Addressing the complexities in measuring cyclodextrin-sterol binding constants: A multidimensional study.

A class of cyclodextrin (CD) dimers has emerged as a potential new treatment for atherosclerosis; they work by forming strong, soluble inclusion complexes with oxysterols, allowing the body to reduce and heal arterial plaques. However, characterizing the interactions between CD dimers and oxysterols presents formidable challenges due to low sterol solubility, the synthesis of modified CDs resulting in varying number and position of molecular substitutions, and the diversity of interaction mechanisms. To address these challenges and illuminate the nuances of CD-sterol interactions, we have used multiple orthogonal approaches for a comprehensive characterization. Results obtained from three independent techniques - metadynamics simulations, competitive isothermal titration calorimetry, and circular dichroism - to quantify CD-sterol binding are presented. The objective of this study is to obtain the binding constants and gain insights into the intricate nature of the system, while accounting for the advantages and limitations of each method. Notably, our findings demonstrate ∼1000× stronger affinity of the CD dimer for 7-ketocholesterol in comparison to cholesterol for the 1:1 complex in direct binding assays. These methodologies and findings not only enhance our understanding of CD dimer-sterol interactions, but could also be generally applicable to prediction and quantification of other challenging host-guest complex systems.

Polysaccharide metabolism in Anacardiaceae (Asian lacquer) cross-linked polymers elucidated using in situ trimethylsilylation pyrolysis-gas chromatography-mass spectrometry.

Carbohydrates from polysaccharides in natural thermoset Anacardiaceae polymers of Gluta usitata, Toxicodendron succedaneum and Toxicodendron vernicifluum were identified using pyrolysis-gas chromatography-mass spectrometry with in situ trimethylsilylation. Pyrolysates resulting from the pyrolytic intermolecular chain scission of the polysaccharides were used to elucidate monomeric units. Polysaccharides, dispersed in the phenolic lacasse catalysed cross-linked macromolecules, showed to be metabolised through various catabolic and anabolic routes. Galactose functionalities, abundantly present in the polysaccharides were determined to be enzymatically converted to glucose-6-phosphate, followed by conversion via glycolysis and pentose phosphate pathways. Determination of specific routes of carbohydrate modification via glycolysis and pentose phosphate pathways facilitated differentiating G. usitata, T. succedaneum and T. vernicifluum polymers, based on the carbohydrate content. It was also found that uronic type acids, present as end groups of the branched polysaccharide structure, were biochemically converted to aldonic acids. Following the pentose phosphate and glycolysis routes, carbohydrates in G. usitata and T. vernicifluum polymers showed to be further modified via shikimate and cinnamate pathways to produce phenylpropanoid compounds. Parent molecules and pyrolysis products thereof were verified using analytical standards of high purity. The mass spectra and Kovats retention indices were compiled in an AMDIS library, which can be made available on request.

Recent advances in biopolymer-based hydrogels and their potential biomedical applications.

Hydrogels are three-dimensional networks of polymer chains containing large amounts of water in their structure. Hydrogels have received significant attention in biomedical applications owing to their attractive physicochemical properties, including flexibility, softness, biodegradability, and biocompatibility. Different natural and synthetic polymers have been intensely explored in developing hydrogels for the desired applications. Biopolymers-based hydrogels have advantages over synthetic polymers regarding improved cellular activity and weak immune response. These properties can be further improved by grafting with other polymers or adding nanomaterials, and they structurally mimic the living tissue environments, which opens their broad applicability. The hydrogels can be physically or chemically cross-linked depending on the structure. The use of different biopolymers-based hydrogels in biomedical applications has been reviewed and discussed earlier. However, no report is still available to comprehensively introduce the synthesis, advantages, disadvantages, and biomedical applications of biopolymers-based hydrogels from the material point of view. Herein, we systematically overview different synthesis methods of hydrogels and provide a holistic approach to biopolymers-based hydrogels for biomedical applications, especially in bone regeneration, wound healing, drug delivery, bioimaging, and therapy. The current challenges and prospects of biopolymers-based hydrogels are highlighted rationally, giving an insight into the progress of these hydrogels and their practical applications.

Folate-modified carboxymethyl chitosan-based drug delivery system for breast cancer specific combination therapy via regulating mitochondrial calcium concentration.

Although various drug delivery systems that regulated Ca2+ concentration has been developed for tumor therapy, their application still presented significant challenges due to the complex preparation and introduction of a large number of inorganic molecules that might cause serious toxic effects. To solve these problems, a folate-functionalized carboxymethyl chitosan (CMCS)/calcium phosphate hybrid nanoparticle (CF/CaP) with Ca2+ production was designed to treat breast cancer combined with the Ca2+ inhibitory effect of encapsulated curcumin (Cur). It was demonstrated that the optimal CF/CaP nanoparticles loaded with Cur (C@CF/CaP) were spherical nanoparticles, which exhibited a smaller size at about 179 nm than non-targeted nanoparticles with size at about 234 nm. C@CF/CaP had good biocompatibility, high stability and acid responsive drug release. Compared with the neutral environment, the cumulative release of Cur was >70 % after culture for 36 h at pH 5.0. Compared with non-targeted nanoparticles, C@CF/CaP could specifically target tumor tissues and then enter tumor cells through folate receptor-mediated endocytosis. C@CF/CaP could cause mitochondrial Ca2+ overload, trigger the mitochondrial apoptotic pathway, destroy the mitochondrial structure and finally have good anti-tumor efficiency. The results proved that Ca2+ nanomodulators based on CMCS might provide a potential organelle targeting strategy for cancer therapy.

18 F-FDG PET/MRI of Primary Hepatic Malignancies: Differential Diagnosis and Histologic Grading

BACKGROUND: Distinguishing between IHCC and HCC is important because of their differences in treatment and prognosis. The hybrid Positron Emission Tomography/magnetic Resonance Imaging (PET/MRI) system has become more widely accessible, with oncological imaging becoming one of its most promising applications. OBJECTIVE: The objective of this study was to see how well 18F-fluorodeoxyglucose (18F-FDG) PET/MRI could be used for differential diagnosis and histologic grading of primary hepatic malignancies. METHODS: We retrospectively evaluated 64 patients (53 patients with HCC, 11 patients with IHCC) with histologically proven primary hepatic malignancies using 18F-FDG/MRI. The Apparent Diffusion Coefficient (ADC), Coefficient of Variance (CV) of the ADC, and standardized uptake value (SUV) were calculated. RESULTS: The mean SUVmax value was higher for IHCC (7.7 ± 3.4) than for HCC (5.2 ± 3.1) (p = 0.019). The area under the curve (AUC) was 0.737, an optimal 6.98 cut-off value providing 72% sensitivity and 79% specificity. The ADCcv value in IHCC was statistically significantly higher than in HCC (p=0.014). ADC mean values in HCCs were significantly higher in low-grade tumors than in high-grade tumors. The AUC value was 0.73, and the optimal cut-off point was 1.20x10-6 mm2/s, giving 62% sensitivity and 72% specificity. The SUVmax value was also found to be statistically significantly higher in the high-grade group. The ADCcv value in the HCC low-grade group was found to be lower than in the highgrade group (p=0.036). CONCLUSION: 18F FDG PET/MRI is a novel imaging technique that can aid in the differentiation of primary hepatic neoplasms as well as tumor-grade estimation.

Prediction of Lumbar Pedicle Screw Loosening Using Hounsfield Units in Computed Tomography

INTRODUCTION: One of the most common issues following pedicle screw fixation is pedicle screw loosening. There are, however, few trustworthy methods for predicting screw loosening. The goal of the current study was to identify an efficient technique for using preoperative CT scanning to predict screw loosening in older patients and to offer recommendations for preoperative surgical planning. METHODS: The current analysis included retrospectively all patients who underwent lumbar pedicle screw fixation for degenerative lumbar diseases in our department between January 2015 and January 2022. Hounsfield units were used to assess each vertebra's attenuation in a CT scan (HU). Postoperative X-ray testing identified screw loosening. Using IBMSPSS 24.00 software, one-way analysis of variance (ANOVA) and receiver operating characteristic (ROC) curve analysis were performed. RESULTS: Over a mean follow-up period of 28.4±11.5 (range 12-44 months) months, screw loosening was noted in 53 of 242 patients (136 male and 106 female, average age 58.7±7.3 years). Gender, BMI, smoking habits, and whether or not a patient had diabetes or spondylolisthesis were not shown to be significantly different among the patients (P>0.05). The difference between the average lumbar vertebral HU values in the screw-loosening group and the control group was significant (P<0.01) at 120.3±31.5HU and 138.6±37.6HU, respectively. The average HU value of L1-L4 exhibited an area under the curve (AUC) of 0.691 (95% CI: 0.614-0.784), according to ROC curve analysis. A HU cut-off value of 122 HU is a likely cut-off point to predict screw loosening with a sensitivity of 70% and a specificity of 58%. CONCLUSION: The use of screw augmentation techniques can be decided using a prospective CT scan HU value-based prediction. An independent risk factor for screw loosening in an instrumented lumbar vertebra is a cutoff L1-L5 average HU value of 122 HU.

A Comprehensive Review on MRI-based Knee Joint Segmentation and Analysis Techniques

Using magnetic resonance imaging (MRI) in osteoarthritis pathogenesis research has proven extremely beneficial. However, it is always challenging for both clinicians and researchers to detect morphological changes in knee joints from magnetic resonance (MR) imaging since the surrounding tissues produce identical signals in MR studies, making it difficult to distinguish between them. Segmenting the knee bone, articular cartilage and menisci from the MR images allows one to examine the complete volume of the bone, articular cartilage, and menisci. It can also be used to assess certain characteristics quantitatively. However, segmentation is a laborious and time-consuming operation that requires sufficient training to complete correctly. With the advancement of MRI technology and computational methods, researchers have developed several algorithms to automate the task of individual knee bone, articular cartilage and meniscus segmentation during the last two decades. This systematic review aims to present available fully and semi-automatic segmentation methods for knee bone, cartilage, and meniscus published in different scientific articles. This review provides a vivid description of the scientific advancements to clinicians and researchers in this field of image analysis and segmentation, which helps the development of novel automated methods for clinical applications. The review also contains the recently developed fully automated deep learning-based methods for segmentation, which not only provides better results compared to the conventional techniques but also open a new field of research in Medical Imaging.

Image Quality Improvement of Low-dose Abdominal CT using Deep Learning Image Reconstruction Compared with the Second Generation Iterative Reconstruction

BACKGROUND: Whether deep learning-based CT reconstruction could improve lesion conspicuity on abdominal CT when the radiation dose is reduced is controversial. OBJECTIVES: To determine whether DLIR can provide better image quality and reduce radiation dose in contrast-enhanced abdominal CT compared with the second generation of adaptive statistical iterative reconstruction (ASiR-V). AIMS: This study aims to determine whether deep-learning image reconstruction (DLIR) can improve image quality. METHOD: In this retrospective study, a total of 102 patients were included, who underwent abdominal CT using a DLIR-equipped 256-row scanner and routine CT of the same protocol on the same vendor's 64-row scanner within four months. The CT data from the 256-row scanner were reconstructed into ASiR-V with three blending levels (AV30, AV60, and AV100), and DLIR images with three strength levels (DLIR-L, DLIR-M, and DLIR-H). The routine CT data were reconstructed into AV30, AV60, and AV100. The contrast-to-noise ratio (CNR) of the liver, overall image quality, subjective noise, lesion conspicuity, and plasticity in the portal venous phase (PVP) of ASiR-V from both scanners and DLIR were compared. RESULTS: The mean effective radiation dose of PVP of the 256-row scanner was significantly lower than that of the routine CT (6.3±2.0 mSv vs. 2.4±0.6 mSv; p< 0.001). The mean CNR, image quality, subjective noise, and lesion conspicuity of ASiR-V images of the 256-row scanner were significantly lower than those of ASiR-V images at the same blending factor of routine CT, but significantly improved with DLIR algorithms. DLIR-H showed higher CNR, better image quality, and subjective noise than AV30 from routine CT, whereas plasticity was significantly better for AV30. CONCLUSION: DLIR can be used for improving image quality and reducing radiation dose in abdominal CT, compared with ASIR-V.

Evaluation of Main Lacrimal Gland through Shear-wave Ultrasound Elastography in Patients with Low Schirmer Value

OBJECTIVE: To compare main lacrimal gland values through shear-wave elastography (SWE) in patients with low Schirmer value and unspecified Sjögren's syndrome (SS) with healthy controls. MATERIAL AND METHOD: Admitted to the ophthalmology department with Schirmer value <10 mm, randomly selected 46 eyes of 46 patients evaluated for Sjögren's syndrome (SS) in the rheumatology department between December 2022 and April 2023 were classified as low Schirmer group (LSG). Randomly selected 48 eyes of 48 patients at a similar age with Schirmer value >10 mm were included as controls. Main lacrimal gland SWE measurements in LSG and control groups were recorded and compared as meter/second (m/sec). RESULTS: Mean SWE values of the main lacrimal gland were measured as 2.78 ± 0.66 m/sec and 2.26 ± 0.29 m/sec in LSG and controls. SWE measurements were significantly higher in LSG patients than in controls (p<0.001). No significant correlation was found in the analysis between the Schirmer and the main lacrimal gland SWE values in LSG patients (p=0.702, r=0.058). No significant correlation was also detected between the Schirmer and main lacrimal gland SWE values in controls (p=0.097, r=0.242). No significant relationship was also found between age, gender, body mass index (BMI), and SWE values (p=0.351, p=0.493, p=0.328, respectively). CONCLUSION: Mean SWE value of the main lacrimal gland was determined as significantly higher in patients with aqueous lacrimal insufficiency without SS than in controls. We consider that SWE measurements may be an imaging method to support the diagnosis of aqueous lacrimal insufficiency and used in follow-ups of those with dry eye syndrome (DES) in the future.

Effects of Deep Venous Thrombosis Treatments on Early and Long-term Quality of Life: Medical Therapy vs. Systemic Thrombolysis vs. Pharmacomechanical Thrombolysis.

OBJECTIVES: The present study aimed to compare the effects of medical therapy (MT), systemic thrombolysis (ST), and pharmacomechanical thrombolysis (PMT) methods used in our clinic for the treatment of deep venous thrombosis (DVT) on symptom reduction, the incidence of post-thrombotic syndrome (PTS) development, and quality of life. METHODS: Data from160 patients diagnosed with acute DVT between January 2012 and May 2021 and treated and followed up in our clinic were retrospectively analyzed. The patients were divided into three groups according to treatment method. The patients who received MT treatment were defined as Group 1, anticoagulant treatment after ST as Group 2, and anticoagulant treatment after PMT as Group 3. The patients were called to the outpatient clinic, informed consent was obtained, EuroQol-5D-3 L (EQ-5D-3 L) scoring and Villalta scoring were performed, and anamnesis was taken. RESULTS: A total of 160 patients were included, with 71 (44.4%) patients in Group 1, 45 (28.1%) in Group 2, and 44 (27.5%) in Group 3. The mean age was 48.9 ± 14.9 years for Group 1, 42.2 ± 10.8 for Group 2, and 29.0 ± 7.2 for Group 3. When the time to return to normal life and the EQ-5D-3 L score index were compared, the differences between Groups 1 and 2 and between Groups 1 and 3 were statistically significant (P = .000 and P = .000, respectively). However, the differences between Groups 2 and 3 were statistically insignificant (P = .213 andp = .074, respectively). When Villalta scores and EQ Visual Analogue Scale (EQ-VAS) scores were compared between groups, the difference between all groups was statistically significant (P = .000). CONCLUSIONS: The medical treatment alone was observed to be insufficient in terms of symptomatic improvement, development of PTS, quality of life, and long-term complications. When the ST and PMT groups were compared, it was determined that PMT treatment was more advantageous in terms of EQ-VAS score and PTS development, although there was no statistical difference regarding complications, such as return to normal life and long-term quality of life, the incidence of recurrent DVT development, and pulmonary thromboembolism incidence.

Transcaval Coil Embolization of Type 2 Endoleak After Endovascular Aortic Repair: An Institutional Review.

OBJECTIVES: Endovascular aortic repair may be complicated by type 2 endoleaks. Intervention is generally recommended when the native sac continues to grow more than 5 mm. Transcaval coil embolization (TCE) of the native aneurysm sac is an emerging technique for repair of type 2 endoleaks. The objective of this study is to report an institutional review of our experience with this technique. METHODS: 11 patients underwent TCE during the study period. Data were gathered on demographics, size increase of native aneurysm sac, operative details, and outcomes. Technical success was defined as resolution of the endoleak during completion sac angiogram at end of the procedure. Clinical success was defined as no growth in the aneurysm sac at interval follow-up. RESULTS: Coils were the embolant of choice in all cases. Technical success was achieved in all cases except 1 resulting in a 91% technical success rate. Median follow-up was 25 months (range, 3-33). Of the ten patients that had technically successful embolization, 8 patients had repeat computed tomography (CT) scans which showed no further expansion of the native sac resulting in a 80% clinical success rate. No complications were noted immediately post-op or at interval follow-up. CONCLUSIONS: This institutional retrospective review demonstrates that TCE is an effective and safe option for type 2 endoleaks after endovascular aortic repair (EVAR) in selected patients with favorable anatomy. Longer term follow-up, more patients, and comparison studies are needed to further define durability and efficacy.

Applying Artificial Intelligence to Predict Complications After Endovascular Aneurysm Repair.

Objective: Complications after Endovascular Aneurysm Repair (EVAR) can be fatal. Patient follow-up for surveillance imaging is becoming more challenging as fewer patients are seen, particularly after the first year. The aim of this study was to develop an artificial intelligence model to predict the complication probability of individual patients to better identify those needing more intensive post-operative surveillance. Methods: Pre-operative CTA 3D reconstruction images of AAA from 273 patients who underwent EVAR from 2011-2020 were collected. Of these, 48 patients had post-operative complications including endoleak, AAA rupture, graft limb occlusion, renal artery occlusion, and neck dilation. A deep convolutional neural network model (VascAI©) was developed which utilized pre-operative 3D CT images to predict risk of complications after EVAR. The model was built with TensorFlow software and run on the Google Colab Platform. An initial training subset of 40 randomly selected patients with complications and 189 without were used to train the AI model while the remaining 8 positive and 36 negative cases tested its performance and prediction accuracy. Data down-sampling was used to alleviate data imbalance and data augmentation methodology to further boost model performance. Results: Successful training was completed on the 229 cases in the training set and then applied to predict the complication probability of each individual in the held-out performance testing cases. The model provided a complication sensitivity of 100% and identified all the patients who later developed complications after EVAR. Of 36 patients without complications, 16 (44%) were falsely predicted to develop complications. The results therefore demonstrated excellent sensitivity for identifying patients who would benefit from more stringent surveillance and decrease the frequency of surveillance in 56% of patients unlike to develop complications. Conclusion: AI models can be developed to predict the risk of post-operative complications with high accuracy. Compared to existing methods, the model developed in this study did not require any expert-annotated data but only the AAA CTA images as inputs. This model can play an assistive role in identifying patients at high risk for post-EVAR complications and the need for greater compliance in surveillance.

Safety and Efficacy of Combining Saphenous Endovenous Laser Ablation and Varicose Veins Foam Sclerotherapy: An Analysis on 5500 Procedures in Patients With Advance Chronic Venous Disease (C3-C6).

BACKGROUND: endovenous laser ablation (EVLA) represents the gold standard in treating both great and small saphenous veins (GSV and SSV) incompetence. To achieve a "no-scalpel" procedure in patients with chronic venous insufficiency (CVI, CEAP C3-C6), concomitant phlebectomies could be replaced by ultrasound-guided foam sclerotherapy (UGFS) into varicose tributaries. The aim of this study is to present a single-centre experience on EVLA + UGFS for patients with CVI secondary to varicose veins and saphenous trunk incompetence, analysing ling-term outcomes. METHODS: all consecutive patients with CVI and treated by EVLA + UGFS from 2010 to 2022 were included in the analysis. EVLA was performed using a 1470-nm diode laser (LASEmaR® 1500, Eufoton, Trieste, Italy), adapting the linear endovenous energy density (LEED) depending on saphenous trunk diameter. Tessari method was used for UGFS. Patients were evaluated clinically and by duplex scanning at 1, 3 and 6 months, and annually up to 4 years, to assess treatment efficacy and adverse reactions. RESULTS: 5500 procedures in 4895 patients (3818 women, 1077 men) with a mean age of 51.4 years were analysed during the study period. A total of 3950 GSVs and 1550 SSVs were treated with EVLA + UGFS (C3 59%, C4 23%, C5 17% and C6 1%). Neither deep vein thrombosis nor pulmonary embolism were detected during follow-up, as well as superficial burns. Ecchymoses (7%), transitory paraesthesia (2%), palpable vein induration/superficial vein thrombosis (15%) and transient dyschromia (1%) were registered. Saphenous and tributaries closure rate at 30 days, 1 and 4 years were 99.1%, 98.3% and 97.9%, respectively. CONCLUSIONS: EVLA + UGFS for an extremely minimally invasive procedure appears to be a safe technique, with only minor effects and acceptable long-term outcomes, in patients with CVI. Further prospective randomized studies are needed to confirm the role of this combined therapy in such patients.

Emerging Approaches to Augmentation Mastopexy in the Nontraditional Weight-Loss Patient.

An aesthetic result of the breast for a body contouring patient is approached from a reconstructive standpoint rather than a cosmetic one. Attenuation of the supportive ligaments, a damaged soft tissue envelope, and generalized laxity of the torso, all contribute to one of the most complex problems in body contouring. The marriage of the reconstructive approach to the breast, advanced soft tissue maneuvers, and new technologies allow for unprecedented results. This chapter presents emerging approaches for supported volumization of the breast through techniques such as breast cerclage suspension, subfascial augmentation, composite augmentation with fat grafting, and additive mesh support.

Secondary Body Contouring.

Body contouring surgeries, common yet intricate owing to unique patient characteristics, often necessitate revisions or secondary procedures. Balancing patient expectations and surgical limitations while methodically addressing shortcomings is crucial. This article aims to provide an extensive understanding of managing such complex cases, thus enhancing the reader's approach to secondary body contouring surgeries.

Lipoabdominoplasty with Anatomical Definition: Update.

There is a continuous search for better technical alternatives for the treatment of abdominal contour deformities in the practice of plastic surgeons. LADE-lipoabdominoplasty (LAP) with anatomical definition-is a step ahead of the traditional LAP technique. This technique incorporated the principles of highlighting the definition of the abdominal musculature, achieving more natural results with fewer reminders of a surgical intervention. The esthetic results are much harmonious, with a true abdominal rejuvenated appearance. We can reduce morbidity by the preservation of perforating blood vessels and suspension of Scarpa's fascia. The correct selection of the patient makes the procedure safe and reproducible.

The Role of Noninvasive and Minimally Invasive Techniques in Open Surgical Interventions for the Purpose of Body Contouring.

In his practice, the author has been using noninvasive devices, including Evolve X-radiofrequency-based procedure for tightening of the skin, melting of the subdermal fat deposits and muscle stimulation, all done simultaneously together and truSculpt flex-electrical muscle stimulation. Minimally invasive procedures include BodyTite, FaceTite, and AccuTite, radiofrequency-based procedures for permanent fat destruction and tightening of the skin. Morpheus8 and Morpheus8 Body are radiofrequency based-procedures for tightening of the skin. VASERlipo is an ultrasound-based procedure for liposuction and muscle definition. Vibrational type of liposuction has been used for the purpose of liposuction and muscle definition in combination with VASERlipo.

Interplay of Oblique Flankplasty with Vertical Medial Thighplasty.

After 25 years' experience, the authors present the senior author's current integration of lower body lift with vertical medial thighplasty. Mostly, oblique flankplasty with lipoabdominoplasty (OFLA) has replaced the traditional transverse posterior lower body lift and abdominoplasty due to improved esthetics and lower rate of complications. OFLA proceeds either immediately or as a first stage to the medially based reduction of thighs. L-vertical medial thighplasty, facilitated by excision site liposuction and scalpel assisted skin avulsion, is our preferred complimentary operation for predictable results and low rate of complications.

Finesse in Fleur-de-lis Abdominoplasty.

Body contouring for weight loss patients usually requires not only lifting but also some extent of central body tightening to achieve complete tissue readjustment. Fleur-de-lis abdominoplasty provides best vector correction with nice contouring results, especially for central body type patients, with superior waist definition with or without associated circumferential belt lipectomies. Special interest has been addressed on technical refinements to enhance vertical scar with neoumbilicoplasty as well as the mons pubis projection with marking and suturing refinements. Both the inner scar umbilicus and the monsplasty are simple, safe, and reproducible techniques, presenting low complication rates with sustainable and natural results.

Management of the Musculoaponeurotic Layer in Abdominoplasty.

Abdominoplasty has evolved in the last few decades, especially the treatment of the myoaponeurotic deformities. Bulging, lack of definition of the abdominal contour, should be understood and treated according to the individual deformity. Many types of deformities have been recognized and treatment respects the local anatomy in most cases. Scientific basis that consolidate these treatments are discussed as well as possible recurrences and pitfalls of these techniques. The histological composition of muscles and fascia are also discussed and anatomical details help to enrich the knowledge of the correction of this layer. Specific types of sutures are suggested for both plications and muscle advancement.