title: Intravenous Hyaluronidase with Urokinase as Treatment for Arterial Hyaluronic Acid Embolism.
abstract: BACKGROUND
  Although injection of hyaluronidase into surrounding tissues was proposed to treat arterial hyaluronic acid embolism, its application is still rather limited. The authors' goal was to investigate whether intravenous use of hyaluronidase can help resolve hyaluronic acid-induced arterial embolism.
  
  
  METHODS
  Inferior epigastric arteries, nourishing inferior abdominal skin of rats, were injected with 0.02 ml of hyaluronic acid to create the animal model. The rats were divided randomly into four groups and given different solutions intravenously: hyaluronidase plus urokinase (group A), hyaluronidase (group B), urokinase (group C), or saline (group D). Progression of tissue necrosis in all groups was recorded for 1 week. The flap survival rate and mean percentage of surviving flap area were analyzed.
  
  
  RESULTS
  The animal model closely imitated actual hyaluronic acid arterial obstruction cases. Flap necrosis occurrence rates of each group were 10 percent in group A, 70 percent in group B, 80 percent in group C, and 90 percent in group D. The mean surviving flap areas of each group were 92.45 percent (group A), 47.67 percent (group B), 41.41 percent (group C), and 33.19 percent (group D). When hyaluronidase and urokinase were used together, the flap necrosis rate decreased significantly compared with that of the control group (p < 0.05). Even in cases of necrosis, group A had a higher average surviving flap area than did the other groups.
  
  
  CONCLUSIONS
  Combined use of hyaluronidase and urokinase can help increase the flap survival rate when administered intravenously in intraarterial hyaluronic acid occlusion cases. Both red thrombus and hyaluronic acid emboli must be dissolved for flap reperfusion. This method shows a promising effect for future application.
authors.affiliation: Shanghai, People's Republic of China From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, affiliated to the School of Medicine, Shanghai Jiao Tong University.
authors.forename: ChengAn
authors.initials: C
authors.lastname: Chiang
authors.forename: ShuangBai
authors.initials: S
authors.lastname: Zhou
authors.forename: Kai
authors.initials: K
authors.lastname: Liu
mesh_terms: D000818:Animals; D016009:Chi-Square Distribution; D004195:Disease Models, Animal; D004359:Drug Therapy, Combination; D004617:Embolism / Q000139:chemically induced / Q000188:drug therapy*; D019074:Epigastric Arteries / Q000187:drug effects* / Q000473:pathology; D006085:Graft Survival; D006820:Hyaluronic Acid / Q000009:adverse effects* / Q000494:pharmacology; D006821:Hyaluronoglucosaminidase / Q000494:pharmacology*; D007275:Injections, Intravenous; D008297:Male; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D015424:Reperfusion; D013524:Surgical Flaps / Q000098:blood supply*; D014568:Urokinase-Type Plasminogen Activator / Q000494:pharmacology*
chemical_list: D006820:Hyaluronic Acid; D006821:Hyaluronoglucosaminidase; D014568:Urokinase-Type Plasminogen Activator