Structured Training of Dermatology Residents in the Management of Soft-Tissue Filler-Induced Vascular Complications

Soft-tissue filler injection-related vascular complications (IRVC) can lead to tissue necrosis, vision loss, and stroke. Hyaluronidase-based injections are the mainstay of treatment, though other options include heat, massage, nitroglycerin, and anticoagulants. Given the narrow therapeutic window and limited early warning signs, we propose training residents to implement a standardized soft-tissue filler vascular complication (SFVC) management protocol.

This study aims to address gaps in procedural knowledge by providing residents with a lecture series followed by a hands-on cadaveric practice session.

An SFVC management protocol was developed based upon a literature review and expert opinion. Didactic instruction and practice sessions with cadavers were conducted with residents at an academic dermatology program. All resident trainees took a survey assessing their knowledge and satisfaction with the quality of training.

Thirteen residents were included in this study. Overall, the aggregate confidence score for recognizing vascular events, acute management of filler complications, and performance of procedures after hands-on simulation on cadavers significantly increased between pre- and post-surveys (P<0.001).

Our intervention successfully demonstrated increased confidence among residents regarding the key components of SFVC, namely, in recognizing the signs and symptoms, managing an acute event, and finally, in performing advanced procedures for SFVC.