Adverse reactions to injectable soft tissue permanent fillers
Adverse reactions to injectable soft tissue permanent fillers
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DOI：
10.1007/s00266-004-0113-6
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发表时间：
2005-01-01
影响因子：
2.4
通讯作者：
Hogdall, E
中科院分区：
文献类型：
--
作者：
Christensen, L;Breiting, V;Hogdall, E
背景：具有永久效果的合成注射面部填充剂广泛无毒且无免疫原性，但它们在成分以及化学和生物特性方面有所不同。然而，它们都在组织中充当异物，引发宿主反应，试图去除凝胶。注射部位可能会出现炎症结节——对于某些填充剂来说，多年后可能会出现，而对于另一些填充剂则不会。为什么会这样？ 方法：根据国际大会和研讨会的要求，来自欧洲和澳大利亚的多位整形外科医生提供了活组织检查。该研究基于 (a) 注射聚丙烯酰胺水凝胶 (Aquamid) 后不同时间获得的 5 个未反应组织的活检； (b) 注射聚丙烯酰胺水凝胶（Aquamid）（20 例）、透明质酸-聚甲基丙烯酸羟乙酯/甲基丙烯酸乙酯凝胶（Dermalive）（2 例）和聚乳酸甘露醇/甲氧甲纤维素凝胶（New-Fill）（6 例）后，对中期或晚期炎症结节进行 28 个活检； (c) 对注射永久性填充剂后不良反应的文献进行回顾。结果：注射 Aquamid 后临床上无反应的组织显示出轻微或无宿主反应。注射 Aquamid 后，炎性结节表现出异物反应增加和细菌感染，注射 Dermalive 和 New-Fill 后出现中度异物反应、纤维化，在某些情况下还出现细菌感染。据文献报道，炎性结节在注射聚丙烯酰胺水凝胶后不晚于1年出现，但在注射组合凝胶(Artecol)后最长可达6年，注射硅凝胶后可达28年。结论：炎性结节很可能是由疏水性硅凝胶和组合凝胶周围的生物膜内维持的低度感染引起的。 Aquamid 凝胶可以通过其高水结合能力来防止生物膜的形成，这解释了为什么注射这种聚丙烯酰胺水凝胶产品后没有看到晚期炎症结节。
Background: Synthetic injectable facial fillers with a permanent effect are widely atoxic and nonimmunogenic, but they differ with respect to composition and in chemical and biologic characteristics. Yet, they all act as foreign bodies in the tissues eliciting a host response that try to remove the gel. Inflammatory nodules may develop at the sites of injection-for some fillers, many years later, for others, not. Why is thatMethods: Biopsies were contributed by various plastic surgeons from Europe and Australia after requests were made at international congresses and workshops. The study was based on (a) 5 biopsies from unreactive tissue obtained at different times after injection of polyacrylamide hydrogel (Aquamid); (b) 28 biopsies from intermediate or late inflammatory nodules after injection of polyacrylamide hydrogel (Aquamid) (20 cases), a hyaluronic acid-poly-hydroxyethylmethacrylate/ethylmethacrylate gel (Dermalive) (2 cases), and a gel consisting of polylactic acid in mannitol/carbomethoxycellulose (New-Fill) (6 cases); and (c) a review of the literature on adverse reactions after injection with permanent fillers.Results: Clinically unreactive tissues after injection with Aquamid showed modest or no host reaction. Inflammatory nodules showed an increased foreign body reaction and a bacterial infection after injection with Aquamid, and a combination of moderate foreign body reaction, fibrosis, and in some cases also bacterial infection after injection with Dermalive and New-Fill. According to the literature, inflammatory nodules occur no later than 1 year after injection with polyacrylamide hydrogel, but up to 6 years after injection of combination gels (Artecol), and up to 28 years after injection of silicone gel.Conclusions: Inflammatory nodules are likely to be caused by a low-grade infection maintained within a biogfilm surrounding the hydrophobic silicone gel and the combination gels. Aquamid gel may prevent formation of a biofilm through its high water-binding capacity, explaining why late inflammatory nodules are not seen after injection of this polyacrylamide hydrogel product.