The role of laser tunnels in laser-assisted lipolysis.

Background And Objectives: Laser-assisted lipolysis (LAL) devices are used as adjuncts to liposuction that create laser tunnels to heat the adipose and connective tissue. Available systems vary significantly across choice of wavelengths, power delivery, and tip design. Rationale are developed for optimum laser parameters evaluated with physical principles and in controlled ex vivo tests.

Optimal parameters for marking upper blepharoplasty incisions: a 10-year experience.

Although a variety of techniques for upper blepharoplasty have been described, few studies illustrate and clinically evaluate a system for marking incisions. Presented is a 10-year experience using a specific method for marking upper blepharoplasty incisions that consistently yielded excellent esthetic results. All upper blepharoplasties performed by the senior author between April, 1994 and April, 2004 were reviewed.

Laser blepharoplasty with transconjunctival orbicularis muscle/septum tightening and periocular skin resurfacing: a safe and advantageous technique.

Carbon dioxide (CO2) laser blepharoplasty with orbicularis oculi muscle tightening and periorbital skin resurfacing is a safe procedure that produces excellent aesthetic results and diminishes the occurrence of complications associated with skin and muscle resection in the lower lid, particularly permanent scleral show and ectropion. The authors present a review of 196 cases of carbon dioxide laser blepharoplasty and periocular laser skin resurfacing performed at their center from April of 1994 to September of 1998. Of these cases, 113 patients underwent four-lid blepharoplasty, 59 underwent upper lid blepharoplasty only, and 24 underwent lower lid blepharoplasty only.

Tubulation repair of peripheral nerves in the rat using an inside-out intestine sleeve.

This study compared the regeneration of peripheral nerves in the Sprague-Dawley rat through a nerve guide prepared from rat small intestine to nerve regeneration using a standard autogenous nerve-graft repair strategy. In one experimental group (n = 15), inside-out rat intestine sleeves were used as nerve guides to bridge a 10-mm defect created in the right sciatic nerve. These nerve guides were prepared by harvesting 14-mm segments of small intestine from Sprague-Dawley rats not otherwise used in the study.

Hyaluronic acid enhances peripheral nerve regeneration in vivo.

Hyaluronic acid has been shown to enhance peripheral nerve regeneration in vitro. It has been proposed that, during the fibrin matrix phase of regeneration, hyaluronic acid organizes the extracellular matrix into a hydrated open lattice, thereby facilitating migration of the regenerating axons. Hyaluronic acid solutions and saline control solutions were injected into a nerve guide spanning a transected gap in the sciatic nerve of Sprague-Dawley rats (five in each group).

Skin tightening effects of the ultrapulse CO2 laser.

This study analyzed the skin tightening or contracture effect of the Ultrapulse carbon dioxide (CO2) laser on the skin of hairless guinea pigs by light and electron microscopic, histologic, and tensiometric evaluations. Two 2 X 2 cm squares of back skin were precision tattooed on each of the animals in the study (n = 12). One square served as the control, and the other square was used as experimental skin.

Transcutaneous access to retrograde axonal flow.

Transcutaneous entry of fluorescent tracer and subsequent retrograde neuronal transport achieved by the use of dimethyl sulfoxide (DMSO) as a vehicle fluorescent dye dissolved in DMSO and applied topically to the hind limb of rats was found in corresponding dorsal root ganglia; aqueous absorption of tracer dye by neuronal tissue was not demonstrated. This example of transcutaneous access and retrograde transport may have implications as to the entry of various toxins, viruses, chemicals, and therapeutic agents to the nervous system.

Complications of laser resurfacing.

The laser demonstrates significant benefits over traditional resurfacing and incisional techniques. Serious complications of laser surgery are easily avoidable provided practitioners and support staff receive proper education and training. The following article describes the more common complications of laser resurfacing followed by a brief discussion of avoidance techniques.

Inframammary crease ligament.

This study was designed to clarify and define the anatomic components of the inframammary crease in the female breast. Thirteen blunt dissections of the female breast were performed in cadavers and one dissection was performed in a living patient undergoing mastectomy. During the course of these dissections, a ligament was identified.

Continuous alteration of the internal milieu of a nerve-guide chamber using an osmotic pump and internal exhaust system.

The use of non-neural conduits to span gaps in regenerating peripheral nerves has been noted in the literature for many years. An intriguing addition to this so-called entubulation repair method is the continuous instillation of neuronotrophic or growth factors into the lumen of the guide to bathe the regenerating nerve. A model is presented which uses an osmotic pump that supplies a constant, reproducible amount of solution into the lumen of a nerve guide without disrupting the regeneration process.

Hyaluronic acid through a new injectable nerve guide delivery system enhances peripheral nerve regeneration in the rat.

The use of non-neural conduits to bridge gaps in peripheral nerves has been noted in the literature for many years. A logical extension of this concept is the introduction of neurotrophic or growth promoting factors into the lumen. We present here an injectable nerve guide that allows percutaneous access to the microenvironment of the regenerating peripheral nerve within the guide's lumen.

Inside-out vein graft repair compared with nerve grafting for nerve regeneration in rats.

The inside-out vein graft is a vein conduit pulled through itself to invert the normal orientation and place the adventitial layer within the lumen of the conduit. Our study compares regeneration of peripheral nerves in the rat through two conduits: inside-out graft of the jugular vein and autogenous nerve graft. In 10 rats, the right jugular vein was harvested, turned inside out, and used to bridge a 10 mm defect created in the right sciatic nerve.

Nipple placement in simple mastectomy with free nipple grafting for severe gynecomastia.

Severe gynecomastia with excessive skin is difficult to treat by only periareolar excision or suction-assisted lipectomy or both. In these patients, total mastectomy and free nipple grafting may be the best option. Placement of the nipple, however, has been arbitrary.

Normal sensation of the human face and neck.

A total of 116 adult volunteers were studied to determine normal values for static two-point discrimination and sensation of pressure of the head and neck. Thirteen regions of the head and neck corresponding to major sensory innervation were examined bilaterally for static two-point discrimination with the Mackinnon-Dellon Disk-Criminator and for sensation of pressure with Semmes-Weinstein monofilaments. Perception of two-point discrimination improved from lateral and posterior areas (17 to 25 mm) to the midline toward the lips (3 to 7 mm).

Immunocytochemistry of skeletal muscle basal lamina grafts in nerve regeneration.

The influence on nerve regeneration of the extracellular matrix glycoprotein laminin was studied after sciatic nerve transection in 90 outbred Sprague-Dawley rats. Nerve regeneration through basal lamina grafts was comparable with regeneration through traditional nerve grafts across gaps up to 2.0 cm in length.

Total versus partial musculofascial coverage for steroid-containing double-lumen breast implants in augmentation mammaplasty.

The use of intraluminal steroids in double-lumen breast implants is effective in preventing fibrous capsular contraction around the implant. This technique has not been accepted widely, however, and remains controversial primarily because steroid-related complications, including extrusion, late inferior migration, and atrophy of the skin, have been associated with their use. This nonrandomized retrospective study of 76 patients (146 breasts) who underwent submuscular augmentation of the breast through inframammary and periareolar incisions compares results after total musculofascial coverage of the implant with partial muscle coverage of the implant.

Inside-out vein graft promotes improved nerve regeneration in rats.

Vein grafts have been used both experimentally and clinically to bridge gaps in peripheral nerves. This study describes a modification of the vein graft technique in which vein graft conduits are pulled inside-out before anastomosis with proximal and distal nerve stumps. This technique creates an autogenous vein conduit with the collagen-rich adventitial surface exposed to the regenerating axons.

Sleeve insertion and collagen coating improve nerve regeneration through vein conduits.

Vein grafts have been used as conduits for nerve regeneration in both research protocols and clinical situations. Results to date are encouraging. This study investigated several variations in the vein graft model in an attempt to enhance peripheral nerve regeneration.

Common complications of wound healing. Prevention and management.

The culmination of any operation is a healed wound. Failure of a wound to heal increases time spent in the hospital and the expense, and may start a cascade of progressive complications. Thus, it is important to optimize as many factors as possible before operation and to have the knowledge and resources to deal with wound problems should they occur.

Single-dose electron beam irradiation in treatment and prevention of keloids and hypertrophic scars.

Low megavolt electron beam irradiation was used on 354 sites in 199 patients at the Lahey Clinic either for palliation of symptomatic hypertrophic scars or as post-operative irradiation in an attempt to prevent formation or recurrence of hypertrophic scars. Electron energies used ranged from 1.5 to 3.

Enhancement of peripheral nerve regeneration.

Numerous factors external to the nerve cell can support and enhance nerve regeneration after injury. The definition of these factors and the elucidation of their mechanisms of action are the central goals of much contemporary neurobiologic research. This research will hopefully lead to the discovery of factors that will prove to be therapeutically beneficial for patients with either peripheral nervous system (PNS) injury or central nervous system (CNS) injury.

Acidic fibroblast growth factor enhances peripheral nerve regeneration in vivo.

When added to a collagen-filled nerve guide, purified acidic fibroblast growth factor (aFGF) increased the number of myelinated axons that regenerated across a 5-mm nerve gap distance. In addition, a greater number of primary sensory and motor neurons extended axons through the nerve guide in animals treated with aFGF. Thus the effect of aFGF on peripheral nerve regeneration is not simply an increase in axonal branching within the nerve guide tube.

Effect of a high-intensity static magnetic field on sciatic nerve regeneration in the rat.

The effect of a high-intensity static magnetic field on peripheral nerve regeneration is evaluated in rat sciatic nerve. Forty-four rats underwent sciatic nerve repair using polyethylene nerve guides. Postoperatively, the animals were exposed to a 1-tesla magnetic field for 12 hours per day for 4 weeks with appropriate controls.