Hematoma em cirurgia dermatológica: dicas para evitar resultados inestéticos a partir da hialuronidase e drenagem de hematomas / Hematoma in aesthetic surgery: tips to avoid unaesthetic results Hyaluronidase and hematoma drainage

Hematomas são comuns após cirurgias cosméticas. Quando pequenos, são conduzidos de maneira conservadora, pois, na maioria das vezes, são reabsorvidos. No entanto, mesmo pequenas coleções, quando não ativamente abordadas, podem resultar em maus resultados estéticos. A drenagem precoce tem sido especialmente descrita em revistas de Otorrinolaringologia e Radiologia. As autoras apresentam uma abordagem para o tratamento precoce de hematomas. Ênfase especial é dada ao uso da hialuronidase, bem conhecida pelos dermatologistas e cirurgiões plásticos por sua capacidade de dissolver o ácido hialurônico, mas sua utilidade no tratamento de hematomas não é amplamente difundida entre esses especialistas.

Hematomas are common following cosmetic surgery. When minor, they are treated with observation only as they are most often reabsorbed. However, even with small collections of blood, if no early intervention is adopted, poor aesthetic outcomes may occur. Early drainage has been especially described in otorhinolaryngology and radiology journals. The authors present an approach to early treating hematomas. Special emphasis is given to the use of hyaluronidase, which is well known by dermatologists and plastic surgeons for its ability to dissolve hyaluronic acid, but its utility in the treatment of hematomas is not so commonly known by these experts.

Complicações vasculares dos preenchimentos faciais com ácido hialurônico: confecção de protocolo de prevenção e tratamento / Vascular complications from facial fillers with hyaluronic acid: preparation of a prevention and treatment protocol

Introdução: Ao longo das últimas duas décadas, houve um avanço exponencial no tratamento dos sinais causados pelo envelhecimento facial. A procura crescente por terapias menos invasivas estimulou a evolução dos biomateriais em direção ao produto ideal, buscando preencher os critérios de segurança, tais como biocompatibilidade e reversibilidade. O ácido hialurônico é o produto mais utilizado mundialmente para preenchimento facial, sendo rotineiro nos consultórios de cirurgia plástica. Mesmo com baixos índices de complicações, é prudente que o cirurgião plástico esteja atento aos sinais de oclusão vascular, pois a interrupção da evolução em direção à necrose e sequela permanente depende da rápida atuação médica. Sendo assim, o nosso serviço vislumbrou a necessidade da confecção de um protocolo de prevenção e tratamento, uma vez que tais intercorrências são graves e algumas vezes até mesmo irreversíveis. Métodos: Revisão sistemática da literatura entre janeiro de 2003 a janeiro de 2018, utilizando descritores de complicações vasculares após preenchimento facial com AH e o respectivo tratamento. Resultados: O preenchimento com AH apresenta baixo potencial de complicação quando realizado por profissionais habilitados. A hialuronidase, atualmente utilizada off-label, é capaz de hidrolisar o ácido hialurônico, mesmo na sua forma cross-linked. Se utilizada corretamente em tempo hábil, pode tratar possíveis complicações vasculares que naturalmente evoluiriam para danos irreversíveis. Para tanto, confeccionamos um protocolo de tratamento à luz das evidências atuais. Conclusão: Todo cirurgião plástico que atua com preenchimentos e ácido hialurônico, deve ter em mãos um protocolo e o material necessário para intervenção precoce.

Introduction: Over the past two decades, there has been an exponential advancement in treating signs of facial aging. The growing demand for less invasive therapies has stimulated the development of biomaterials toward better products, seeking to fulfill safety criteria, such as biocompatibility and reversibility. Hyaluronic acid (HA) is the most widely used facial filler worldwide, being routine in plastic surgery clinics. Even with low complication rates, it is prudent for the plastic surgeon to be attentive to the signs of vascular occlusion because the interruption of the progression towards necrosis and permanent sequelae depends on rapid medical action. Thus, our service saw the need to create a prevention and treatment protocol, since such complications are serious and sometimes even irreversible. Methods: A systematic review of the literature was conducted from January 2003 to January 2018, using descriptors of vascular complications after facial filling with HA and its treatment. Results: Filling with HA presents a low potential for complications when performed by qualified professionals. Hyaluronidase, which is currently used offlabel, can hydrolyze HA, even in its cross-linked form. If used correctly in a timely manner, it can treat possible vascular complications that would progress to irreversible damage. Accordingly, we prepared a treatment protocol given the current evidence. Conclusion: Every plastic surgeon who works with fillers and HA must have a protocol and be aware of the necessary material for early intervention.

Late hyaluronidase injection in local anesthesia: Morphofunctional evaluation in rat sciatic nerve block.

INTRODUCTION: Despite the enhancing effects of hyaluronidase (HYAL) over duration of anesthesia, this enzyme could cause adverse effects when injected concomitantly with local anesthetics in dental blocks. OBJECTIVE: This study aimed to assess the tissue alterations caused by a local anesthetic protocol consisting of a late HYAL injection and confirm its functional effectiveness. MATERIALS AND METHODS: The protocol efficacy was proved by evaluating sensory and motor functions in rats. The sciatic nerve was blocked with 2% lidocaine (LID) with epinephrine (n = 25). Thirty minutes later, 75 TRU/ml HYAL was injected into the same site (experimental group, LID/HYAL). One week later, this protocol was repeated in the contralateral hindlimb, injecting only HYAL's vehicle (control group, LID/vehicle [LID/V]). To observe the integrity of the local tissues, histological specimens were obtained 1, 24, 48, and 72 h after treatment with LID/HYAL or LID/V (n = 16 each) and stained with hematoxylin/eosin and picrosirius red. RESULTS: Local inflammation was similar in both groups. The integrity of the nerve fibers was preserved, in spite of some inflammation-associated injuries in the surrounding tissues. The reversible tissue disorganization caused by HYAL, probably facilitated the diffusion of the residual anesthetic to the nerve, resulting in a prolonged anesthetic effect (P < 0.05). CONCLUSIONS: No irreversible morphological alterations are caused by the administration of HYAL prior the end of the LID-induced block. Moreover, this protocol prolongs LID's anesthetic effect.

A new scenario of bioprospecting of Hymenoptera venoms through proteomic approach

Venoms represent a huge and essentially unexplored reservoir of bioactive components that may cure diseases that do not respond to currently available therapies. This review select advances reported in the literature from 2000 to the present about the new scenario of Hymenoptera venom composition. On account of new technologies in the proteomic approach, which presents high resolution and sensitivity, the combination of developments in new instruments, fragmentation methods, strategic analysis, and mass spectrometry have become indispensable tools for interrogation of protein expression, molecule interaction, and post- translational modifications. Thus, the biochemical characterization of Hymenoptera venom has become a major subject of research in the area of allergy and immunology, in which proteomics has been an excellent alternative to assist the development of more specific extracts for diagnosis and treatment of hypersensitive patients to Hymenoptera venoms.

A new scenario of bioprospecting of Hymenoptera venoms through proteomic approach

Venoms represent a huge and essentially unexplored reservoir of bioactive components that may cure diseases that do not respond to currently available therapies. This review select advances reported in the literature from 2000 to the present about the new scenario of Hymenoptera venom composition. On account of new technologies in the proteomic approach, which presents high resolution and sensitivity, the combination of developments in new instruments, fragmentation methods, strategic analysis, and mass spectrometry have become indispensable tools for interrogation of protein expression, molecule interaction, and post- translational modifications. Thus, the biochemical characterization of Hymenoptera venom has become a major subject of research in the area of allergy and immunology, in which proteomics has been an excellent alternative to assist the development of more specific extracts for diagnosis and treatment of hypersensitive patients to Hymenoptera venoms.(AU)