Skin necrosis following sclerotherapy. Part 2: Risk minimisation and management strategies

Area of Science:

• Vascular Surgery
• Dermatology
• Medical Complications

Background:

• Tissue necrosis is a rare but serious complication following sclerotherapy.
• Early detection and management are vital to prevent severe outcomes.
• This paper focuses on risk minimization and treatment strategies, following a review of pathogenic mechanisms.

Purpose of the Study:

• To outline strategies for minimizing the risk of tissue necrosis post-sclerotherapy.
• To describe management approaches for post-sclerotherapy tissue necrosis.
• To highlight the importance of addressing both treatment-related and patient-specific risk factors.

Main Methods:

• Review of risk factors associated with sclerotherapy, including sclerosant type, concentration, volume, injection technique, and anatomical location.
• Identification of patient-specific risk factors requiring pre-operative optimization.
• Discussion of proposed treatments for extravasation of irritant sclerosants and inadvertent intra-arterial injections.
• Outline of management protocols for veno-arteriolar reflex vasospasm (VAR-VAS) necrosis.

Main Results:

• Necrosis risk is influenced by treatment factors (sclerosant choice, technique) and patient factors.
• Extravasation of irritant sclerosants poses a higher risk than foam sclerosants.
• Proposed treatments for complications include fluid infiltration, hyaluronidase, systemic steroids, anticoagulation, and thrombolysis.
• Current treatments are largely anecdotal; prevention is key as reversal of established necrosis is difficult.

Conclusions:

• Addressing modifiable risk factors pre-operatively is essential for preventing sclerotherapy-induced necrosis.
• Prompt and appropriate management of complications like extravasation and intra-arterial injection is critical.
• Long-term care involves managing comorbidities, infections, and utilizing compression and specialized dressings for ulcer healing.