Скачать или смотреть Leeches and Ischemia Part 2

Leeches and ischemia Part 2.

This is only one case report, but I think that it sheds some light into what happens when we get ischemia and necrosis with facial filler injections. We know that when we get an embolic vascular occlusion, a quantity of filler gets inside an artery and obstructs blood flow, but there’s two schools of thought about how that happens. Does the filler stay in a clump and then travel down until it obstructs an arterial branch denting blood flow to all of the tissue that this branch supplies, or does it break up into a million little micro emboli and obstruct blood flow in a bunch of capillaries? I think that both situations happen, but this case illustrates that it's probably the micro emboli scenario that happens more often. My surgical experience suggests this as well, since we would cut and tie off arterial branches all of the time without ever seeing an incident of blood flow issues to the skin.
In this case, the leech was anti coagulating very locally at the skin and we saw almost instant resolution of ischemia. This would not have happened if the obstruction was further up in a big branch.

I would love to see more research on the topic, but I think  this case suggests that, in treating ischemia and impending necrosis, it may be more fruitful to focus on treating the blood flow issues at the skin rather than trying to find a large obstruction higher up in the arterial tree.

Does that make sense? Let me know in the comments.


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