"Sure-closure" skin stretching system.
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Dermatologic Surgical Procedures↗
Biomedical subjects
B Hirshowitz
Publications and source records attributed to B Hirshowitz.
Static-electric field induction by a silicone cushion for the treatment of hypertrophic and keloid scars.
Silicone gel and silicone occlusive sheeting are widely used at present for the treatment of hypertrophic and keloid scars, without any scientific explanation as to their mode of action. In a recent paper the possibility was raised that static electricity generated by friction-activated silicone sheeting could be the reason for this effect, and that it can, with time, cause involution of hypertrophic and keloid scars. The objective of this study was to test this hypothesis and to observe whether a continuous and also an increased negatively charged static-electric field will shorten the treatment period. A device to implement these requirements gradually evolved over a 5-year period. A number of prototypes were tested until the final product was attained. Some of the patients in this study were treated initially with a silicone sponge inserted in the cushion. Later this version was changed to the final design described herein. A silicone cushion was developed with the purpose of increasing a negative static-electric charge to accelerate the regression process. The cushion is custom-made using a silicone occlusive sheeting envelope of 0.75-mm thickness, which does not deteriorate with use, and is partially filled with high viscosity silicone oil. Its edges are sealed, and its size is designed to extend a little beyond the scarred area. Static electricity readings, generated by activating the cushion by pumping action with the fingers, stretching or deforming the cushion, are invariably much higher when compared with those obtained with silicone occlusive sheeting and silicone gel sheeting. The interaction between the negatively charged ions of the cushion and the ionic charges of the tissue fluids may be the critical factor in achieving hypertrophic and keloid scars involution. Of the 30 patients enrolled in the study, 3 patients dropped out. Treatment with the silicone cushions yielded 63.3 percent cessation of itching and burning followed by pallor and flattening of the scar, some markedly so, over a few weeks to 6-month period. An additional 26.6 percent had their scars resolved in up to 12 months of treatment. Good contact of the cushion over the scar has been shown to be important in this clinical trial, and much creativity is needed for making elastic strap bindings that ensure this contact. The clinical trials extended over a 12-month period. Ten patients (33.3 percent) who had recalcitrant scars with little response to the use of the silicone cushion were given intralesional corticosteroid injections, in addition to the continued use of the cushion, resulting in a fairly rapid resolution of these scars over a period of months to a year.
Adolescent↗
Computerized morphometric quantitation of elastin and collagen in SMAS and facial skin and the possible role of fat cells in SMAS viscoelastic properties.
Recently, the superficial musculoaponeurotic system (SMAS) was found to be a composite tissue comprising collagen, elastic fibers, and fat cells in an extracellular viscous matrix. Both SMAS and facial skin tissues exhibit viscoelastic properties, but SMAS tissue has delayed stress relaxation. As a consequence, SMAS is viewed as a firmer elastic foundation for the more viscous facial skin. In some patients, a slackening effect of SMAS tissue takes place over a period ranging from weeks to months after tightening. To determine the relative quantity of viscoelastic components and better understand their biomechanical behavior, a quantitative morphometric study of the elastic and collagen fibers in the SMAS and facial skin was conducted. Thirty-four SMAS preparations were taken from 17 patients during either primary face lift operations (12 women) or reoperative face lift procedures (4 women, 1 man), which were performed 4 to 9 months after the original surgery, to examine the elastin and collagen content. For comparison, preauricular skin was also gathered from these patients. The specimens were stained with Weigert's staining to identify elastin and collagen fibers. Using a computerized morphometric analysis, 100 fields of each SMAS and skin specimen were examined. According to our findings, the average percentage of elastin and collagen fibers in SMAS and facial skin was as follows: (1) the percentage of elastin fibers in the SMAS was 4.71 +/- 1.2 (standard error of mean +/- 0.0291); (2) the percentage of elastin fibers in the skin was 6.1 +/- 1.8 (standard error of mean +/- 0.0436); (3) The percentage of collagen fibers in the SMAS was 38.7 +/- 5.9 (standard error of mean +/- 0.1430); and (4) the percentage of collagen fibers in the skin was 48.47 +/- 6.96 (standard error of mean +/- 0.1688). A statistical significance of p < 0.0001 was demonstrated between the collagen and elastin groups. A different percentage of elastin and collagen fibers was found among the 17 patients and within each of them separately. Neither gender nor age differences were found regarding elastin and collagen fiber content. No statistical differences were demonstrated between specimen sources, i.e., whether the operations were primary or reoperative face lift procedures. Findings from previous studies indicate that the cheek has two viscoelastic layers, the skin and the SMAS. The proportional similarity in average percentages of elastin and collagen in SMAS and facial skin cannot explain the relatively delayed stress relaxation effect of the SMAS. Therefore, the fat cells that are found exclusively in the SMAS probably lend a certain degree of firmness to this layer and play a significant role in the long-term efficacy of SMAS surgery.
Adipocytes↗
Modified topical photodynamic therapy of superficial skin tumors, utilizing aminolevulinic acid, penetration enhancers, red light, and hyperthermia.
BACKGROUND: Photodynamic therapy (PDT) is a noninvasive selective therapy for a specific group of skin tumors. OBJECTIVE: In this study we used a modified topical medication in which ethyleneamine tetra acetic acid (EDTA) and dimethylsulphoxid (DMSO) were added to 5-aminolevulinic acid 20% (ALA) followed by exposure to a novel high output light source emitting red and infrared irradiation. METHODS: ALA 20%-EDTA 2%-DMSO 2% in a water in oil cream base was applied to the tumors. After 12 hours the tumor was exposed to red (585-720 nm; 150 mW/cm2) and near infrared irradiation (1.25-1.6 mm; 50 mW/cm2) for 10-15 minutes by the VersaLight incoherent filtered light source. RESULTS: Complete responses were achieved after one to three ALA-PDT treatments in 26/31 lesions of superficial or small nodular basal cell carcinoma (BCC) (84%), and in four of five in superficial squamous cell carcinoma (SCC) (80%). Complete clearance was achieved in one patient with Bowen's disease of the penis. CONCLUSIONS: Topical PDT utilizing ALA 20%-EDTA 2%-DMSO 2% as the photosensitizer and VersaLight as the light source is a noninvasive, nearly painless treatment with excellent therapeutic and cosmetic results. Our data show the efficiency of this therapy for patients with certain subtypes of BCC, SCC, and Bowen's disease.
Administration, Cutaneous↗
Closure of wounds in the upper extremity using a skin stretching device.
A skin stretching device (SSD) harnessing the viscoelastic properties of skin using incremental traction has been used in 20 patients with skin deficits in the upper extremity. Complications were few considering the extensive damage to the skin and included slight partial dehiscence, necrosis of skin edges, local infection and hypertrophic scars. All wounds healed without the need for further surgical procedures. Application of the SSD is simple and it can even be used at the bedside under local anaesthesia. It reduces the need for more complicated surgical procedures like grafts or flaps.
Adult↗
Insulin-induced lipohypertrophy treated by liposuction.
Lipohypertrophy is one of the local side effects of repeated subcutaneous insulin injections. This case report demonstrates the successful cosmetic and therapeutic treatment of two lipohypertrophic masses in the lower abdomen of a young diabetic patient by suction-assisted lipectomy.
Adipose Tissue↗
Mechanical properties and microstructure of the superficial musculoaponeurotic system.
Because of the widespread reliance on SMAS tightening procedures in present-day face lift surgery, a study was undertaken to examine the physical properties and microscopic structure of both virginal (40 specimens) and reoperated (8 specimens) SMAS tissue. The findings could be of practical value to the surgeon and are reported herewith: First, the SMAS is a composite fibrofatty layer comprising collagen and elastic fibers interspersed with fat cells. Second, microscopic appearance shows a considerable amount of elastic fibers in close relationship to the collagen fibers. Third, on scanning electron microscopy, the collagen fibers in the virginal SMAS show a convoluted appearance similar to that found in the dermis. In the reexcised SMAS tissue, there is some evidence of parallelization of the collagen fibers as seen in the stretched dermis. Fourth, mechanical testing (Instron), i.e., a series of loading/unloading tests at various rates and amplitudes, and stress relaxation tests were performed on samples of preauricular skin and SMAS. These indicated definite viscoelastic properties for both sets of specimens, with the tendency of an increased stiffness and a reduction in viscoelastic effects on repeated working of the samples. Overall, the mechanical behavior of both tissues was somewhat similar, the viscoelastic effects in SMAS being less pronounced. A nonlinear viscoelastic model is under development to represent the behavior of both tissues. The implications of these results may help to explain the slackening effect observed in some postoperative patients.
Biomechanical Phenomena↗
Closure of an open high below-knee guillotine amputation wound using a skin-stretching device.
A skin-stretching device (SSD) which is designed to harness the viscoelastic properties of the skin using incremental traction is described. It has proved to be of value in securing closure, within 72 h, of an open high below-knee guillotine stump wound which did not heal during a period of 2 months after amputation. The skin-stretching device provided healthy, durable and sensate skin for stump coverage. Hospitalization time was shortened and an early post-surgical prosthetic fitting and ambulation was achieved.
Amputation Stumps↗
A skin-stretching device for the harnessing of the viscoelastic properties of skin.
A skin-stretching device that is designed to harness the viscoelastic properties of the skin using incremental traction is presented as an addition to the surgeon's armamentarium. It has proved to be of value in helping to close problematic areas of skin shortage which would otherwise have required more complicated procedures for their solution. It is simple in application and can even be put to use at the bedside. It consists of two pins that are threaded through the dermis of the wound margins on either side of the defect and which are in turn engaged by the hooks of the stretching device. The stretching force on the skin margins is spread over a wide area, thus preventing damage to the skin itself that individual hooks applied to the skin might cause. The device is employed over a duration of 20 to 30 minutes to 1 to 3 days depending on the condition of the skin adjoining the defect. The device can be applied over three different periods of time: (1) preoperatively (presuturing), lasting 1 to 2 days, (2) intraoperatively, extending over a period of 20 to 30 minutes, and (3) postoperatively (or delayed), which takes place over a time span of hours to 1 to 3 days. Five illustrative cases are presented.
Adult↗
Corset platysmaplasty.
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Dermatologic Surgical Procedures↗
The securing of a polyethylene tube prior to intravascular dye injection in anatomic microcirculation research: the three-tie technique.
A simple and reliable method for securing the cannulated polyethylene tube to the blood vessel wall prior to intravascular dye injection is described. The three-tie technique has been used in many vascular anatomic studies without any leakage of the injection fluid taking place around the tube.
Blood Vessels↗
The management of exposed cardiac pacemaker pulse generator and electrode using restricted local surgical interventions; subcapsular relocation and vertical-to-horizontal bow transposition techniques.
This paper describes an approach to the treatment of exposed pacemaker generator and electrode. Local infection is controlled by the administration of systemic antibiotics and topical antibacterial solutions. Because the generator and lead are enveloped by an inert synthetic coating, it is possible to eradicate an infection without their removal if it is due to a weak opportunist pathogen fully sensitive to antibiotics. Thereafter, subcapsular relocation of the exposed generator or vertical-to-horizontal transposition of the exteriorised lead is carried out. These surgical interventions are designed to overcome the vertical force which tends to cause the extrusion of the pacing hardware.
Aged↗
Pulmonary complications in burn patients resuscitated with a low-volume colloid solution.
The occurrence of the adult respiratory distress syndrome (ARDS) and pneumonia was assessed in 482 patients with severe burns, but without evidence of inhalation injury. The patients were resuscitated during the burn shock period with a low-volume formula consisting mainly of plasma. The incidence of ARDS was 2.5 per cent for the entire burn population, and 9.4 per cent for 65 patients with burns covering more than 50 per cent of the body surface area. The general incidence of pneumonia was 4.4 per cent but was 12.5 per cent for the 65 patients with the extensive burns. These incidences were compared with other studies, and a pathophysiological explanation has been offered to explain differences in the frequency of pulmonary complications. The present review indicates that resuscitation with a low-volume formula consisting mainly of colloids can act as prophylaxis for reducing the incidence of ARDS and pneumonia.
Adolescent↗
Effect of decidua angiogenic factors on experimental dermis allografts.
Meshed human dermis allografts containing human uterine angiogenic factor were implanted over full thickness surgical skin wounds in rats. Enhanced angiogenesis of the wound bed, three times more than that observed in control grafts, was found in experimental grafts at 3 days postimplantation. This was accompanied by a greater amount of granulation tissue formation, enhanced granulation tissue penetration into the dermal grafts and accelerated incorporation of the grafts. Angiogenesis of the wound bed regressed to control levels at 7 days postimplantation. The growth and penetration of the granulation tissue and the accelerated incorporation of the dermis grafts, however, continued ahead in the experimental grafts while necrosis appeared in the control grafts. The relevance of these results for acceleration of wound healing and improvement of the wound bed for subsequent application of cultured epidermal grafts is discussed. This method may be extended to the treatment of ulcers and burns.
Angiogenesis Inducing Agents↗
Burn resuscitation with a low-volume plasma regimen--analysis of mortality.
The results of a mortality analysis from the Burn Center in Rambam Medical Center, Haifa, Israel, over a 5-year period are presented. The management of severe burns during the 'shock' period included a low-volume resuscitation formula consisting mainly of plasma and a small volume of crystalloid solution. The efficacy of burn management was assessed by probit analysis of the mortality data. We derived the percentage of body surface area burned associated with a 50 per cent probability of death (LA50) for four different age groups. The LA50 values obtained were compared to those obtained from other series; they compared favourably, demonstrating that resuscitation with low volumes consisting mainly of colloids may reduce complications associated with fluid overloading and therefore improve the LA50.
Adolescent↗
[Is Solcoderm suitable for treating malignant skin tumors?].
Solcoderm, a liquid preparation developed in the USSR, is recommended for topical treatment of benign and malignant skin tumors. We present 5 out of 25 patients treated in our department over the past 2 years who had been treated with Solcoderm for malignant skin tumors. The preparation appeared to have affected only the superficial layers of the tumor and had not penetrated in depth. Cellular remnants tended to spread far beyond the confines of the original tumor and seemed to become much more aggressive. To be effective, the technique of applying the drug would have to be much more complicated than originally specified. Both the functional and esthetic results are much worse than expected.
Acetates↗