Abdominal wall reconstruction with Two-step Technique (TST): a prospective study in 20 patients.

Abdominal wall defects continue to be a challenging problem for reconstructive surgeons. The aim of our study was to report a 3-year experience using a simple Two-step Technique (TST) to treat abdominal wall defects. Between January 2008 and December 2010, 20 patients with abdominal wall defects were treated by TST. Patients had a mean age of 37·5 ± 14·9 years (range: 22-85 years); 5 were women and 15 were men. The size of the defects was prospectively analysed. Early and late complications were recorded. Hospital stay, post-procedure downtime and patient overall satisfaction were systematically assessed. A secondary defect resulting from self-manipulation and an infection were responsible for a complication rate of 10%. Both underwent successful surgical revision which led to full resolution. The average hospital stay was 11·2 ± 4·9 weeks for the series. Long-term complications were scar hyperpigmentation in 11 cases, scar hypertrophy in 5 cases and scar widening in 3 cases. Mean patient satisfaction was 8·3 ± 0·5 [visual analogue scale (VAS) 0-10]. Average downtime post surgery was 4·1 ± 1·2 weeks. The mean follow-up was 24·6 ± 6·7 months. Reconstruction of abdominal wall defect with the TST is a reliable and reproducible technique. This technique provides excellent outcomes, and we anticipate that it will become widespread in the near future.

Six-month follow-up multicenter prospective study of 368 patients, phototypes III to V, on epilation efficacy using an 810-nm diode laser at low fluence.

Laser hair removal is currently a popular cosmetic procedure. Traditional high-fluence laser treatment for hair elimination is associated with discomfort and adverse events and it is restricted to low phototype skins. A multicenter study of hair epilation with low fluences and high repetition pulse rate using an 810-nm diode laser was carried out on 368 patients (phototypes III to V) to test its efficacy in a 6-month follow-up after five treatments on the face and various body areas. Objective and subjective assessment as well as histologies show a high index of patient satisfaction due to high efficacy of hair elimination, also proved histologically by the damage observed at hair structure level. Results obtained a high degree of patient satisfaction and a low index of adverse events. Laser epilation was well accepted regarding discomfort and was also complication-free for dark and tanned skins. Treatment is easy to conduct and requires adapting the movement of the hand-piece to a constant speed in order to achieve high-energy deposit on tissue avoiding risks of burning.

Histological findings in adipocytes when cellulite is treated with a variable-emission radiofrequency system.

Cellulite is a disorder of the subcutaneous fat layer and the overlying superficial skin. Recently, radiofrequency (RF) has been proposed as an effective treatment of cellulite; however, the mechanism through which the absorbed electrical energy acts on the tissue is still not fully clear. This study reports on the histological findings from biopsies taken immediately after a single RF treatment session, on cellulite located in the buttocks, with a novel technology called automatic multi-frequency and low impedance (AMFLI) RF. Tissue samples were stained with either haematoxylin and eosin (H&E), so that we could study the morphological findings, or with oil red O, to enable us to identify lipid deposits. The histological findings observed in biopsies taken after a single RF treatment showed changes in shape, size, and lipid content, as well as in cytoplasmic and nuclear morphology. After RF treatment adipocytes were more polyhedric, with irregular, degenerated membranes, with less or no lipid content and apoptotic changes. We postulate that RF treatment on cellulite produces a decrease in lipid content of cells as well as changes in the adipocyte membrane which will lead to cell rupture and the death and extrusion of lipid content out of the cell. Further studies are needed to characterise the nature of the extra-cellular lipid material that we have demonstrated with the oil red O stain in our biopsies.

A multicenter study of cellulite treatment with a variable emission radio frequency system.

Radio frequency (RF) systems have been reported as producing electrothermally mediated and subcutaneous effects. The present study evaluates a new approach to treat cellulite with a bipolar RF device. The buttocks of 50 patients were treated, 10 from each of five multinational centers with a novel bipolar RF technology set at 6 J/cm(3), which changes its frequency between 0.6 and 2.4 MHz according to impedance of tissue. Twelve weekly sessions were given for 12 minutes on each buttock, with a treatment end point of 42 degrees C external skin temperature. Cellulite changes and tissue condition were assessed before and immediately after the first session, before the final 12th session, and 2 months thereafter. The patient Satisfaction Index was recorded. Objective evaluation involved clinical photography, three-dimensional optical skin surface measurement, and histological findings. Almost all patients noted improvement of cellulite and body silhouette at the final session, which slightly decreased at the 2-month assessment. Improved skin appearance was objectively detected. Histological findings following the first session showed reactive edema and lysis of adipocyte membranes, possibly implicated in the final effects achieved. The RF technology used in the present multicenter study improved the general aspect of skin and cellulite, with high patient Satisfaction Index. Maintenance sessions might lead to even better and longer-lasting results.

Abdominal Wall Reconstruction with the Two-step Technique: Procedure Optimization and Three-year Follow-up in 26 Surgeries.

BACKGROUND: Complex or recurrent abdominal wall defects may be the result of trauma, infection, tumor resection, or a previous failed attempt at closure, among other causes. This article describes a new surgical technique that better addresses these defects and provides safety and efficacy data from 26 consecutive surgeries with a 3-year follow-up. METHODS: Prospective study in 18 men and 8 women with serious abdominal wall defects, who were surgically operated on using the two-step technique, which includes a first regenerative and closure step using a vacuum device (vacuum-assisted closure), and a second reconstructive step that does not require the use of any type of surgical mesh. The safety and efficacy results were evaluated through clinical examinations and questionnaires. The severity of patient-experienced pain and both patient and surgeon satisfaction were quantified on a scale from 0 to 10 points. The statistical calculations focused on the mean (m), range (r), and percentage (%). RESULTS: The mean complete surface area of the abdominal wall defects was 250.2 cm2 (r = 78-770 cm2). The patient and surgeon satisfaction rates at the time of hospital discharge were m = 9.0 (r = 3-10) and m = 9.4 (r = 8-10), respectively. After 3 years, these rates were m = 7.2 (r = 3-10) and m = 9.8 (r = 9-10), respectively. No relevant complications were observed in any stage of the study and no recurrence was observed 3 years later. The main complaint of patients was the presence of hypertrophic scars from the surgical wound (57% of cases). CONCLUSION: The two-step technique is an excellent alternative for the repair of complete abdominal wall defects of up to 800 cm2 because it allows serious complications to be avoided, prevents recurrences, and shows high rates of both patient and surgeon satisfaction.

Hair structures are effectively altered during 810 nm diode laser hair epilation at low fluences.

BACKGROUND: Diode lasers with high fluence and cooling technology are effective at removing unwanted hair but are also associated with discomfort and morbidity, especially when treating dark or tanned skins. METHODS: Thirty patients with skin phototypes IV and V (range: 23-62 years of age; average: 39 years) underwent a single hair removal treatment using a new diode laser (810 nm) technology that incorporates low fluence but very high average power. The treatment technique employed multiple, in-motion, repetitive laser passes on a 100 cm(2) area of the skin. A 5mm punch biopsy was carried out before and after a single treatment. Tissue samples were harvested and stained with haematoxylin-eosin. RESULTS: The physical integrity of hair follicles was altered with inflammatory infiltrate, hair shaft detachment from its sheath, and perifollicular oedema, related to incipient necrosis. CONCLUSION: Low fluence but high average power diode laser technology yields significant changes in hair structure and architecture in patients with dark skin types. The procedure caused low levels of discomfort and was well tolerated.