Superselective Internal Pudendal Artery Thrombolytic Therapy Combined With Concentrated Growth Factor for Hyaluronic Acid Embolization After Vulvovaginal Rejuvenation: A Case Report and Review of Literature.

Abstract

Background: Vulvovaginal rejuvenation procedures are increasingly popular. Hyaluronic acid (HA) filler injection, a significant representative of non-surgical method, can cause a rare but serious complication: vascular embolism. Mild cases may present as skin necrosis and ulceration, while severe cases can be life-threatening.

Methods: The possible complications caused by vulvovaginal injection of hyaluronic acid were systematically reviewed. A 47-year-old Asian woman underwent a vulvovaginal rejuvenation procedure with HA fillers for labia majora, labia minora, and vaginal rejuvenation. She experienced a vascular occlusion event characterized by severe pain and necrotic skin ulceration. 7 days after the HA injection, she received superselective intra-arterial thrombolysis. Necrotic wounds were treated with CGF via topical application and local injection.

Results: Three cases of vascular complications have been reported previously. This paper describes the fourth. After immediate intra-arterial thrombolytic therapy (IATT), angiography showed improved blood supply in the right internal pudendal artery. The patient's severe pain was relieved, and the necrosis was under control. The patient achieved complete wound healing within 5 days following CGF treatment and was subsequently discharged from the hospital.

Conclusion: Serious vascular embolic events can be caused by hyaluronic acid injection for vulvovaginal rejuvenation, which can be treated with superselective IATT. For wound repair resulting from compromised skin perfusion caused by HA injection, CGF therapy offers a viable alternative.

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