Hand: Clinical Anatomy and Regional Approaches with Injectable Fillers.

BACKGROUND: Cosmetic physicians are more and more frequently asked for hand rejuvenation. They commonly propose the same techniques as for the face. The authors undertook an anatomical study of the hand dorsum to understand the optimal location for an injected filler and to design the safest technique of placement. METHODS: The first part of the study included dissections of 19 fresh cadaveric hands and duplex ultrasounds investigation of 28 healthy hands. A technique of injection specifically designed from anatomical findings was then tested on 8 fresh cadaveric hands using magnetic resonance imaging and dissection in comparison with 3 other commonly used techniques of rejuvenating injections. RESULTS: Between the dermis and the tendons, the thickness of the fascial plane was measured from 0.3 to 2.2 mm. Because of numerous fibrous septa, the entire plane was found as a 3-dimensional sponge-like framework. Veins could be located in all levels of this framework. There was no predefined free space. The optimal place for the deposition of a filler was found to be the undersurface of the dermis. The specific technique named Scrape Skin Threading Technique and using a cannula scraping the deep side of the dermis was checked as the only technique which could give a perfect placement of product restricted to the fascial layer. CONCLUSION: The Scrape Skin Threading Technique was designed to inject safely and accurately any kind of injectable in contact with the undersurface of the dermis, which appeared anatomically as the optimal location of a filler for enhancing the outer appearance of the dorsum of hands.

Great saphenous vein surgery without high ligation of the saphenofemoral junction.

OBJECTIVE: The aim of this study was to evaluate whether great saphenous vein (GSV) surgery without high ligation of the saphenofemoral junction (SFJ) is beneficial in terms of varicose vein recurrence. METHODS: This was a prospective randomized trial set in a private practice. From December 2000 to May 2004, 120 patients were enrolled. Patients were randomly allocated preoperatively to two groups undergoing GSV surgery with (group A, n = 60) or without (group B, n = 60) high ligation of the SFJ. In four patients (two in each group), both limbs were operated on. Inclusion criteria were primary varicose veins with SFJ incompetence resulting in GSV reflux. Exclusion criteria were age <18 years, inability to give informed consent, associated small saphenous vein incompetence, and prior GSV surgery. Mean follow-up was 8 years and was complete in all but one patient (99.2%). The primary end point was varicose vein recurrence, defined as treated lower limbs with new thigh varices at clinical evaluation (CEAP ≥ 2) or venous reflux at the thigh or groin level, as assessed by duplex ultrasound imaging. RESULTS: The follow-up included 123 limbs. The combined clinical and ultrasound-determined recurrence rate was 24.4% (30 of 123): 32.2% (20 of 62) in group A vs 16.4% (10 of 61) in group B (P = .045). Postoperatively, recurrence of even minimal varices was observed in 24 limbs (19.5%): 18 of 62 (29.0%) in group A vs six of 61 (9.8%) in group B (P = .014). The ultrasound-detected recurrence rate was 22% (27 of 123): 32.2% (20 of 62) in group A vs 11.4% (7 of 61) in group B (P = .010). The average time to recurrence was 3.5 ± 1.2 years in group A and 4.1 ± 1.6 years in group B (P = .258). CONCLUSIONS: GSV surgery without high ligation of the SFJ is associated with low rates of clinical and ultrasound-determined recurrence of varicose veins.