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Background@#Fat grafting is a commonly employed aesthetic procedure for contour enhancement. However, outcome prediction is challenging due to the complex regeneration and remodeling processes involved. We investigated whether adenosine improves engraftment and fat graft survival under conditions of obesity. @*Methods@#Fat was harvested from mice fed a high-fat diet. This fat was washed with either Krebs-Ringer bicarbonate HEPES buffer (the vehicle group) or a buffer containing 500 nM adenosine (the adenosine wash group). Subsequently, the fat was transplanted into normal mice at 0.2 mL per mouse. In both groups, 50% of the mice were sacrificed at 1 week and the remainder at 4 weeks post-transplantation. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) analysis was conducted during week 1. In week 4, micro-computed tomography, immunofluorescence staining, and RT-qPCR were performed. A sample of the initially harvested fat was set aside for lipolysis assay. @*Results@#Adenosine washing improved fat graft retention volumes by up to 50%. One week post-transplantation, the expression of adipogenic and angiogenic genes was found to be upregulated in the adenosine wash group. After 4 weeks, immunofluorescence staining revealed greater adipocyte integrity and an increased number of vessels. Furthermore, adenosine appeared to modulate inflammation by stabilizing the lipolysis rate. @*Conclusions@#Adenosine washing increased the fat graft survival rate under conditions of obesity. Clinically, this suggests a simple, cost-effective adjuvant method for improving fat graft survival in individuals with obesity. Further research is warranted to elucidate the underlying mechanisms and explore the applicability of this technique for autologous transplantation.
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Background@#Adipose tissue-derived stem cells (ASCs) represent a rapidly evolving area of cell-based therapies. ASCs are harvested from the stromal vascular fraction (SVF), a heterogeneous mixture of ASCs and other cell types. Two methods are typically employed to obtain the SVF: enzymatic and mechanical. In this study, we examined the efficacy of ultrasonic cavitation in isolating the SVF from adipose tissue. @*Methods@#Human adipose tissue was procured from three patients through an aesthetic liposuction procedure. This tissue was then subjected to either an enzymatic method utilizing type II collagenase or an ultrasonic cavitation method using an Ultra Stemcell device. The cell counts and viability were determined using a cell counter. The immunophenotype of the SVF was analyzed using real-time polymerase chain reaction. @*Results@#Compared to the enzymatic method, the total cell count and cell viability of the SVF isolated through ultrasonic cavitation were relatively low. However, no significant difference was observed in the immunophenotype of CD45, CD11b, CD34, and CD105. @*Conclusions@#The ultrasonic cavitation method constitutes a clinically practical approach that offers straightforward access in the operative field. This technique is a rapid and cost-effective method for isolating the SVF.
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Background@#Botulinum toxin type A is widely used to improve facial wrinkles associated with aging, and various types are available. However, the efficacy, particularly the duration of effect, varies among these types, and research on this subject is limited. This study aimed to compare the efficacy and safety of incobotulinum toxin A and abobotulinum toxin A. @*Methods@#This prospective analysis included cases of moderate to severe glabellar lines treated with either incobotulinum toxin A or abobotulinum toxin A. After a 24-week follow-up, clinical photos were taken at each visit. The severity of the glabellar lines was evaluated by three groups: the investigator, the patients, and an independent evaluator. @*Results@#The study included a total of 42 patients. When comparing the improvement rates of glabellar lines at maximum frown for both groups at the week-4 visit, which was the primary efficacy endpoint, no statistically significant difference was observed. However, the abobotulinum toxin A group demonstrated a higher improvement at the week-24 visit, as evaluated by the investigator, and this difference was statistically significant. @*Conclusions@#Overall, the abobotulinum toxin A group exhibited a higher improvement rate in the glabellar lines at the frown state. The difference in the improvement rate at the week-24 visit was 36.86%, which was statistically significant.
ABSTRACT
Botulinum toxin treatment is the most common non-surgical cosmetic treatment. Although there are many available treatments using botulinum toxin, their effects are temporary and repeated injections are required. These frequent injections can trigger an immunological response. In addition, botulinum toxin acts as an antigen in the body; thus, its effect disappears progressively due to this immunological reaction, which may cause treatment failure. Active botulinum toxin consists of a core neurotoxin and complexing proteins, the exact effects of which remain unclear. However, the complexing proteins are closely related to the immune response and the formation of neutralizing antibodies. Since neutralizing antibodies can lead to treatment failure, their formation should be prevented. Furthermore, various methods of detecting neutralizing antibodies have been used to predict treatment failure.
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Tattoos, which people choose to have performed for various reasons, can have multiple colors, ranging from conventional black to red, yellow, blue, and others. As tattoos have become increasingly popular, the need for tattoo removal has also grown, and the most commonly used method for removal is a laser. However, the extent to which various types of lasers remove different tattoo pigments is clearly important. Although extensive research has been done on black tattoos, red tattoos have not been adequately studied, and there are few case reports on red tattoos. We present a case of effective removal of a red tattoo from the lips using a picosecond laser.
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Background@#This study aimed to evaluate the efficacy and safety of a topical antioxidant cream containing tocotrienol after 1064-nm picosecond neodymium-doped yttrium aluminum garnet (Nd:YAG) laser treatment for environment-induced skin pigmentation. @*Methods@#A split-face study was conducted between December 2020 and March 2021 in 26 patients (25 women and one man) who were treated with a 1064-nm picosecond Nd:YAG laser. On the right side of the face, an antioxidant cream containing tocotrienol was applied after picosecond laser treatment, and on the left side, only picosecond laser treatment was performed. We compared the right and left sides of the face at 4 weeks after laser treatment using an automatic skin analysis device to investigate skin pigmentation. The melasma severity scores of the two sides were evaluated before and 4 weeks after picosecond laser treatment. @*Results@#The skin pigmentation score showed a significant difference between pretreatment and 4 weeks after picosecond laser treatment on both sides of the face (P0.05). @*Conclusions@#Our results show that, for the treatment of environment-induced skin pigmentation, the application of a tocotrienol-containing antioxidant cream after 1064-nm picosecond laser treatment can provide good results without any complications.
ABSTRACT
Tattoos, which people choose to have performed for various reasons, can have multiple colors, ranging from conventional black to red, yellow, blue, and others. As tattoos have become increasingly popular, the need for tattoo removal has also grown, and the most commonly used method for removal is a laser. However, the extent to which various types of lasers remove different tattoo pigments is clearly important. Although extensive research has been done on black tattoos, red tattoos have not been adequately studied, and there are few case reports on red tattoos. We present a case of effective removal of a red tattoo from the lips using a picosecond laser.
ABSTRACT
Background@#This study aimed to evaluate the efficacy and safety of a topical antioxidant cream containing tocotrienol after 1064-nm picosecond neodymium-doped yttrium aluminum garnet (Nd:YAG) laser treatment for environment-induced skin pigmentation. @*Methods@#A split-face study was conducted between December 2020 and March 2021 in 26 patients (25 women and one man) who were treated with a 1064-nm picosecond Nd:YAG laser. On the right side of the face, an antioxidant cream containing tocotrienol was applied after picosecond laser treatment, and on the left side, only picosecond laser treatment was performed. We compared the right and left sides of the face at 4 weeks after laser treatment using an automatic skin analysis device to investigate skin pigmentation. The melasma severity scores of the two sides were evaluated before and 4 weeks after picosecond laser treatment. @*Results@#The skin pigmentation score showed a significant difference between pretreatment and 4 weeks after picosecond laser treatment on both sides of the face (P0.05). @*Conclusions@#Our results show that, for the treatment of environment-induced skin pigmentation, the application of a tocotrienol-containing antioxidant cream after 1064-nm picosecond laser treatment can provide good results without any complications.
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A 3,480 g male neonate showed tachypnea symptom with a serum ionized calcium level of 0.66 mmol/L by routine clinical analysis. He was injected calcium gluconate intravenously through femoral vein catheter to treat the hypocalcemia. On second day after the injection, he started to show erythema in the flank area. The lesion became firm and changed into whitish crust consist of small crystals. Abdominal X-ray and ultrasonography showed the accumulation of calcium deposit in the subcutaneous layer of the lesion. Surgical debridement was performed to remove the crust with calcium deposit and acellular fish skin graft rich in omega-3 (Kerecis) was applied to the defect site for secondary intention of the defect wound. After 2 months, the skin and soft tissue defect were fully covered with healthy normal skin without depression or contracture. This report is a first case of iatrogenic calcinosis cutis without extravasation symptom.
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Objective@#: Percutaneous pedicle screw (PPS) fixation is a needle based procedure that requires fluoroscopic image guidance. Consequently, radiation exposure is inevitable for patients, surgeons, and operation room staff. We hypothesize that reducing the production of radiation emission will result in reduced radiation exposure for everyone in the operation room. Research was performed to evaluate reduction of radiation exposure by modifying imaging manner and mode of radiation source. @*Methods@#: A total of 170 patients (680 screws) who underwent fusion surgery with PPS fixation from September 2019 to March 2020 were analyzed in this study. Personal dosimeters (Polimaster Ltd.) were worn at the collar outside a lead apron to measure radiation exposure. Patients were assigned to four groups based on imaging manner of fluoroscopy and radiation modification (pulse mode with reduced dose) : continuous use without radiation modification (group 1, n=34), intermittent use without radiation modification (group 2, n=54), continuous use with radiation modification (group 3, n=26), and intermittent use with radiation modification (group 4, n=56). Post hoc Tukey Honest significant difference test was used for individual comparisons of radiation exposure/screw and fluoroscopic time/screw. @*Results@#: The average radiation exposure/screw was 71.45±45.75 μSv/screw for group 1, 18.77±11.51 μSv/screw for group 2, 19.58±7.00 μSv/screw for group 3, and 4.26±2.89 μSv/screw for group 4. By changing imaging manner from continuous multiple shot to intermittent single shot, 73.7% radiation reduction was achieved in the no radiation modification groups (groups 1, 2), and 78.2% radiation reduction was achieved in the radiation modification groups (groups 3, 4). Radiation source modification from continuous mode with standard dose to pulse mode with reduced dose resulted in 72.6% radiation reduction in continuous imaging groups (groups 1, 3) and 77.3% radiation reduction in intermittent imaging groups (groups 2, 4). The average radiation exposure/screw was reduced 94.1% by changing imaging manner and modifying radiation source from continuous imaging with standard fluoroscopy setting (group 1) to intermittent imaging with modified fluoroscopy setting (group 4). A total of 680 screws were reviewed postoperatively, and 99.3% (675) were evaluated as pedicle breach grade 0 (<2 mm). @*Conclusion@#: The average radiation exposure/screw for a spinal surgeon can be reduced 94.1% by changing imaging manner and modifying radiation source from real-time imaging with standard dose to intermittent imaging with modified dose. These modifications can be instantly applied to any procedure using fluoroscopic guidance and may reduce the overall radiation exposure of spine surgeons.
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Purpose@#Chronic ankle instability is a very common abnormality of the ankle, but there is still controversy regarding its evaluation criteria. The stress view has difficulties in reflecting the patient’s symptoms and treatment progress. Therefore, this study examined the relationship between the center of pressure (COP) measured by a pedobarograph and the symptoms of the patient. @*Materials and Methods@#Thirty patients with chronic ankle instability from February to August 2018 were included. Each patient was surveyed with the foot and ankle outcome score (FAOS). The COP was measured with a foot pressure scanner, and the travel distance and ellipse area of the COP were calculated. Each patient was measured on one foot and on two feet with his or her eyes closed and open. The relationship between the COP measurement and FAOS score was analyzed using the Pearson correlation coefficient. @*Results@#The participants were consisted of 21 male and nine female, with a mean age of 30 years, mean weight of 72 kg, and mean foot size of 259 mm. With the eyes open, the correlation coefficient between the FAOS and travel distance of the affected side was –0.394 (p<0.05) and that between the FAOS and the ellipse area of the affected side was –0.425 (p<0.05). On the other hand, no significant correlations were found between the travel distance and ellipse area of the affected side when patients closed their eyes. @*Conclusion@#Measurement of the COP using foot pressure scanner could evaluate objectively patients with chronic ankle instability, with measurements in patients with their eyes open being more significant. Based on the findings of this study, an analysis of the COP with the patients with their eyes open and standing on one foot may help determine the management strategy and assess the progress of the patients.
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Background@#Latissimus dorsi (LD) flaps are often used in breast reconstruction procedures, but seroma formation is a frequent complication. To decrease the incidence of seroma formation, fibrin sealants and/or quilting sutures have been proposed, with controversial results. The primary objective of this study was to assess the effectiveness of the Harmonic scalpel in association with Tisseel and three-point deep dermal sutures in reducing the incidence of this complication. @*Methods@#A retrospective study was conducted of 108 patients undergoing immediate unilateral breast reconstruction with LD flaps over a 3-year period (2016–2018) by a single surgeon. In the experimental group, 37 patients underwent the procedure with a Harmonic scalpel and three-point deep dermal sutures (a modified version of quilting sutures), and the other 71 received conventional electrocautery. Fibrin sealant was applied to the donor site of all patents to reduce seroma formation. @*Results@#Statistically significant differences in the incidence of seroma were found between the two groups. There was a lower incidence of seroma formation in the group of patients treated with a Harmonic scalpel and three-point deep dermal sutures than in the other group. The total drainage amount and drain removal date between the two groups were not significantly different. @*Conclusions@#Within the limitations of this study, we suggest that Harmonic scalpel use can be a good choice among the many ways to reduce seroma formation following LD flap procedures, and that this technique will be very helpful for patients.
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Background@#To produce patient-specific nasal implants, it is necessary to harvest and grow autologous cartilage. It is crucial to the proliferation and growth of these cells for scaffolds similar to the extracellular matrix to be prepared. The pore size of the scaffold is critical to cell growth and interaction. Thus, the goal of this study was to determine the optimal pore size for the growth of chondrocytes and fibroblasts. @*Methods@#Porous disc-shaped scaffolds with 100-, 200-, 300-, and 400-µm pores were produced using polycaprolactone (PCL). Chondrocytes and fibroblasts were cultured after seeding the scaffolds with these cells, and morphologic evaluation was performed on days 2, 14, 28, and 56 after cell seeding. On each of those days, the number of viable cells was evaluated quantitatively using an MTT assay. @*Results@#The number of cells had moderately increased by day 28. This increase was noteworthy for the 300- and 400-µm pore sizes for fibroblasts; otherwise, no remarkable difference was observed at any size except the 100-µm pore size for chondrocytes. By day 56, the number of cells was observed to increase with pore size, and the number of chondrocytes had markedly increased at the 400-µm pore size. The findings of the morphologic evaluation were consistent with those of the quantitative evaluation. @*Conclusions@#Experiments using disc-type PCL scaffolds showed (via both morphologic and quantitative analysis) that chondrocytes and fibroblasts proliferated most extensively at the 400-µm pore size in 56 days of culture.
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Objective@#: The aim of this study is to evaluate the feasibility of posterior cervical foraminotomy (PCF) for adjacent segmental disease (ASD) after anterior cervical fusion (ACF). As ACF is accepted as the standard treatment for cervical spondylosis, many studies have been conducted to evaluate the efficacy of various surgical techniques to overcome symptomatic ASD after the previous surgery. Herein, PCF was performed for the treatment of symptomatic ASD and the feasibility of the surgery was evaluated. @*Methods@#: Forty nine patients who underwent PCF due to symptomatic ASD from August 2008 to November 2017 were identified. For demographic and perioperative data, the sex, age, types of previous surgery, ASD levels, operation times, and bleeding amount were recorded. The clinical outcome was assessed using the visual analogue scale for the neck and arm, the modified Odom’s criteria as well as neck disability index. Radiologic evaluations were performed by measuring disc softness, disc height, the cervical 2–7 sagittal vertical axis, cervical cobb angle, and facet violation. @*Results@#: Thirty-seven patients were enrolled in this study. The patients were divided into two groups based on the location of the pathology; paracentral (group P) or foramina (group F). Both groups showed significant clinical improvement (p0.05). @*Conclusion@#: PCF showed satisfactory clinical and radiologic outcomes for both paracentral and foraminal pathologies of ASD after ACF. Complications related to anterior revision were also avoided. PCF can be considered a feasible and safe surgical option for ASD after ACF.
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BACKGROUND: Diode lasers are the gold standard for removing unwanted hair. Lowering the energy should result in less pain and could theoretically affect therapeutic efficacy. This study evaluated the efficacy of an 808-nm diode laser at different fluences for permanent axillary hair removal in Korean women. METHODS: Twenty-four Korean women were divided into two groups. Each patient received laser treatment at both axillae, which were divided into upper and lower parts. Each part received different fluence from an HR808 prototype diode at 1-month intervals: 8, 10, 12, and 14 J/cm². Hair count and thickness were recorded at each follow-up visit and at a 3-month follow-up after the final laser treatment by photography and using a folliscope. At the final visit, pain and patient satisfaction were surveyed. Three plastic surgeons assessed the results on photographs. RESULTS: The mean hair follicle density reduction was 62.18%, 65.28%, 73.08%, and 78.29% on the right upper side, right lower side, left upper side, and left lower side, respectively. The mean hair follicle thickness reduction was 45%, 48%, 54%, and 59% on the right upper side, right lower side, left upper side, and left lower side, respectively. In the plastic surgeons' assessment, the left upper and lower sides scored 2.71. The right upper and lower sides scored 2.38 and 2.04, respectively. CONCLUSIONS: High-fluence (14 J/cm²) treatment with an HR 808 prototype diode laser efficiently removed unwanted hair. No significant difference in comfort was reported compared to the low-fluence mode (8–10 J/cm²).
Subject(s)
Female , Humans , Asian People , Axilla , Follow-Up Studies , Hair Follicle , Hair Removal , Hair , Laser Therapy , Lasers, Semiconductor , Patient Satisfaction , Photography , Plastics , Prospective Studies , SurgeonsABSTRACT
A-50-year-old male patient presented with complaint of tenderness on the left malar area after traffic accident. Our first impression on him was zygomatic fracture, we did radiologic work-up and physical examination on him. But, on the computed tomography scan, there was no fracture or discontinuity on his facial bone. The computed tomography scan was revealed a 4-cm long foreign body in left maxillary sinus with a large amount of fluid collection. After thorough history taking from him, we reveal the patient had a history of trauma 30 years back on the left zygomatic area with a chopstick. The foreign body was removed via transoral approach with the endoscopic assist. There was no complication after operation.
Subject(s)
Humans , Male , Accidents, Traffic , Facial Bones , Foreign Bodies , Maxilla , Maxillary Fractures , Maxillary Sinus , Physical Examination , Tomography, X-Ray Computed , Zygomatic FracturesABSTRACT
The purpose of this study is to discuss several approaches to addressing naso-orbito-ethmoidal (NOE) fracture. Orbital fracture, especially infraorbital fracture, can be treated through the transconjunctival approach easily. However, in more severe cases, for example, fracture extending to the medial orbital wall or zygomatico-frontal suture line, only transconjunctival incision is insufficient to secure good surgical field. And, it also has risk of tearing the conjunctiva, which could injure the lacrimal duct. Also, in most complex types of facial fracture such as NOE fracture or panfacial fracture, destruction of the structure often occurs, for example, trap-door deformity; a fracture of orbital floor where the inferiorly displaced blowout facture recoils to its original position, or vertical folding deformity; fractured fragments are displaced under the other fragments, causing multiple-packed layers of bone.
Subject(s)
Congenital Abnormalities , Conjunctiva , Fractures, Multiple , Lacrimal Apparatus , Maxillary Fractures , Orbit , Orbital Fractures , Sutures , TearsABSTRACT
BACKGROUND: Few scales are currently available to evaluate changes in hand volume. We aimed to develop a hand grading scale for quantitative assessments of dorsal hand volume with additional consideration of changes in skin texture; to validate and prove the precision and reproducibility of the new scale; and to demonstrate the presence of clinically significant differences between grades on the scale. METHODS: Five experienced plastic surgeons developed the Hand Volume Rating Scale (HVRS) and rated 91 images. Another five plastic surgeons validated the scale using 50 randomly selected images. Intra- and inter-rater agreement was calculated using the weighted kappa statistic and intraclass correlation coefficients (ICCs). Paired images were also evaluated to verify whether the scale reflected clinical differences. RESULTS: The intra-rater agreement was 0.95 (95% confidence interval, 0.922–0.974). The interrater ICCs were excellent (first rating, 0.94; second rating, 0.94). Image pairs that differed by 1, 2, and 3 grades were considered to contain clinically relevant differences in 80%, 100%, and 100% of cases, respectively, while 84% of image pairs of the same grade were found not to show clinically relevant differences. This confirmed that the scale of the HVRS corresponded to clinically relevant distinctions. CONCLUSIONS: The scale was proven to be precise, reproducible, and reflective of clinical differences.
Subject(s)
Humans , Asian People , Hand , Plastics , Rejuvenation , Skin , Skin Aging , Surgeons , Weights and MeasuresABSTRACT
Secondary nail deformities are often seen at some time after fingertip and nail bed injuries. A proper evaluation of the fingernail enables appropriate diagnosis and treatment, especially in patients who need surgical management. To date, ultrasound and magnetic resonance imaging are the only diagnostic tools that most surgeons use in cases of nail deformities. Herein, we report the case of a patient with a nail deformity who underwent successful correction based on the preoperative use of real-time optical coherence tomography.
Subject(s)
Humans , Congenital Abnormalities , Diagnosis , Magnetic Resonance Imaging , Nails , Plastic Surgery Procedures , Surgeons , Tomography, Optical Coherence , UltrasonographyABSTRACT
Necrotizing ulcerative stomatitis (NUS) refers to ulceration of the oral mucosa that precedes rapid orofacial soft- and hard-tissue destruction. NUS on the upper lip is considered a reconstructive challenge because of the functional importance and complex multidimensional structure of the facial units that are involved, and is most commonly found in developing countries. Therefore, few studies have been conducted on NUS. Moreover, reconstruction options vary from local regional flaps to free-tissue transfers. We report a very interesting case in which we performed regional flap surgery using bilateral cheek advancement in a patient with NUS. A 75-year-old woman with a history of diabetes mellitus and hypertension, but no other immunological diseases, presented with skin necrosis on the upper lip. At presentation, necrotic tissue covered the upper lip and philtrum, but it had not invaded the nose or lower lip. After debridement of the necrotic tissue, approximately 70% of the upper lip was missing. We therefore designed a bilateral cheek advancement and rotation flap, in which the flap was sutured in 3 layers. There was no need to perform additional procedures, as the flap healed well and showed no other complications or recurrence. The patient exhibited good voluntary muscle control and oral competence while eating and drinking, and she was also very satisfied with the cosmetic results. Thus, regional flap surgery using a simple advancement flap may result in good recovery of both functional and aesthetic units in patients with NUS.