Will necrosis caused by sclerotherapy heal without debridement? (Photo)

Question

My derm over injected my vein causeing it to explode & the sclerotherapy solution got under my skin. He didn't tell me any of this at the time. He injected me w/ another injection after returning to the room 20 min later. I asked what he was putting in my leg & he said an anti inflammatory to keep the swelling down. Told me I may get a little skin break in a week and to put a bandaid over it. A week later the area was black and felt like leather. Then shortly after that, the area became concaved

Hratch Karamanoukian, MD, FACS · Answer

It is likely that he injected hyaluronidase. I think he was diluting the sclerosant that extravasated into your subQ tissue.Most likely he used hypertonic saline. H Karamanoukian MD FCS
certified vein specialist from ABVLM and double board certified surgeon
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W.Y. Chung, MD · Answer

It is unfortunate that this has occurred. The complication rates for sclerotherapy are quite low.  However, the type of solution used, the concentration of the solution, and the experience of the injector can all factor in to the likelihood of ulceration to occur. The skin will eventually heal over time but a scar will remain.I would recommend laser resurfacing of the scar after adequate healing.

Aaron Shiloh, MD · Answer

I'm so sorry you are experiencing this unfortunate issue.   What type of sclerotic agent was used and at what concentration is really important.  For spider veins, I don't use anything stronger than .25% asclera or STS because it is inevitable that some product will end up under the skin.  It seems to me that the necrotic tissue is slowly healing and will eventually completely heal on its own but will likely leave a scar.  Good luck!

Alix J. Charles, MD · Answer

Thanks for your question, and I'm sorry to see you suffered this complication. Ulcers like these can happen in 1-2% of patients who undergo sclerotherapy, and can happen for a number of reasons. When I encounter these I generally do not debride them. Rather we have the patient keep the area moist so that it heals appropriately and may even give them a special wound healing ointment like Biafine.  It does typically heal with a scar, and if this is unsightly you may be able to make the scar look better with laser resurfacing treatments. Best of luck to you!

Ivan Brooks, MD · Answer

This is a skin breakdown from extravascular injection of sclerosing agent in the dermal layer.  It should heal on its own over time but a scar defect may result.  It is important to keep the area clean and infection free.  Neosporin or Bacitracin ointment can be applied over the ulceration and I would avoid excessive sun exposure.  There are other healing agents that many dermatologist offer to help with scarring.

John Landi, MD · Answer

Your pictures show a post sclerotherapy ulcer. You can treat this by waiting for the scab to fall off on its own and this will take a long time or by debridemont of the scar which will result in more rapid healing.  I prefer removing the scab and then applying a topical agent to the area to heal it.

Will necrosis caused by sclerotherapy heal without debridement? (Photo)

Answers (6)

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