Hyaluronic Acid-based Fillers for Facial Rehabilitation in Inherited Neuropath.

Charcot-Marie-Tooth (CMT) disease is the most prevalent inherited neuromuscular disorder. It commonly leads to various musculoskeletal deformities, profoundly impacting the quality of life. The present case report explores the often under-recognized body image dissatisfaction in CMT, highlighting the potential benefits of a multidisciplinary approach to enhance aesthetic satisfaction. We present a case of a 54-year-old woman with CMT, who experienced chronic facial asymmetry, significantly impairing her quality of life. Seeking cosmetic enhancement, she underwent two sessions of facial treatment using hyaluronic acid-based fillers. The first session focused on correcting right mandibular hypoplasia and other facial asymmetries, whereas the second session focused on enhancing perioral aesthetics. The treatment resulted in significant aesthetic improvements, as demonstrated by high ratings in both the Physician Global Aesthetic Improvement Scale and the Subject Global Aesthetic Improvement Scale. Besides, there was a marked reduction in lip corner asymmetry, the patient's primary concern. The role of hyaluronic acid fillers in facial aesthetic enhancement is well established, and their application in the context of CMT is a promising under-investigated field, to our knowledge. This case study highlights the importance of considering body image in CMT patients and suggests that minimally invasive aesthetic procedures can be a valuable addition to the multidisciplinary care of patients with inherited neurological disorders. Despite being a single-case study, the significant improvement in the patient's aesthetic satisfaction requires further research in this field.

Resolve and dissolve-An ultrasound-guided investigation on the effects of hyaluronidase on different soft tissue fillers.

BACKGROUND: Nonsurgical cosmetic procedures, particularly the use of hyaluronic acid (HA)-based soft tissue fillers, are becoming increasingly popular. This trend has catalyzed the development of a plethora of HA-based products differing in product characteristics, thereby catering to an ever-widening spectrum of aesthetic applications. However, complications rise concomitant with the increasing number of procedures. Among the strategies to manage such adverse events is the enzymatic breakdown with hyaluronidase. OBJECTIVE: To analyze the response of different HA-based soft tissue filler materials to hyaluronidase injections. METHODS: A total of 11 different HA-based soft tissue fillers were evaluated using noninvasive ultrasound imaging to assess their behavior in response to hyaluronidase injections. The HA-based soft tissue fillers were categorized according to their product characteristics into a structuring, volumizing, and lip volumizing group. Standardized injections of 0.2 cc were performed in chicken breast to simulate human tissue. Ultrasound measurements of width, height, and calculated volume were performed immediately after filler injection, 1 h and 24 h following hyaluronidase injection. RESULTS: Regardless of the soft tissue filler analyzed, the most significant volume reduction occurred within the first h after applying hyaluronidase, with a 64.1% decrease from the initial volume. After 24 h, the total volume reduction reached 81.7%. No statistically significant differences were found when comparing the three groups at each follow-up time period, except for the height measurement after 1 h. While width was statistically significant in all groups between the investigated follow-up groups, the volume reduction was only statistically significant in the groups with the highest and second highest G' values (i.e., Group 1-structuring, Group 2-volumizing). CONCLUSION: The effectiveness of hyaluronidase in dissolving HA-based fillers is initially independent of product characteristics of HA-based fillers such as G-prime, with increased efficacy in fillers with higher G-prime values, as evidenced by significant volume reductions in such groups.

Dermal Thickness Increase and Aesthetic Improvement with Hybrid Product Combining Hyaluronic Acid and Calcium Hydroxyapatite: A Clinical and Sonographic Analysis.

Hyaluronic acid filler injections are regarded as the gold standard procedure for facial rejuvenation. Standing as the second most injected cosmetic filler, calcium hydroxyapatite-based fillers are also widely used worldwide. However, to our knowledge, prospective studies assessing patient satisfaction and sonographic changes in dermal thickness after a single session of a hybrid filler combining hyaluronic acid and calcium hydroxyapatite have not been previously published. Methods: This was a single-center, prospective, quasi-experimental study comprising 15 participants between 32 and 63 years of age. Each participant received a single-session treatment based on facial subcutaneous injections of HArmonyCa, a hybrid combination filler comprising hyaluronic acid and calcium hydroxyapatite. This study involved an intrapatient control design and a 120-day follow-up with clinical and sonographic assessment. For this purpose, standardized photographic images, high-frequency ultrasound evaluations, and physician- and patient-oriented overall aesthetic improvement scores were recorded at 0, 30, 90, and 120 following the procedure. Results: According to our findings, 20% of the subjects had an exceptional improvement; 20%, "very improved"; and 60%, "improved." Intrapatient sonographic comparison showed a significant increase in dermal thickness, at 90 and 120 days, only on the side treated (P < 0.001). Conclusion: In our clinical study, a single-session treatment with a hybrid product combining hyaluronic acid and calcium hydroxyapatite resulted in positive cosmetic satisfaction and increased dermal thickness.

Biosensing strategies for the detection of SARS-CoV-2 nucleic acids.

The COVID-19 pandemic had devastating effects throughout the world, producing a severe crisis in the health systems and in the economy of a long list of countries, even developed ones. Therefore, highly sensitive and selective analytical bioplatforms that allow the descentralized and fast detection of the severe acute respiratory síndrome coronavirus 2 (SARS-CoV-2), are extremely necessary. Since 2020, several reviews have been published, most of them focused on the different strategies to detect the SARS-CoV-2, either from RNA, viral proteins or host antibodies produced due to the presence of the virus. In this review, the most relevant biosensors for the detection of SARS-CoV-2 RNA are particularly addressed, with special emphasis on the discussion of the biorecognition layers and the different schemes for transducing the hybridization event.

How were modified the human anatomy study habits during and after confinement by the COVID-19 pandemic? / ¿Cómo se modificaron los hábitos de estudio en anatomía humana durante y después del confinamiento por la pandemia del COVID-19?

SUMMARY: During 2020 and 2021 the anatomy subject was developed by online classes. In 2022, face-to-face teaching activities were resumed. The objective was to compare the autonomous study habits of two student generations that coursed the Human Anatomy subject in online and face-to-face mode. Two groups of students were asked to fill-out an online questionnaire. Online Generation (OL) (n=185) and Face-to-face Generation (FF) (n=154). The difference between both groups was the learning activities. OL received only online classes, and FF received theoretical classes and laboratory activities in face-to-face sessions. The most of OL subjects had greater clarity about the contents (71.9 %) and the depth (50.8 %) that they should study them, in contrast with FF (58.4 %, p = 0.0124 and 24.7 %, p < 0.0001 respectively). In OL, 47 % spent more than 4 hours weekly studying human anatomy, whereas in FF 68.2 % (p<0.0001). In both groups, the most important resource was the Video Recorded Classes (90.8 % in OL, and 83.1 % in FF). For OL, the three priority resources were exclusively electronic: 1) Video Recorded Classes, 2) Apps on smartphone or tablets, and 3) Apps on laptop or computer. FF generation prioritized: 1) Video Recorded Classes, 2) Anatomy Atlas, and 3) Class Slides. During the COVID-19 pandemic, the students that received only online classes were able to plain their study time in a better way than whose were in face-to-face classes. However, they spent less time to study the topics. In addition, it was possible to determine that students prefer digital resources (video classes recorded and apps in smartphone or computer) over traditional resources such as textbook and anatomy atlas. It proposes to consider these results in the Human Anatomy subjects design, in virtual or face-to-face mode.

Durante 2020 y 2021, la asignatura de anatomía fue desarrollada exclusivamente en modalidad online. En 2022 se retomaron las clases presenciales. El objetivo de este estudio fue comparar los hábitos de estudio autónomo de dos generaciones de estudiantes de anatomía. Dos grupos de estudiantes completaron un cuestionario online: Generación Online (OL) (n=185) y Generación Presencial (FF) (n=154). La principal diferencia entre ellos fue que OL recibió clases exclusivamente en modalidad online y FF exclusivamente presencial. La mayoría de los sujetos de OL tuvieron mayor claridad acerca de los contenidos (71,9 %) y la profundidad con que debían estudiarlos (50,8 %) en contraste con FF (58,4 %, p = 0,0124 and 24,7 %, p < 0,0001, respectivamente). En OL, el 47 % empleó más de 4 horas semanales de estudio, mientras en FF fue el 68,2 % (p<0.0001). En ambos grupos, el recurso más importante empleado fue la clase grabada (90,8 % en OL y 83,1 % en FF). Para OL la prioridad en el uso de los recursos de estudio fueron 1) Videoclase grabada, 2) Aplicación en teléfono o tablet y 3) Aplicación en computador. Para FF el orden de prioridad fue 1) Videoclase grabada, 2) Atlas de Anatomía y 3) Diapositivas de clases. Durante la pandemia de COVID-19, los estudiantes que recibieron exclusivamente clases online planearon su tiempo de estudio de mejor manera que quienes tuvieron clases presenciales y emplearon menos tiempo de estudio. Además, fue posible determinar que los estudiantes prefieren recursos de información digital (Videoclase Grabada y aplicaciones para teléfono celular o computador) por sobre los recursos tradicionales tales como texto y atlas de anatomía. Se propone considerar estos resultados en el diseño de los programas de asignatura de Anatomía Humana, a impartir en modalidad online o presencial.

Cómo clasificar llanto del recién nacido mediante una red neuronal supervisada / How to classify newborn cry through a supervised neural network

El llanto es una vía de comunicación del recién nacido con el medio circundante. Investigaciones acerca del llanto infantil han correlacionado características acústicas de éste con patologías, demostrándose que el llanto puede reflejar la integridad neurofisiológica del niño y dar una medida de su interacción con el ambiente y su desarrollo cognitivo y social. Esta contribución muestra cómo clasificar el llanto de neonatos con hipoxia y de un grupo de control, en normal o patológico, a través de una red neuronal artificial supervisada. Para implementar la red neuronal se aprovechan las posibilidades de la plataforma MATLAB®. El diseño y estructuración de la red considera algoritmo de aprendizaje o entrenamiento, iteraciones, pruebas e intervalos de clasificación, obteniéndose arquitectura y topología, y funcionalidades de la red neuronal que en la generalización proporciona la mejor clasificación. En el trabajo se aplica el método de selección de casos, el método acústico para extraer parámetros cuantitativos de la señal de llanto en tiempo, intensidad y frecuencia, así como métodos vinculados con el diseño, implementación y validación, con pruebas diagnósticas, de la red neuronal artificial obtenida para cumplir el objetivo del trabajo que es la generación de clases (clasificación del llanto). Con precisión del resultado de clasificación del 90 por ciento se está en condición de concebir una solución informática (agregando interfaz para interactuar con base de datos) para ayudar complementariamente al diagnóstico médico no invasivo usando el llanto del neonato provocado ante dolor(AU)

Cry from newborn (0-28 days) is a way of communication for the interaction with surrounding world. Infant cry researches provide information that correlate among cries acoustic features with pathologies. It has been demonstrated that the infant cry is able to reflect child neurophysiology integrity and give meaning from newborn interaction with environment, also cognitive and social development from child. This contribution shows how to classify the cry of neonates with hypoxia and of a control group, into normal or pathological, through a supervised artificial neural network. Network implementation makes use of MATLAB® platform possibilities. Design and structuring of network take into consideration aspects as training algorithm, iterations, tests and classification intervals. All these referred aspects give as result an architectural, topology and functionalities from neural network able to classify cry in generalization stage offering good outcome. Different methods are applied in this paper as selection of cases, acoustic methods in order to obtain quantitative parameters from cry signals (in time, intensity and frequency domain). Methods related with design, implementation and validation (diagnostic test) of an artificial neural network able to carry out the goal of this paper (classification of cry) are used. With accuracy results in cry classification about 90 percent, authors get ready conditions for an informatic solution (with addition of interface for data base interaction) for help as a non-invasive complement to medical diagnosis using cry from neonate induced by pain(AU)

A Retrospective Study Supporting the Importance of Individualizing the Dose of Botulinum Toxin According to the Age.

BACKGROUND: Botulinum toxin type A injection remains the leading nonsurgical cosmetic procedure worldwide with a high rate of efficacy and patient satisfaction. OBJECTIVE: This study aims to demonstrate the importance of individualization of botulinum toxin doses to treat the upper face according to the age of the patients, considering the muscles particularities and the specificities of each face area. MATERIALS AND METHODS: A retrospective study with 389 female patients treated with botulinum toxin type A in the upper third of the face (forehead, glabellar, and periorbital lines). Statistical analysis of the data was performed. RESULTS: The mean age was 47.49 years old and the median total dose of botulinum toxin type A was 53.76 units, whereas the median dose in the glabella was 26.28 U, the mean forehead dose was 12.23 U, and in the periorbital area was 14.79 U, adding both sides. It is possible to observe that the doses are negatively correlated with age, except in the periorbital area, where an increase in the dose was observed. CONCLUSION: It is important to highlight that although there is consensus on pre-established dose suggestions, the treatment should be individualized, respecting the individual characteristics of each patient.

Septal Ulcer After Nasal Filling with Hyaluronic Acid.

Nonsurgical rhinoplasty is a good treatment choice when surgery is not a viable option. However, serious complications, including blindness or cerebral ischemia, can occur given this area is one of external and internal carotid anastomosis. Here, we describe a case of a patient with a septum ulcer secondary to local ischemia postnasal fillling with hyaluronic acid without skin lesion. Due to the rarity of the condition, her diagnosis was made late, but she was treated with hyaluronidase and showed total resolution.

Analysis of the Columellar-Labial Angle in Perioral Aging.

BACKGROUND: The young face presents a convex and rounded aspect; with aging, this changes to a more concave and flattened aspect, with the angles of the face undergoing changes through soft tissue repositioning and bone remodeling. The columellar-labial angle is one of the features that change. OBJECTIVES: The objective of the present study was to analyze the columellar-labial angle at different stages of adult life and assess its contribution to facial changes during aging. METHODS: We analyzed a database (December 2017-March 2018) of 722 female patients, aged 21 to 88 years, and obtained anthropometric measurements of the columellar-labial angle with a Canfield Vectra 3D image analysis system. Our database originates from a private clinic where all patients were registered and photographed. RESULTS: Our analysis showed a decrease in the columellar-labial angle, mainly observed from patients aged 60 years and older. This decrease can be explained by the absorption of body structures that occurs during aging. CONCLUSIONS: The columellar-labial angle decreases with age, and this finding may provide a better understanding of the transformation that occurs with aging. Obtaining a clearer view of the changes that occur in the face will improve treatments for facial rejuvenation, either conservative or surgical, and provide a basis for future studies and knowledge expansion.

Ultrasound-guided poly-l-lactic acid nodule excision: The importance of the injector ultrasonographic experience.

The possibilities for facial and body treatments are wide, but when it comes to treatment for the cervical region, the options are more restricted and among them, the use of poly-l-lactic acid (PLLA) stands out. PLLA is used for collagen biostimulation and improvement of skin turgor with good results; however this procedure is not free of complications, and for the treatment of these, a correct diagnosis is essential. As it is esthetic medicine, the guarantee of results requires that complications are not tolerated, and thus, any resource that enriches the diagnostic and therapeutic arsenal is of great value. The objective of this study is to report the diagnosis of a PLLA nodule with the help of high-frequency ultrasound, establishing a clinical, radiological, and histopathological correlation, in a patient submitted to PLLA injection for esthetic improvement of the cervical region. We present a case in a female patient presenting a nodule in the cervical region after the application of PLLA, where we performed the excision guided by high-frequency ultrasound. Mastering the diagnostic technique with high-frequency ultrasound can play a valuable role in indicating early surgical exeresis, also contributing to complete patient care. It allows the application of the product, monitoring, diagnosis of the complication, and treatment to be carried out dynamically and precisely by the injector.

Effect of the aging process on columella-labial, naso-mental and facial angles and how to apply it in clinical practice.

BACKGROUD: Aging is the result of the interplay of changes occurring in the facial skeleton, ligaments, muscles, adipose tissue, and skin (1), and these changes befall each mentioned structure at a different pace, start in each individual at a different age, and differ between ethnic background. (4) It changes directly the measurements of the face angles, making the face more concave and flattened aspect, while the young face presents a more convex and rounded aspect. Female skulls had an increase in all transverse facial widths and depth of the middle face with increasing age. Therefore, aging is consequence of progressive changes through intrinsic and extrinsic factors (5) and different methods can be used to assess and diagnose these changes. AIMS: The aim of the study is to evaluate facial angles and their aging changes. METHODS: A retrospective study was performed with a total of 1213 Caucasian female patients in the author's private clinic. The angles evaluate age-related changes were analyzed: facial, naso-mental, and columella-labial angle. Photograph analysis program Vectra 3D (Canfield) was used to perform the anthropometric assessment of the angles, and after data collection, the analysis was performed statistics. RESULTS AND CONCLUSION: We could conclude angles analyzed change with age, while two angles increase (naso-mental and facial angle), the other decreases (columella-labial angle). The study reinforces the principle of an objective clinical anthropometric assessment of facial angles as a relevant guide for a more appropriate treatment plan for the doctor to perform aesthetic procedures in order to restore a youthful face.

Definition of the Mandibular Angle Using Botulinum Toxin Type A: A New Technique for the Improvement of Mandibular Contour and Definition.

While the injection of botulinum toxin type A (BoNTA) in the neck area, for face contouring through the blockade of the platysmal bundles, and in the mandibular body line has previously been explored, reports of its application for the demarcation of the mandibular angle are more limited. This article described a new technique of BoNTA injection in the mandibular angle for the improvement of contour and definition. At roughly 15 days after application in 30 patients, better visualization of the mandibular angle and its contours was evident and, consequently, smoothing of the appearance of sagging around the mandible with no adverse effects was noted. Further investigation of this technique is warranted.

Use of Hyaluronic Acid Fillers to Correct Scleral Show: A Review of Technique.

Generally, the shape of women's eyes are distinctly different in intercatal height from that in men. Ideally, in a woman, the lateral intercostal point is positioned above the medial intercostal point, which gives the eyes a cat-like appearance that culturally suggests youth and health. Because of aging and/or physiological changes, this area can be altered with the inversion of the lateral intercantal line lower than the medial intercantal line, producing a tired and/or sad looking appearance. Hyaluronic acid is a quick and safe method of elevating the lateral intercantal area of the eye. This article describes a technique for using hyaluronic acid for the treatment of scleral show.

Evaluation and Proportion in Nasal Filling with Hyaluronic Acid.

The nose is an essential feature when considering the aesthetic appeal of the face. As aesthetic preferences vary from person to person, the concept of the "ideal" nose must be applied on a case-by-case basis, with respect to the classical patterns of anthropometry, sex, ethnic group, and psychosocial factors. Interest in less invasive procedures for nasal correction has increased considerably, among which is the emerging use of hyaluronic acid for nonsurgical rhinoplasty. In this article, the authors present an objective review of the anatomy of the nasal region, the evaluation and indications of nasal filling with hyaluronic acid, a description of the technique, and brief discussion of associated complications.

Treatment of vascular lesions located in the lip and in the oral cavity with Nd:YAG laser.

Vascular lesions such as hemangiomas can be found in the oral cavity. Some therapeutic modalities can be used in the treatment of these lesions and Nd:YAG 1064 nm long pulse laser shows good results with easy application, fewer complications and satisfactory results. This study describes the technique and outcome of a case of hemangioma located on the tongue treated with Nd:YAG laser.

Tratamento de cicatriz de queimadura com luz intensa pulsada e laser ablativo fracionado Erbium: YAG / Treatment of burning scars with intense pulsed lip and fractionated ablative laser Erbium: YAG / Tratamiento de cicatrices por quemaduras con luz intensa pulsada y láser ablativo fraccionado Erbio: YAG

Cicatrizes decorrentes de queimadura acarretam grandes danos físicos e emocionais aos pacientes. Seu tratamento permanece um desafio na prática clínica. O uso atual de tecnologias a laser e luz, como o laser ablativo fracionado e a luz intensa pulsada (LIP), tem se mostrado eficaz na recuperação estética e funcional da pele acometida. Este trabalho tem por objetivo a demonstração do resultado do tratamento de cicatriz de queimadura extensa com LIP e laser ablativo fracionado Erbium: YAG a partir do relato de caso de uma paciente de 38 anos vítima de queimadura por chama direta aos 6 anos de idade. A paciente apresentou melhora clínica significativa no aspecto estético e funcional da lesão. O uso desses métodos combinados apresenta resultados favoráveis para o tratamento desses casos.

Scars resulting from burning causes great physical and emotional damage to patients. Its treatment remains a challenge in clinical practice. Current use of laser and light technologies, such as fractional ablative laser and intense pulsed light (ILP), have been shown to be effective in aesthetic and functional recovery of affected skin. This work aims to demonstrate the results of the treatment of extensive burn scarring with ILP and fractional ablative laser Erbium:YAG relating the case report of a 38-year-old female victim of direct flame burn at 6-years-old. The patient presented significant clinical improvement in the aesthetic and functional aspect of the lesion. The use of these combined methods presents favorable results for the treatment of these cases.

Las cicatrices resultantes de quemaduras causan grandes daños físicos y emocionales a los pacientes. El tratamiento sigue siendo un reto en la práctica clínica. El uso actual de tecnologías láser y de luz, tales como el láser ablativo fraccionado y la luz pulsada intensa (LPI) han demostrado ser herramientas eficaces para la recuperación estética y funcional de la piel afectada. Este trabajo tiene como objetivo mostrar el resultado del tratamiento de una cicatriz extensa por quemadura usando LPI y láser ablativo fraccional Erbio:YAG a partir del caso clínico de una paciente de 38 años de edad víctima de quemaduras por fuego directo (llama) a los 6 años de edad. La paciente mostró una mejoría clínica significativa en el aspecto estético y funcional de la lesión. El uso de estos métodos combinados mostró resultados favorables para el tratamiento de este tipo de casos.

Siliconoma: Report of Two Cases.

UNLABELLED: Injectable silicone has been used illegally for more than 60 years. Siliconoma is the term used to describe a foreign body reaction in the human body caused by the presence of silicone. The aim of this study is to report two cases of patients who underwent application of large volumes of injectable silicone with non-medical and unqualified professionals, which led to serious complications sometime after the procedure. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Histomorphometric analysis of early epithelialization and dermal changes in mid-partial-thickness burn wounds in humans treated with porcine small intestinal submucosa and silver-containing hydrofiber.

The objective of this study was to determine the healing rates of mid-partial-thickness burns treated with a porcine intestinal submucosa (SIS) vs. silver-containing cellulose hydrofiber (AgH) dressings. This was done by comparing healing response of burn wounds treated with SIS vs that of burns treated with AgH dressings. Five patients with mid-partial-thickness burns ≤10% of body surface were treated simultaneously, but in different areas, with SIS and AgH dressings; full-thickness biopsies were taken at days 0 and 7. Tissues treated with SIS presented higher epithelial maturation index (6.2 ± 0.84 vs. 3.2 ± 3.28; [mean ± standard deviation], P = .029), better orientation and differentiation of epithelial cells, as well as an appropriate basal lamina structure, collagen deposition, and higher transforming growth factor-ß3 expression (7.4 ± 8.1 vs. 2.1 ± 2.6; P = .055) than tissues treated with AgH dressings. Importantly, after the treatment SIS was not integrated in healed tissues. After 3 months of treatment, SIS produced a lower score according to Vancouver Scar Scale (3.6 ± 2.6 vs. 7.2 ± 2.5, P = .025).The submucosa dressing does not simply act as scaffolding for the wound, it provides stimulation in the healing area, probably via growth factors initially present in SIS or matrikines derived from its digestion in the wound site. In conclusion, the present study demonstrated that biological matrices favor the wound-healing process.

Endoscopic abdominoplasty: an alternative approach.

We describe a technique for endoscopic abdominoplasty in which we used 3 incisions, following the triangulation principles. To maintain the subcutaneous cavity, CO2 was insufflated at 8 mm Hg, and Esmarch bandages were placed at the submammary fold in a circumferential way to prevent subcutaneous emphysema. The aponeurosis plication was done with interrupted "8" figure sutures, with extracorporeal knots tied up in a double fisherman knot. The rest of the technique is similar to those previously described. Seven patients were treated, with an average age of 35.7 years (range, 25-60), and the mean length of surgery was of 197.11 minutes (range, 129-240). After surgery, 2 patients had mild pulmonary hypoventilation treated only with oxygen through a nasal mask for 24 hours. There were other complications such as seromas, inadequate implantation of the navel, and superficial periumbilical necrosis. According to the patients' opinion, the esthetic results have been satisfactory so far.

Maintenance of subcutaneous cavities with CO2.

UNLABELLED: Since mechanical retractors in endoscopic plastic surgery cause certain drawbacks, we developed a model in dogs, which, by insufflating CO2 into a subcutaneous cavity, we were able to maintain. We evaluated the magnitude of subcutaneous emphysema and absorption of CO2 by insufflating different pressures and the efficacy of external pressure on the skin with the purpose of limiting the subcutaneous emphysema. Sixteen dogs were divided in 3 groups, A, B, and C. We controlled the pulmonary function by using a volume-cycle ventilator. In all groups, we maintained a subcutaneous cavity by insufflating CO2. Groups A and C were insufflated at 15 mm Hg; group B, at 8 mm Hg. We placed circumferential Esmarch bandages on the thorax of groups B and C to delimit superiorly and inferiorly the surgical area. Arterial blood gas analyses (ABGA) were taken from the femoral artery 60 minutes after intubation, 60 minutes after Esmarch bandage was placed and at the end of the CO2 insufflation. Statistically, results were analyzed by Wilcoxon test. P < 0.05 was considered statistically significant. Group A showed extensive subcutaneous emphysema. Two dogs died. The systemic increase of the CO2 showed a median of 9.6 mm Hg (P < 0.05). In Group B, Esmarch bandages caused increase in CO2, with a median of 1.65 mm Hg (P < 0.028). None of these dogs showed subcutaneous emphysema during the insufflation after CO2 insufflation pressure augmented with a median of 3.7 mm Hg (P < 0.028). In Group C, chest restriction increased CO2 median of 6.1 mm Hg (P < 0.043), and subcutaneous emphysema shown was less extensive than group A. The CO2 increased after insufflation a median of 16 mm Hg (P < 0.043). CONCLUSIONS: Subcutaneous cavities can be maintained open with CO2 insufflation at 8 mm Hg, limiting perfectly the surgical area; as done with Esmarch bandages, it reduces CO2 absorption and makes this procedure safe.