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Arterial Wall Penetration Forces in Needles versus Cannulas

Pavicic, Tatjana, M.D.; Webb, Katherine L.; Frank, Konstantin, M.D.; Gotkin, Robert H., M.D.; Tamura, Bhertha, M.D.; Cotofana, Sebastian, M.D., Ph.D.

Plastic and Reconstructive Surgery: March 2019 - Volume 143 - Issue 3 - p 504e-512e
doi: 10.1097/PRS.0000000000005321
Cosmetic: Original Articles
Patient Safety CME

Background: If safety is defined as the diminished ability to penetrate facial arteries, the goal of this study was to investigate whether different-sized cannulas are safer than correspondingly sized needles for the application of facial soft-tissue fillers.

Methods: Two hundred ninety-four penetration procedures of the facial and superficial temporal arteries were performed in four fresh frozen cephalic specimens using both needles (20-, 22-, 25-, and 27-gauge) and cannulas (22-, 25-, and 27-gauge). Continuously increasing force was applied and measured until intraarterial penetration occurred.

Results: No statistically significant differences were detected when comparing forces required to penetrate the facial arterial vasculature between different sexes, arteries, or sides of the face (all p > 0.05). Forces needed to penetrate significantly (p < 0.001) decreased with smaller diameter needles (20-gauge, 1.12 ± 0.29 N; 22-gauge, 1.08 ± 0.25 N; 25-gauge, 0.69 ± 0.24 N; and 27-gauge, 0.70 ± 0.29 N) and in cannulas (22-gauge, 1.50 ± 0.31 N; 25-gauge, 1.04 ± 0.36 N; and 27-gauge, 0.78 ± 0.35 N). Comparing 27-gauge injectors, no statistically significant difference was detected between needles and cannulas; an artery could be penetrated with a similar force independent of whether the injector was a needle or a cannula (0.70 ± 0.29 N versus 0.78 ± 0.35 N; p = 0.558).

Conclusions: Cannulas, in all measured sizes except 27-gauge, required greater forces for intraarterial penetration compared with correspondingly sized needles, confirming the safety of 22- and 25-gauge cannulas; 27-gauge cannulas, however, required similar forces as 27-gauge needles, indicating that 27-gauge cannulas are not safer than 27-gauge needles.


Patient Safety CME.

Munich, Germany; Albany and New York, N.Y.; and Sao Paulo, Brazil

From private practice and the Department for Hand, Plastic and Aesthetic Surgery, Ludwig Maximilian University; the Department of Medical Education, Albany Medical College; private practice; and Medical School General Hospital, University of Sao Paulo.

Received for publication May 2, 2018; accepted August 21, 2018.

Disclosure:None of the authors has any commercial associations or financial disclosures that might pose or create a conflict of interest with the methods applied or the results presented in this article.

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Sebastian Cotofana, M.D., Ph.D., Albany Medical College, 47 New Scotland Avenue, MC-135, Albany, N.Y. 12208,, Instagram: @professorsebastiancotofana, Facebook: professorsebastiancotofana

Copyright © 2018 by the American Society of Plastic Surgeons