A Quantification of Scalp Thickness before and after Posterior Vault Distraction Osteogenesis.

SUMMARY: Previous literature has documented craniometric changes of the bony calvaria, increases in intracranial volume, and resolution of Chiari malformations following posterior vault distraction osteogenesis. No studies have analyzed changes to the soft-tissue envelope after posterior vault distraction osteogenesis. In this study, the authors aimed to provide objective measurements of scalp thickness in patients undergoing posterior vault distraction osteogenesis, utilizing facial soft-tissue thickness as a proxy to control for growth. The authors hypothesized that the soft tissues of the scalp are not made thinner by the distraction process, either in the region of distraction or in neighboring areas. Subjects who underwent posterior vault distraction osteogenesis for a craniosynostosis diagnosis who had high-resolution predistraction and post-distractor removal computed tomographic scans within 100 days of each operation were included. The scans were analyzed on Materialise Mimics version 21 software (Materialise, Ghent, Belgium). Six key craniometric landmarks (glabella, pogonion, zygion, vertex, euryon, and opisthocranium) were identified on the three-dimensional bone masks in the Frankfort horizontal plane. The points were overlaid onto soft-tissue thickness masks and thicknesses were recorded. Percent change in postoperative facial soft-tissue thickness was used to control for growth of the craniofacial soft-tissue envelope during the study interval. The preoperative and postoperative posterior vault distraction osteogenesis cohorts did not differ significantly at the glabella, pogonion, opisthocranium, vertex, and zygion. The corrected median thickness at the euryon was significantly increased in the post-posterior vault distraction osteogenesis cohort [2.67 mm (IQR, 2.49 mm to 4.02 mm) versus 5.26 mm (IQR, 3.83 mm to 7.82 mm), p = 0.002]. This is the first study to quantify changes in soft-tissue thicknesses preoperatively and postoperatively in patients undergoing posterior vault distraction osteogenesis, demonstrating maintenance of scalp thickness. . CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Reconstrucción de cuero cabelludo, por quemadura química extensa, en tiempos de COVID / Scalp reconstruction, from extensive chemical burn, in time of COVID

Las quemaduras químicas en cuero cabelludo, que se producen en lugares públicos como salones de belleza o peluquerías causadas por mezclas de sustancias activas como persulfatos y peróxido de hidrógeno, secundarias a la decoloración de cabellos, producen graves secuelas de alopecias en pacientes jóvenes. Se trata de un caso clínico, de quemadura química, espesor completo, extensa, en cuero cabelludo. Productos utilizados en forma cotidiana en salones de belleza, peluquerías o domicilios, que tiene estrecha relación con el daño. Resolución del caso con colgajos locales, con tiempos de internación y quirúrgicos cortos, en tiempos de COVID. Enfoque de la falta de control de sustancias usadas en peluquerías, pocos casos publicados y secuelas psicosociales importantes, con pronta mejoría de calidad de vida y reinserción social

Chemical burns in scalp after hair bleaching are produced in public places such as hairdressing salons and are caused by the combination of active agents like persulfate and hydrogen peroxide. The burns leave severe sequels of alopecia in young patients. This is about a clinical case of a chemical burn in the sculp which is full thickness and has a great large. Products used on a daily basis in hairdressing salons or in the domiciles have a close connection with the hurt. In times of COVID the case was resolved with local flaps, and short period of hospitalization and surgical. Focus on the lack of control in the usage of substances made by hairdressing salons, the existence of few published cases and the main psychosocial sequels, a speedy recovery in the quality of life and social reintegration

Scalp thickness as a predictor of wound complications after cerebral revascularization using the superficial temporal artery: a risk factor analysis.

OBJECTIVE: Cerebral revascularization using the superficial temporal artery diverts some of the blood supply from the scalp to the brain. This may compromise the blood supply to the scalp and could result in more wound complications. OBJECTIVE: This retrospective chart review aimed to identify the incidence of, and independent risk factors for, wound complications after cerebral revascularization using the superficial temporal artery. METHODS: Patients who underwent cerebral revascularization using the superficial temporal artery between January 2003 and February 2017 were studied. Minor wound complications included superficial skin necrosis, and mild wound dehiscence, while major wound complications included full-thickness skin necrosis, deep infection, and osteomyelitis that required additional surgical treatment. RESULTS: A total of 482 cerebral revascularization procedures using the superficial temporal artery were included. Wound complications developed in 32 cases (6.6% of the total), including 7 classified as major in severity (1.5% of the total). The multivariate analysis revealed diabetes mellitus (odds ratio 4.058, p = 0.001), low body mass index (odds ratio 1.21, p = 0.009), and thin scalp (odds ratio 1.82, p < 0.001) as the main risk factors for wound complications. Every 1-mm increase in scalp thickness was associated with a protective effect on wound complications (odds ratio 0.549). CONCLUSION: Cerebral revascularization using the superficial temporal artery was associated with a relatively high incidence of wound complications. Diabetes mellitus, low body mass index, and thin scalp were found to be independent risk factors for wound complications. The thickness of the scalp could be a useful predictor of wound complications.

Method for Human Eccrine Sweat Gland Isolation from the Scalp by Means of the Micropunch Technique and Vital Dyes.

The isolation of eccrine sweat glands from human skin has always been a difficult task. The human scalp contains thousands of eccrine glands. Recently, the close anatomic relationship of the eccrine gland with the scalp hair follicle has been described. Taking advantage of this anatomic relationship as well as of the availability of follicular units (FUs) obtained in hair transplant procedures, we describe here a simple and efficient method to isolate eccrine sweat glands from the human scalp. This method is identical to the micropunch hair graft harvesting method known as follicular unit excision (FUE), used in modern hair transplantation. Once the FU has been extracted, it needs to be stained with methylene blue or neutral red in order to make the sweat gland visible for stereoscopic microdissection. Only the secretory (coiled) portion of the sweat gland can be obtained with this method. The efficiency of this isolation method should encourage further research into human eccrine sweat glands and opens possibilities for new translational applications.

Hair Whorl Direction: The Association with Handedness, Footedness, and Eyedness.

Hair whorl direction and handedness were stated to have a common genetic basis in the random recessive model. This study was carried out with a total of 317 healthy young males. The association between hair whorl swirling direction and handedness, footedness and eyedness were assessed. The direction of hair whorl was clockwise at a rate of 76.7%, and counter clock wise at a rate of 23.3%. There was no significant association between hair whorl direction and handedness, footedness, and eyedness (p > .05). The results indicate that hair whorl swirling direction is not an evident marker of functional laterality.

Pediatric Montages in Clinical Practice.

The montages in clinical EEG recordings in neonates, infants, and children follow some basic principles of adolescent or adult EEG recordings; however, special considerations are needed to obtain optimal diagnostic yield in pediatric patients. The aim of this review is to summarize the pediatric montages recommended in clinical practice in the standard clinical neurophysiology laboratory and in special situations.

Scalp-to-cortex distance of left primary motor cortex and its computational head model: Implications for personalized neuromodulation.

BACKGROUND: Non-invasive brain stimulation (NIBS) is increasingly used as a probe of function and therapeutics in experimental neuroscience and neurorehabilitation. Scalp-to-cortex distance (SCD), as a key parameter, has been shown to potentially impact on the electric field. This study aimed to examine the region-specific SCD and its relationship with cognitive function in the context of age-related brain atrophy. METHODS: We analyzed the SCD and cortical thickness (CT) of left primary motor cortex (M1) in 164 cognitively normal (CN) adults and 43 dementia patients drawn from the Open Access Series of Imaging Studies (OASIS). The degree of brain atrophy was measured by the volume of ventricular system. Computational head model was developed to simulate the impact of SCD on the electric field. RESULTS: Increased SCD of left M1 was only found in dementia patients (P < .001). When considering CT, the ratio of SCD to CT (F = 27.41, P < .001) showed better differential value than SCD. The SCD of left M1 was associated with worse global cognition (r = -.207, P = .011) and enlarged third ventricle (r = .241, P < .001). The electric field was consequently reduced with the increased SCD across cognitively normal elderly and dementia groups. CONCLUSIONS: Scalable distance measures, including SCD and CT, are markedly correlated with reduced electric field in dementia patients. The findings suggest that it is important to be aware of region-specific distance measures when conducting NIBS-based rehabilitation in individuals with brain atrophy.

Tissue biomechanics of the human head are altered by Thiel embalming, restricting its use for biomechanical validation.

Thiel embalming is a well-known method of anatomical fixation giving lifelike optical and haptic tissue properties. Beyond these characteristics, Thiel embalming may also be a promising method to provide lifelike tissues for validation purposes of human head biomechanics. Recent investigations using Thiel-embalmed human tissues of the upper and lower limb yielded contradicting biomechanical results on fixation-induced changes in the tissues' load-deformation behavior. It is to date unclear if Thiel embalming may have a softening or stiffening effect on human soft tissues or no global effect on biomechanics compared to the fresh state, with the latter being the most desirable outcome. The given study aimed at assessing the effects of Thiel embalming on the uniaxial tensile properties of human head soft tissues. Age-matched fresh and Thiel-embalmed dura mater, temporalis muscle, temporalis muscle fascia, and scalp samples were examined. Dura, fascia, and scalp samples showed significantly different elastic moduli compared to fresh tissues (all P < 0.01). The observed ultimate tensile strength supports the theory of an increased collagen crosslinking of the embalmed tissues when compared to the fresh state. Thiel-embalmed muscles failed any tensile testing approach as a result of the muscles dissolving due to the embalming. Furthermore, collagen integrity seems altered in scanning electron microscopy by the Thiel embalming, limiting their use for ultrastructural failure analyses. Thiel-embalmed soft tissues may consequently not serve to reflect the biomechanical properties of the human head. Consequently, the application of Thiel embalming should be limited to preliminary tests for biomechanical purposes. Clin. Anat. 32:903-913, 2019. © 2019 Wiley Periodicals, Inc.

Hairline Lowering Surgery With Bone Tunneling Suture Fixation: Effectiveness and Safety in 91 Patients.

BACKGROUND: People with a wide forehead often look older. Hairline lowering surgery is a good treatment option, which is generally performed utilizing Endotine. OBJECTIVES: We describe our hairline lowering surgical technique involving bone tunneling without Endotine, a method designed to produce comparable outcomes with fewer side effects. We evaluated the effectiveness and safety of our technique. METHODS: Charts of 91 patients who underwent hairline lowering surgery without Endotine were reviewed retrospectively. We utilized standardized preoperative and postoperative photographs to measure the proportions of 3 face parts and the length of the forehead. We also determined changes in forehead length at various times after surgery, occurrence of postoperative complications, and overall patient satisfaction with their surgical results. RESULTS: Of the 91 patients, 80 were female and the mean age was 28.67 ± 7.15 years. Preoperatively, the mean forehead length was 8.09 ± 0.69 cm and ratio of facial part lengths was 1.08:1:0.99 (cranial to caudal). The hairline was advanced 18.37 ± 2.90 mm. One month postoperatively, the mean forehead length was 6.57 ± 0.52 cm and facial parts ratio was 1:1:0.99. Compared with preoperatively, forehead length was significantly reduced at 1, 3, 6, and 12 months postoperatively. Forehead length was not significantly different at 1 and 12 months postoperatively. All patients were satisfied or very satisfied with their overall surgical results. CONCLUSIONS: Hairline lowering surgery with bone tunneling was effective and safe, and patients were satisfied with the results. The effects appeared immediately following surgery and were sustained over time.

Study on Hair Distribution in Healthy Males for Hair Restoration Design.

BACKGROUND: The incidence of hair loss among Chinese male has increased to 21.3 per hundred. Hair restoration has been an effective technique. Detailed hair distribution has a tremendous impact on the surgery design. OBJECTIVE: To investigate the pattern of hair distribution in Chinese young adult males. METHODS: A total of 1000 males without hair disease were enrolled. We evaluated the locations of the main anatomical marks at different sites on the scalp and analyzed the hair density and follicular unit structure using the standard photographs and trichoscope. RESULTS: The hairline shapes were classified as: linear (48.7%), linear with central protrusion (27.9%), round (9.8%), round with central protrusion (13.7%). The average height of the median line was 6.78 ±â€Š0.75 cm, the ratio of the median line and the forehead height was 0.333. The average distance from the parietal whorl to the vertical bimeatal line was 7.05 ±â€Š3.32 cm, and most of the PWs were on the right (51.4%) and had a clockwise pattern (73.3%). The hair density was 171.12 ±â€Š18.32 hairs/cm in the vertex. 1-hair follicular units were (75.90% and 56.39%) in anterior hairline and temporal area. CONCLUSION: Our study clearly assisted understanding of scalp anatomy and hair distribution in Chinese young adult males.

Dermatitis de contacto alérgica por regiones anatómicas. Claves diagnósticas / Allergic Contact Dermatitis by Anatomical Regions: Diagnostic Clues

La dermatitis de contacto alérgica (DCA) es una enfermedad frecuente en la práctica clínica diaria, con una prevalencia que ha aumentado en los últimos años. Clínicamente se caracteriza por grados variables de eritema, vesiculación, descamación y liquenificación, signos que también están presentes en otros procesos eccematosos. Las pruebas epicutáneas constituyen la principal herramienta diagnóstica para confirmar una DCA, sin embargo, su correcta interpretación requiere de una correcta correlación entre la anamnesis (historial de exposición) y el examen físico. En este artículo se describen de forma práctica y didáctica los patrones clínicos más frecuentes de DCA dependiendo de su localización. El conocimiento de estos patrones no solo ayudará al clínico en el diagnóstico diferencial, sino que también le permitirá sospechar el posible alérgeno y su forma de aplicación

Allergic contact dermatitis (ACD) is a common disease in daily clinical practice, and its prevalence has increased in recent years. It is characterized clinically by varying degrees of erythema, vesiculation, flaking, and lichenification, though these signs can also be present in other eczematous diseases. Patch testing is the main diagnostic tool to confirm ACD, but its accurate interpretation requires correct correlation with the medical history (details of exposure) and physical examination. We provide a practical and instructive description of the most common clinical patters of ACD depending on the area affected. Knowledge of these patterns will not only help the clinician reach the diagnosis but will suggest possible allergens and forms of contact

Hairline Restoration: Difference in Men and Woman-Length and Shape.

Hair restoration has become increasingly popular in recent years with both men and women. New technologies such as follicular unit extraction and grafting have made it possible for patients to get a natural looking result with minimal downtime. Men usually experience hairline recession as a result of androgenic alopecia, while women most commonly experience thinning of the crown and vertex, with the preservation of the hairline. However, there is a growing population of women who wish to advance their hairline forward because of congenital high hairline, traction alopecia, or previous facial cosmetic surgery. There are several key differences between the female and male hairline. Understanding such differences and following certain guidelines will help the facial plastic surgeon to obtain beautiful and natural appearing results.

Eccrine sweat glands associate with the human hair follicle within a defined compartment of dermal white adipose tissue.

BACKGROUND: Eccrine sweat glands (ESGs) are critical for thermoregulation and are involved in wound healing. ESGs have traditionally been considered as separate skin appendages without connection to the pilosebaceous unit (PSU). However, recent preliminary evidence has encouraged the hypothesis that the PSU and ESG are more interconnected than previously thought. OBJECTIVES: To re-evaluate the morphology of human skin adnexa with an integrated three-dimensional (3D) perspective in order to explore the possible interconnections that the PSU and the ESG may form. METHODS: A systematic 3D reconstruction method of skin sections, direct visualization of human scalp follicular unit transplant grafts and a scalp strip ex vivo were used to validate and further explore the hypothesis. RESULTS: We demonstrate that the coiled portion of most ESGs is morphologically integrated into the PSU of human scalp skin and forms a structural unit that is embedded into a specific, hair follicle-associated region of dermal white adipose tissue (dWAT). This newly recognized unit is easily accessible and experimentally tractable by organ culture of follicular units and can be visualized intravitally. CONCLUSIONS: We propose a model of functional human skin anatomy in which ESGs are closely associated with the PSU and the dWAT to form a common homeostatic tissue environment, which may best be encapsulated in the term 'adnexal skin unit'. The challenge now is to dissect how each component of this superstructure of human skin functionally cooperates with and influences the other under physiological conditions, during regeneration and repair and in selected skin diseases.

Scalp Acupuncture for the Treatment of Motor Function in Acute Spinal Cord Injury: A Case Report.

An acute spinal cord injury is the result of a traumatic injury to the spinal cord caused by a contusion, compression, or severing of the spinal cord. There are approximately 17,000 new cases each year, of which, males account for 80%. Approximately 65% of these injuries cause incomplete or partial damage to the spinal cord. Comprehensive treatment is essential to restore maximum function. Surgical procedures, stem cell therapy, pharmaceutical agents, and physical therapy are employed to minimize and repair damage done to the nervous system. The majority of motor and sensory recovery occurs during the first 12 to 15 weeks after the injury. Acupuncture has shown promising results in mediating neural plasticity and could be a useful treatment modality in hospital and rehabilitation settings. This case presents the treatment of an acute spinal cord injury, level T5, incomplete, with scalp acupuncture both within and beyond the optimal recovery window. The treatments given within the optimal window seemed to facilitate better restoration of nervous system communication when performing specific action.

An efficient method for eccrine gland isolation from human scalp.

We describe a simple and efficient method to isolate eccrine sweat glands from the human scalp. This method is inspired by the hair graft harvesting method used in hair transplantation. Based on the recently described anatomical relationship between the scalp hair follicle and the eccrine gland, we have found that scalp follicular unit grafts are an excellent eccrine gland isolation source, especially for the coiled component. In order to make the gland visible for stereoscopic microdissection, the follicular units need to be previously stained with a vital dye like methylene blue or neutral red. The simplicity and efficiency of this isolation method should encourage further research into human eccrine sweat gland function which has always been hindered by the difficulty of gland isolation.

A Multimedia Dissection Module for Scalp, Meninges, and Dural Partitions.

Introduction: For students beginning their medical education, the neuroscience curriculum is frequently seen as the most difficult, and many express an aversion to the topic. A major reason for this aversion amongst learners is the perceived complexity of neuroanatomy. By means of a video tutorial, this module aims to help students feel confident with the cadaveric dissection and identification of key anatomical structures as well as improve comprehension of associated clinical correlations presented for the scalp, meninges, and dural partitions. Methods: The authors expanded upon an established neuroscience curriculum, designed for first-year medical students, with the addition of a dissection video tutorial. A survey was provided to all students for feedback. Results: Of 36 students who participated in the survey, a majority (72%, n = 26) rated the video tutorial 5 out of 5 for helpfulness, and 53% (n = 19) rated the video 4 out of 5 for perceived confidence after viewing prior to the dissection. Most students viewed the tutorial only once prior to the dissection. Discussion: This video tutorial focuses on the structures and clinical correlations related to the scalp, meninges, and dura; provides useful graphics for identification of checklisted structures for predissection preparation; and serves as a succinct step-by-step guide for the dissection and as a study aid for review. Its addition to the already established curriculum was well received by the student group, a majority of whom found it helpful and had a high level of perceived confidence prior to the start of the dissection.

Scalp and Forehead Defects in the Post-Mohs Surgery Patient.

Scalp and forehead reconstruction after Mohs micrographic surgery can encompass subcentimeter defects to entire scalp reconstruction. Knowledge of anatomy, flap design, and execution will prepare surgeons who operate in the head and neck area to confidently approach a variety of reconstructive challenges in this area.