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BACKGROUND A bipolar fractional radiofrequency (RF) device was developed to generate cutaneous thermal injuries using a temperature-controlled microneedle electrode array. OBJECTIVE Evaluate safety and efficacy of a novel subcutaneous microneedle RF for treatment of posterolateral thigh cellulite. METHODS The study design was an institutional review board-approved multicenter clinical trial after a perprotocol analysis. Fifty subjects with Nurnberger-Muller Grade II or III cellulite were enrolled at 4 treatment centers and received 1 subcutaneous microneedle RF treatment (67°C/4-second duration). Efficacy was evaluated by blinded grading by 3 dermatologists using randomized, standardized photographs and investigator grading at baseline, 1-, 3-, and 6-month follow-up. As per the Food and Drug Administration, treatment success was defined by ≥1-point improvement on dimple number or severity of undulation irregularities scales by at least 2 of 3 blinded physicians. Study subjects' self-assessments and satisfaction questionnaires and procedural pain levels and adverse events were monitored. RESULTS Blinded physician evaluations revealed a procedural success rate of 93% at 6-month follow-up. Procedural pain level was 3.74 ± 1.96 on a 10-point scale. There were no adverse events. Seventy-five percent of subjects were satisfied with the results at 6-month follow-up. CONCLUSION The results indicate that subcutaneous microneedle RF treatment is safe and effective for long-term treatment of Type II and III cellulite in a single session. [ABSTRACT FROM AUTHOR]

Background Tissue adhesives have been widely used for wound closure, especially in children, because they are painless, fast, and easy to use and result in minimal scarring. Objective To analyze the biocompatibility of an adhesive based on n-butyl-cyanoacrylate in the subcutaneous tissue of rats. Materials and Methods Two surgical sites were prepared (approximately 3 cm apart): one on the left side of the animal and the other on the right side); polyethylene tubes were implanted in each surgical site. The tube on the left was filled with n-butyl-cyanoacrylate (treated group) and the tube on the right side was unfilled (control group). After 7, 30, and 120 days, the animals were killed, and the specimens were processed for histologic analysis. Results No significant inflammatory reaction occurred in the treated group, showing results similar to the control group. Conclusion This adhesive based on n-butyl-cyanoacrylate is biocompatible in the subcutaneous tissue of rats. [ABSTRACT FROM AUTHOR]

BACKGROUND Although the Z-plasty has been used on the lips in various applications, its novel utility in improving classic vertical (radial) lip reconstruction has not been described previously. OBJECTIVE To demonstrate the advantages of Z-plasties in vertical lip reconstruction, to explore six distinct causes of lip deformities that arise during reconstructive surgery and how those complications can be avoided by employing traditional Z-plasties or a new modification we term the 'sliding Z-plasty,' and to provide an entirely original first-time analysis of the geometry and physical dynamics of lip reconstruction. MATERIALS AND METHODS We explored the planning and execution of lip reconstruction using traditional Z-plasties and a new sliding Z-plasty modification. This analysis uses case reports, original illustrations, and an in-depth discussion of the spatial dynamics of lip reconstruction. CONCLUSION Traditional or sliding Z-plasties can improve the final outcome of vertical lip reconstruction while avoiding or mitigating six distinct potential complications associated with classic repairs. The authors have indicated no significant interest with commercial supporters. [ABSTRACT FROM AUTHOR]

The authors have indicated no significant interest with commercial supporters. [ABSTRACT FROM AUTHOR]

Although various commercially available filler materials are now commonly used, their variable degrees of resorption require repeated percutaneous injections. To overcome these drawbacks, a new injectable in vitro differentiated adipocyte filler has been developed, and animal studies have demonstrated that implantation of the filler successfully enhances in vivo adipose tissue formation. This study was undertaken to evaluate the clinical efficacy of this method, particularly in soft tissue augmentation. Autologous adipose-derived stromal cells were isolated, cultured, and differentiated to adipocytes in vitro. The differentiated adipocytes were suspended in Dulbecco's modified Eagle medium and injected into the lesion requiring soft tissue augmentation. Eight patients were treated with this tissue-engineered filler. Long-term follow-up for longer than 1 year was possible in all patients. Two or 3 weeks after the injection, volume increment of subcutaneous tissue was observed around the injection area in the ensuing 1 to 5 weeks. Thereafter, additional volume augmentation was not found and the augmentation effect was well-maintained. All patients agreed on the clinical effectiveness of the procedure, and no complications occurred. The results obtained indicate that this method is well tolerated and may be an effective means of achieving soft tissue augmentation. The authors have indicated no significant interest with commercial supporters. [ABSTRACT FROM AUTHOR]

The author has declared no conflicts in regards to this article. [ABSTRACT FROM AUTHOR]

The article discusses the proper knot tying technique in dermatological surgery to ensure good outcomes and avoid suturing complications such as infection and scarring. It states that knot orientation and strand ends may be controlled by observation and analysis of square knot tying process which is important in proper healing of the wound. It mentions that the oblique buried suture on standard vertical subcutaneous sutures covers more tissue area that allows surgeons to stitch easily.

The authors have indicated no significant interest with commercial supporters. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 63-year-old man with lesion on his scalp. He was subjected to biopsy under local anesthetic and histopathologic examination, revealed a dermal and subcutaneous lesion, and was diagnosed with superficial angiomyxoma. The patient was undergone Mohs micrographic surgery.

BACKGROUND Cellulite is characterized by alterations in the relief of the skin surface. Magnetic resonance imaging (MRI) is recognized as a reliable technique for measuring adipose volume according to body site and for the visualization of the subcutaneous structures. OBJECTIVE To compare subcutaneous tissue in areas with and without cellulite on the buttocks of same subjects using a noninvasive technique. METHODS AND MATERIALS Thirty female patients with cellulite on the buttocks underwent MRI. An area with cellulite and another without cellulite on the contralateral buttock were selected. Two soft gelatin capsules of different sizes were used as skin markers to differentiate the areas with and without cellulite. RESULTS Fibrous septa were visualized in 96.7% of the area with cellulite depressions; most of them were ramified (73.3%) and presented a high-intensity signal on T2 images (70%). All fibrous septa found in the examined areas were perpendicular to the skin surface. The average fibrous septa thickness was 2.18 ± 0.89 in the area with cellulite and 0.27 ± 0.64 in the area without cellulite. CONCLUSION Results of the MRI analysis showed that cellulite depressions on the buttocks were significantly associated with the presence of underlying fibrous septa. [ABSTRACT FROM AUTHOR]

BACKGROUND Dystrophic calcification (DC) is a risk factor for conservative treatment failure in chronic leg ulcers of various pathologies. PATIENTS AND METHODS We performed a retrospective noncontrolled trial of 212 patients with 362 chronic leg ulcers who underwent ulcer shave excision with subsequent skin grafting. The ulcers existed for at least 3 months, and no healing was achieved with good ulcer care. Tissue was subjected to histopathology (hematoxylin-eosin and van Kossa stains). RESULTS DC was evident in 39 patients (18%). Metaplastic subcutaneous bone formation was observed in 15 patients (7%). Clinical symptoms associated with DC were resistance to good ulcer care, pain, and ineffective effects of compression therapy (in venous ulcers). Ulcers were treated with deep dermatome shaving of the ulcer bed and surgical removal of DC. In the same setting, defects were closed using mesh graft transplantation. The procedure achieved a complete take rate in 80% and a significant decrease of pain in 95% of cases. When comparing the take rates in patients with and without DC, DC had a negative effect on outcome (take rate: 91% without DC vs 80% with DC, p<.05). CONCLUSIONS DC is resistant to conservative treatment. The first-line treatment is deep ulcer dermatome shaving and complete removal of calcifications whenever possible. [ABSTRACT FROM AUTHOR]

A case study of a 62-year-old woman with a subcutaneous nodule is presented. This appears within a scar on the left parietal and posterior auricular scalp. She first noted a nodule at that site at age 46 that slowly enlarged over 5 years until she first sought medical attention. A magnetic resonance image of the head and neck with and without contrast showed no bony changes, so the patient and physician decided to follow the area clinically rather than perform further surgery.

The article focuses on the string-of-beads biopsy, a standard punch biopsy technique that was easy to use and quick in obtaining diagnostics for evaluation of dermal and subcutaneous processes. The string-of-beads biopsy technique was proposed as an alternative to the traditional large biopsy or incision biopsy that was believed to be sufficient in creating an accurate histopathologic diagnosis. It enumerates the materials to be used and the methods on how to perform the string-of-beads biopsy.

BACKGROUND Subcutaneous sweat gland suction curettage (SSGSC) is gaining acceptance as a therapy for axillary hyperhidrosis. Despite its acceptance, there remains a lack of prospective data describing the efficacy and long-term outcome of SSGSC. OBJECTIVE We examined the sweat rates and patients' satisfaction of 12 months following SGSC in 28 patients with axillary hyperhidrosis. METHODS Axillary sweat rates were determined by semiquantitative gravimetry. A questionnaire was used to determine patients' satisfaction. RESULTS A 58% reduction in sweat rate under resting conditions and an 85% reduction during aerobic exercise in sweat rates was observed. A subdivision of patients into three groups based on their baseline preoperative sweat rates (<25, 25–50, and >50 mg/min) showed that patients with resting sweat rates over 25 mg/min benefited particularly from this procedure, whereas patients with less than 25 mg/min did not. CONCLUSION SSGSC produces a significant reduction in the preoperative sweat rates. A low complication rate and a high degree of patient satisfaction were observed. Long-term follow-up evaluations demonstrate a low number of relapses, making SSGSC a convenient and satisfactory method of treating axillary hyperhidrosis. It should be considered in patients refractory to conventional therapies with baseline sweat rates greater than 25 mg/min. [ABSTRACT FROM AUTHOR]

BACKGROUND Liposuction provides further reduction of axillary sweating and malodor when combined with dermal curettage with sharp rasping cannulas. This aggressive approach is associated with relatively higher rate of hematoma formation when compared to the conventional simple liposuction. OBJECTIVE The aim of this prospective, randomized, controlled trial was to evaluate the effect of quilting sutures on the incidence of hematoma formation after liposuction-curettage for treatment of axillary hyperhidrosis (AH). MATERIALS AND METHODS The trial randomized 59 male patients (118 axillae) undergoing liposuction-curettage for AH to quilting procedures (61 axillae) or control group (57 axillae) for intention-to-treat analysis. Outcome measures included the incidence of hematoma formation, operative time, degree of postoperative pain, and amount of analgesics consumption. RESULTS Quilting sutures significantly reduced the incidence of axillary hematoma from 28.1% to 4.9%. Quilting was associated with the lengthening of operative time but did not affect the postoperative pain. CONCLUSION Considering its efficacy in reducing postoperative hematoma, quilting is recommended in combination with aggressive liposuction-curettage procedure for treating AH and osmidrosis. [ABSTRACT FROM AUTHOR]

The article discusses bilateral advancement flaps with helical rim Z-plasty modification for the management of ear defects. The reconstructive procedure involves the closure of the ear defect with bilateral advancement flaps. The flaps are mobilized by undermining in the subcutaenous tissue and tissue movement is achieved by movement of flaps toward the defect.

The article discusses the subcutaneous island pedicle (SIP) flap as an ideal option for the repair of the upper lateral cutaneous lip defects in the U.S. Accordingly, the significant disadvantage of the flap is the cosmetic deformity caused by the obligatory scar which extends through apex along its medial boundary. Moreover, a scar can be treated by adding a Z-plasty to the inferior margin of the flap which breaks up its line. Also presented is the case report of an 80-year-old woman.

BACKGROUND. When a physician encounters a benign subcutaneous cyst in the cheek, his or her decision whether to excise and how to excise the cyst takes into account the potential risk of postsurgical scarring. OBJECTIVE. To describe and show an intraoral buccal mucosal approach to excising a cyst in the inferior-anterior cheek so that skin scarring is avoided. METHOD. An incision was made intraorally in the buccal mucosa, and dissection was carried through the buccinator muscle until the cyst wall was seen. Careful separation of tissue around the cyst was done by blunt dissection, and the unruptured cyst was removed through the buccal mucosal incision. RESULT. The entire intact cyst was removed without creating any excision marks in the cheek skin. No complications were encountered, and buccal mucosal healing was excellent. CONCLUSION. A buccal mucosal intraoral approach is an alternative to a percutaneous excision to remove a cyst in the lower cheek region. The intraoral approach avoids a visible scar on the cheek skin. [ABSTRACT FROM AUTHOR]

BACKGROUND. The subcutaneous pedicled nasolabial flap is a useful material for alar reconstruction. OBJECTIVE. This article describes the difficulties and considerations in this procedure and discusses the procedural problems involved, drawing conclusions from them. METHODS. Case 1: a folded flap was used with a conchal cartilage strut sandwich. Case 2: only a folded flap was used. Case 3: the flap was used to cover the outer surface of the ala, and a muco-periosteal graft from the hard palate was used for the ala lining. RESULTS. The cartilage strut was not sufficient to support the shape of the ala in case 1. Harvesting a sufficiently wide flap is thought to be important. However, a folded flap had some drawbacks, with the formation of a thick alar rim. CONCLUSIONS. The combination of a flap for the outer surface and a mucoperiosteal graft as a lining is thought to be an excel- lent option for alar reconstruction. [ABSTRACT FROM AUTHOR]

The subcutaneous island pedicle flap is a useful closure in many areas on the face, particularly the cheek and upper lip. One disadvantage can be that the advancing edge of the flap leaves a scar at right angles to the local lines of relaxed skin tension. Tension on free edges such as the lid can also be a problem, but may be mitigated by incorporating an element of rotation into the closure. A variation on the subcutaneous island pedicle flap is described to help avoid the problems of the subcutaneous island pedicle flap while retaining its strengths. Our experience with more than 120 rotating island pedicle flaps over 10 years is described to demonstrate the versatility of this subcutaneous island pedicle flap for facial and reconstructive surgery. The technique is described and seven representative cases are presented with photographs. The flap is simple to perform, has minimal complications, and has good cosmetic results. Temporary alteration of sensation in the flap skin is a possible complication and can be largely avoided with a bipedicled dissection technique Our experience shows the rotating island pedicle flap to be versatile, reliable, and aesthetic island pedicle flap for skin cancer surgery both on and off the face and a practical modification of the subcutaneous island pedicle flap. PAUL J. M. SALMON, MBCHB, FRACP, AND MICHAEL F. KLAASSEN, MBCHB, FRACS HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [ABSTRACT FROM AUTHOR]

BACKGROUND. As the human face ages, there is a depletion of fat that occurs in the submalar region. Various techniques such as fat transfers, fillers, alloplastic implants, and composite rhytidectomies have been used to augment this area in the past. OBJECTIVE. To describe a technique that augments the submalar areas during facelift surgery without the use of fat transfer, fillers, alloplastic implants, or a risky composite technique. METHOD. An oval is scribed over the depressed submalar areas preoperatively. During facelift surgery, a fusiform area is scribed over the SMAS. This fusiform is scribed so that the medial end is directed at the center of the submalar depression, and the lateral end is toward the posterior earlobe. A defect is created within the lateral aspect of the fusiform, but not the medial portion. The fusiform is subsequently closed with a 2-0 Ethibond suture using three horizontal mattress sutures and two interrupted sutures. Upon closure of this defect, SMAS, subSMAS, and subcutaneous tissue overlying the SMAS are recruited into the submalar defect by the simple phenomenon of dog-ear formation. Additionally, there is a component of frank elevation of the tissues inferior to the medial aspect of the fusiform and submalar space. RESULTS. The aforementioned technique has been performed on 123 patients over 7 years and has resulted in consistently good improvement in the submalar space. The procedure is not difficult to learn, and good results can be achieved with initial cases. The learning curve was not found to be steep, with good results being achieved quickly. CONCLUSION. Depression of the submalar space plays a significant role in creating an aged face. In the past, various fillers and/or alloplastic implants have been used to augment this region. A low-risk method is described that mobilizes SMAS, subSMAS, and subcutaneous tissues into the submalar space through the phenomenon of dog-ear formation after fusiform closure. [ABSTRACT FROM AUTHOR]

Background. With the advent of tumescent liposuction, many advances in cosmetic surgery have occurred. Liposuction of excess adipose tissue from the submental area, jowls, and neck, along with cold steel surgery, has become an attractive alternative to the facelift for cervicomental aesthetic surgery. Objective. To describe new techniques for tumescent neck liposuction, platysma repair, and subcutaneous musculoaponeurotic system plication, evaluate results, and assess complications with the procedures. Methods. We reviewed the results of the last 35 patients who underwent neck liposuction, simultaneous platysma plication, subdermal CO2 laser resurfacing, and/or subcutaneous musculoaponeurotic system plication at our institution. Results. Three of 35 patients (9%) experienced mild complications from the procedure. Two of the three complications (66%) were in patients who underwent subdermal and/or platysma laser resurfacing at the time of liposuction. Good to excellent results were achieved in 91% of patients and fair to good results were achieved in 9%. No major complications such as nerve injury occurred. Conclusion. Neck liposuction can be a safe method for facial rejuvenation when performed properly. Platysma repair, and in some cases subcutaneous musculoaponeurotic system plication, can further improve results when combined with the liposuction procedure. [ABSTRACT FROM AUTHOR]

Background. Increasing demand exists for cosmetic correction of soft tissue contour defects. Treatments include simple tissue augmentation techniques or more complex surgeries with consequent relevant recuperation time for the patient. The search for new simple techniques to correct scars and age-related wrinkles and folds is therefore one of the main goals of cosmetic dermatologic surgery. Objective. To improve the cosmetic outcome of patients suffering from soft tissue contour defects by the use of a novel surgical instrument and technique, subcutaneous dissection by wire scalpel. Methods. Fifty-four patients were treated with the wire scalpel technique with no skin incisions to correct a total of 132 depressed cosmetic defects of the face. Forehead lines, glabellar, nasolabial and oral commissure folds, upper lip wrinkles, and acne scars were treated. A 2-month to 4-year follow-up allowed subjective and photographic evaluation of results. Results. Good or satisfactory results were obtained in 79.7% and 16.6% of the cases, respectively. Minor complications did not change the overall positive outcome of the surgery. Conclusion. Subcutaneous dissection by wire scalpel is a simple, safe, and effective method to improve the contour appearance of patients affected with scars or age-related contour defects. [ABSTRACT FROM AUTHOR]

Background. The treatment of chronic lesions in hidradenitis suppurativa remains a challenge. For some clinical types surgical management is an excellent alternative. Objective. This study evaluates an alternative surgical approach for the treatment of hidradenitis suppurativa of specific bridging lesions by subcutaneous resection of the tubular fibrotic tissue. Methods. Periorificial fusiform skin incisions were made around the orifices parallel to the axillary or inguinal folds and the subcutaneous tubular fibrotic tissue was removed en bloc before skin suturing. Results. The outcome was evaluated as satisfactory due to lower morbidity, minimizing the excised skin areas, prevention of bridles or adherences, shorter incisions, no healing difficulties, and less dehiscence or wound exposure. Conclusion. The subcutaneous fistulectomy is a surgical option in bridging hidradenitis suppurativa. [ABSTRACT FROM AUTHOR]

Dermatologic surgery can usually be performed under local anesthesia. The range of options for this type of anesthesia was expanded by the finding that even highly diluted solutions of local anesthetics are effective when combined with epinephrine. Such solutions were first used in large quantities for tumescent anesthesia in liposuction, since they are much more effective in the subcutaneous tissue than in the dermis. Since that time, tumescent anesthesia has also proved to be useful for vein stripping, dermabrasion, and many other procedures as well, and special pumps have been developed that make the injection of large amounts of liquid effortless.

The article discusses how surgeons close the wide hair transplantation donor wound. It states the need of surgeons to minimize the follicle damage by performing a tension-free skin closure with trichophytic closure and allow the hairs to grow through donor scar. It also mentions that modified two-layer closure technique moved tension deeper into dermis and subcutaneous tissue.

The article offers information on subcutaneous inverted cross mattress (SICM) stitch, which is a combination of pragmatic buried vertical mattress and buried pulley stitches. It states that the combination of the said stitches enables SICM stitch to reduce tension and evert wound edges to ease approximation. It adds that SICM's pulley system locks together wound edges; thus, tying of knots can be made without slipping. Moreover, the stitch can be used in all intermediate and complex closures.

The article presents an evaluation of a nonsurgical technique for improving the structure and contour of the nose that uses subcutaneously injected calcium hydroxylapatite filler. It reveals that surgical rhinoplasty has been the therapeutic gold standard for individuals seeking to improve cosmetic appearance of their nose. It states that in many cases, post-operative edema and ecchymoses have resulted in prolonged downtimes and significant delays in achieving desired cosmetic outcomes.

BACKGROUND. Only seven cases of cartilaginous tumors of the skin have been described in the dermatologic literature. OBJECTIVE. We studied the nature of cutaneous cartilaginous tumors and their clinical spectrum. METHODS. We describe a 56-year-old woman with a superficial cartilaginous tumor of the sole of the foot. The tumor appeared to be a cutaneous mass and was resected. RESULTS. Histologically, the tumor extended from the dermis to the subcutaneous tissue. Despite the presence of foci of nuclear changes that suggested a malignancy, there has been no recurrence in the 3 years since its removal. Our review of previous reports indicated that this case may have been a soft tissue chondroma. And it confirmed that cutaneous cartilaginous tumors comprise a superficial soft tissue chondroma and a true cutaneous chondroma primarily located in the dermis. CONCLUSION. Our case appeared to be a cutaneous cartilaginous tumor. A complete local removal is the treatment of choice. [ABSTRACT FROM AUTHOR]

The article provides information on cutaneous crepitus, a rare sign that indicates subcutaneous emphysema (SE) which leads to gas gangrene disorder. This condition may be due to infection and traumatic events including iatrogenic maneuvers, perforation of the pulmonary tracts and dental extraction. The condition of a 76-year-old female patient who was examined to have benign subcutaneous emphysema after a skin biopsy was carried out is also discussed.

The article discusses a suture technique in the closure of a small wound under tension. This technique easily permits the placement of two buried vertical mattress subcutaneous sutures in the small wound. The treatment of a small lesion on a pilomatricoma overlying the bicep of a college athlete using this technique is discussed.

The article reports on the case of a 69-year-old man with a subcutaneous tophaceous nodule of the medial third of the dorsal portion of the nose. The patient has a history of gouty arthropathy. The nodule involved the joint between the triangular cartilage and the septum superiorly. An intraoperative view of the lesion is presented.