Cited by 17 publications

References 12 publications

Injectable Shape-Memorizing Three-Dimensional Hyaluronic Acid Cryogels for Skin Sculpting and Soft Tissue Reconstruction

Injectable Shape-Memorizing Three-Dimensional Hyaluronic Acid Cryogels for Skin Sculpting and Soft Tissue Reconstruction

Bevacizumab tested for treatment of knee osteoarthritis via inhibition of synovial vascular hyperplasia in rabbits

Dermal embolization associated with peroneal mononeuropathy: an unusual complication after hyaluronic acid intra‐articular injections

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