Abstract:
PURPOSE:Soft tissue dermal fillers, both temporary and permanent, are used frequently in facial rejuvenation. As the use of fillers increases, ischemic complications including skin necrosis are becoming more prevalent. In the literature, topical nitroglycerin paste has been recommended in the early treatment of patients presenting with ischemia. The purpose of this study was to evaluate the vascular perfusion effects of topical nitroglycerin paste in an animal model using indocyanine green (ICG) imaging. METHODS:After Animal Research Committee approval, a rabbit ear model was used to create filler-associated skin ischemia. Ischemia was confirmed to occur after intra-arterial occlusion. Four commonly used soft tissue fillers were injected intra-arterially: Radiesse (Merz USA, Greensboro NC), Restylane (Galderma, Ft. Worth, TX), Juvederm Ultra (Allergan, Irvine CA), Belotero (Merz USA, Greensboro NC) (0.1 ml). A total of 15 ears were used, 1 control and 4 experimental per product. Thirty minutes after occlusion, nitroglycerin ointment USP, 2%(Nitro-Bid) was applied topically to the experimental ears. Vascular perfusion was evaluated with the SPY System (Novadaq Inc.) using ICG imaging. Perfusion images were obtained at baseline, immediately after, and 30 minutes after intra-arterial filler injection, and at 30, 60, 90, and 120 minutes after application of topical nitroglycerin ointment. RESULTS:In this rabbit ear model, no statistically significant improvement in perfusion was noted after topical application of nitroglycerin paste with ICG imaging. In addition, the skin of the rabbit ear post-nitroglycerin ointment appeared to have more of a congested appearance than the controls. CONCLUSIONS:Ischemic filler complications are becoming increasingly prevalent. Practitioners often treat these complications with topical nitroglycerin paste based on the knowledge that topical nitroglycerin causes vasodilation. In filler-induced tissue ischemia, however, filler product is present within arterioles. Theoretically, applying nitroglycerin paste, at least early, may not improve perfusion and could worsen ischemia with dilation of vessels and further propagation of product into the smaller arterioles and capillaries. In addition, nitroglycerin paste has systemic effects, including hypotension and dizziness, which may not be tolerated by some patients. Therefore, the authors caution the use of topical nitroglycerin paste in patients presenting with filler-associated ischemia. Further studies in the best treatment algorithms for patients presenting with ischemic complications need to be performed.
journal_name
Ophthalmic Plast Reconstr Surgjournal_title
Ophthalmic plastic and reconstructive surgeryauthors
Hwang CJ,Morgan PV,Pimentel A,Sayre JW,Goldberg RA,Duckwiler Gdoi
10.1097/IOP.0000000000000446subject
Has Abstractpub_date
2016-03-01 00:00:00pages
118-22issue
2eissn
0740-9303issn
1537-2677journal_volume
32pub_type
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journal_title:Ophthalmic plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/IOP.0000000000000416
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journal_title:Ophthalmic plastic and reconstructive surgery
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doi:10.1097/00002341-198903000-00002
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journal_title:Ophthalmic plastic and reconstructive surgery
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doi:10.1097/00002341-200001000-00006
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abstract::A 65-year-old man with a history of renal transplantation presented with facial pain, purulent nasal discharge, and periorbital swelling. Signs of optic nerve compromise developed and persisted despite medial orbital wall decompression. Further imaging revealed an orbital floor abscess secondary to direct communicatio...
journal_title:Ophthalmic plastic and reconstructive surgery
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journal_title:Ophthalmic plastic and reconstructive surgery
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doi:10.1097/IOP.0b013e3182696552
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journal_title:Ophthalmic plastic and reconstructive surgery
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doi:10.1097/00002341-198701000-00004
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journal_title:Ophthalmic plastic and reconstructive surgery
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doi:10.1097/IOP.0b013e31824dd9d4
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journal_title:Ophthalmic plastic and reconstructive surgery
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doi:10.1097/00002341-200009000-00014
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journal_title:Ophthalmic plastic and reconstructive surgery
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journal_title:Ophthalmic plastic and reconstructive surgery
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journal_title:Ophthalmic plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/IOP.0b013e31802d97dd
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journal_title:Ophthalmic plastic and reconstructive surgery
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doi:10.1097/IOP.0b013e318185a72c
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journal_title:Ophthalmic plastic and reconstructive surgery
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doi:10.1097/00002341-200111000-00015
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journal_title:Ophthalmic plastic and reconstructive surgery
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doi:10.1097/IOP.0000000000000132
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journal_title:Ophthalmic plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00002341-199012000-00004
更新日期:1990-01-01 00:00:00
abstract::Most bony and cartilaginous lesions of the orbit and periorbital compartments are benign, grow endophytically, and are composed of dense lamellar bone (eburnated or ivory osteomas). An 87-year-old woman had a well-circumscribed, firm, round, and exophytic lesion of the brow region for at least 15 years. Excisional sur...
journal_title:Ophthalmic plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/IOP.0000000000000943
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abstract::This study was designed to evaluate the characteristics of human orbital fat and connective tissue. Two exenteration specimens were studied by light microscopy with special stains. Four distinct regions were identified on the basis of their connective tissue septa, which contained blood vessels and were composed of el...
journal_title:Ophthalmic plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00002341-199811000-00004
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journal_title:Ophthalmic plastic and reconstructive surgery
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journal_title:Ophthalmic plastic and reconstructive surgery
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doi:10.1097/00002341-199109000-00002
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abstract::An 88-year-old woman presented with a longstanding superomedial cyst of the orbit complicated by recurrent acute infection. Despite a clinical picture typical for a sino-orbital mucocele, no sinus abnormality was demonstrated. Histopathologic examination revealed a respiratory epithelial lining similar to that of the ...
journal_title:Ophthalmic plastic and reconstructive surgery
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journal_title:Ophthalmic plastic and reconstructive surgery
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journal_title:Ophthalmic plastic and reconstructive surgery
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更新日期:2018-05-01 00:00:00
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journal_title:Ophthalmic plastic and reconstructive surgery
pub_type: 杂志文章
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更新日期:2003-05-01 00:00:00
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journal_title:Ophthalmic plastic and reconstructive surgery
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journal_title:Ophthalmic plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00002341-199506000-00013
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journal_title:Ophthalmic plastic and reconstructive surgery
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journal_title:Ophthalmic plastic and reconstructive surgery
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journal_title:Ophthalmic plastic and reconstructive surgery
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