Hyaluronidase injection for the treatment of facial and neck hematomas

Treatment of post-traumatic hematoma and fibrosis using hyaluronidase injection

“…Therefore, a more aggressive treatment is needed when hematoma is confirmed. Various methods have been tried to treat hematoma and fibrosis caused by trauma; however, no effective method have been identified [ 1 ]. Herewith, we report observing significant improvements in a patient with hematoma and another patient with fibrosis by hyaluronidase injection.…”

“…Hyaluronidase has been shown to break down hyaluronic acid, which is the ground substance of the connective tissue, by separating 1,4-glucosaminidic bond between C1 and the glucosamine moiety and C4 of the glucuronic acid [ 3 ]. Treatment with hyaluronidase is effective owing to increases in the diffusion and absorption rate, which in turn, increases the intercellular permeability [ 1 , 4 , 5 ]. No complications were observed after treatment with hyaluronidase.…”

“…We injected hyaluronidase directly into the fibrosis site, and it degraded hyaluronic acid to lower the concentration of the intercellular ground substance [ 1 ], hence improving the status of pain, pliability and stiffness on the fibrosis site. The improvement of fibrosis may be due to physical dissection by the needle itself during injecting hyaluronidase by the crisscross method which results in an increase in the spacing between the fibrotic tissues, and hence, the improvement of fibrosis.…”

“…To minimize needle-induced adhesiolysis, we used the thinnest needle (30-gauge needle). Injection of hyaluronidase into the fibrotic scar lesion was effective in improving the pliability, height, and pigmentation of the fibrotic lesions by breaking down the ground substance of the connective tissue [ 1 ].…”

“…Especially, hematoma develops often after facial contusion in patients taking anticoagulants, such as aspirin, clopidogrel, and warfarin for the prevention or treatment of heart or cerebrovascular disease, and unfortunately, conservative methods have their limitations. Hyaluronidase has the ability to break down the hyaluronic acid, facilitating the absorption of hematomas and edema through peripheral lymphatic channels and capillaries while the local intercellular permeability increase [ 1 , 2 ]. We report one case of hematoma and another case of fibrosis in which the patient’s clinical condition improved after administration of a hyaluronidase injection for the early treatment of hematoma or fibrosis after facial trauma.…”