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PubMed2005

The concentric malar lift: malar and lower eyelid rejuvenation.

Midface rejuvenation surgery is most challenging. The margin of error for the lower lid is on the order of 0.5 mm, and the cosmetic result can sometimes look unnatural. A minimally invasive technique for malar and lower lid lift is proposed. Two incisions are used: the standard subciliary lower eyelid incision and one on the lateral part of the upper eyelid. Through these incisions a skin flap lower eyelid dissection and a subperiosteal malar dissection are performed. The arcus marginalis itself is not transected as is the case when the malar area is entered from the lower eyelid. Rather, a subperiosteral release of the arcus marginalis is performed through a muscle-splitting incision at the lateral canthus. Eyelid malposition is avoided because the muscles, vessels, and nerves converging toward the medial canthus are not interrupted. The subperiosteal dissection of the arcus marginalis extends to the medial canthus and also releases the insertion of the orbicularis oculi superior malar part. Consequently, all the attachments of the tear trough are released. Two subperiosteal suspensions connect the central part of the nasolabial volume and, more laterally, the central part of the malar area to the inferolateral orbital rim. The elevation of the malar volume resulting from these suspensions is concentric with the orbit. A final third suspension vertically connects the orbicularis oculi muscle with the underlying periosteum to the bone of the lateral orbital rim. Significant skin excess is removed from the lower eyelid. Complete disinsertion of the tear trough attachments combined with the malar elevation treats the entire palpebromalar groove. The lifted fat volume fills the space resulting from the subperiosteal disinsertion. A safer, more natural and more reliable result is achieved because the vectors of traction with this technique are exactly opposite those of the midface aging process, and because a very stable fixation is created between the lifted malar periosteum and the malar and latero-orbital rim bones.

Adult↗

PubMedDate not supplied

Full face rejuvenation in three dimensions: a "face-lifting" for the new millennium.

Traditional facial rejuvenation techniques address the face by lifting the soft tissues in one or two dimensions. The face is a tri-dimensional structure and aging occurs in three dimensions, therefore, facial rejuvenation should be done in three dimensions. Sagging of facial soft tissues occurs inferiorly and inferomedially. The ideal reorientation during rejuvenation is in the opposite direction: vertically and supero-laterally. Two other elements not routinely addressed by traditional rejuvenative operations are reduction of skeletal framework and atrophy of soft tissues, particularly subcutaneous fat layer. These are the third dimension of facial aging. By principle, any technique that unfolds, pulls, or lifts produces a flattening effect of the structure being treated. They may give a false impression of augmentation if these tissues are advanced over bony prominences. These stretched out tissues also have a tendency to recoil. For that reason, the author suggests use of structures or methods less susceptible to a stretch relaxation or recoil. A prerequisite to 3-D facial rejuvenation is to perform a 2-D-(bi-dimensional) lift. A third dimension is integrated into it. There are four methods to provide the third dimension: (1) augmentation of the skeletal framework; (2) augmentation of subcutaneous layer with fat injection; (3) imbrication of soft tissues; (4) mobilization and repositioning of fat pockets as pedicle flaps. These methods are not exclusive to each other. One, a few, or all methods could be integrated according to the patient's needs and aesthetic goals. Tridimensional changes in facial rejuvenation can be assessed by a standard photographic comparison, using tools for in-vivo measurements or 3-D digital imaging. 3-D facial rejuvenation is an advanced concept in our pursuit to provide superior results with the more aesthetic, natural, and harmonious youthful look to our patients.

Adult↗

PubMed2004

Endoscopic robot-assisted extended thymectomy by subxiphoid approach with sternal lifting: feasibility in the pig.

BACKGROUND: In the search for novel approaches to thoracoscopic thymectomy we assessed the feasibility of a subxiphoid approach using computer-enhanced instruments and sternal lifting. METHODS: In 12 pigs, after lifting of the sternum, ports were placed subxiphoid (stereoscope) and in the left and right fourth intercostal space (instruments). Using computer-enhanced instruments, dissection of the thymus and anterior mediastinal fat pads was started at the diaphragm and continued cephalad. RESULTS: After setup of the robot system (23 +/- 6 min, mean +/- SD), the thymus, including both superior horns, and fat pads in the anterior mediastinum and cardiophrenic angles were dissected (109 +/- 23 min), with excellent view of the phrenic nerves. Visual inspection after sternotomy after the procedure showed all thymic and fatty tissue was removed. CONCLUSIONS: In the pig, endoscopic extended thymectomy can be safely performed by subxiphoid access using computer-enhanced instruments, sternal lifting, and three ports total.

Animals↗

PubMed1999

Peritoneal response to a septic challenge. Comparison between open laparotomy, pneumoperitoneum laparoscopy, and wall lift laparoscopy.

BACKGROUND: Laparoscopic surgery has a lower incidence of surgical infection than open surgery. Differential factors that may modify the bacterial biology and explain this finding to some extent include CO(2) atmosphere, less desiccation of intraabdominal structures, fewer temperature changes, and a better preserved peritoneal and systemic immune response. Previous data suggest that the immune response and acute phase response are better preserved after laparoscopy. Therefore, we designed a study to evaluate the early peritoneal response to sepsis in an experimental peritonitis model comparing open surgery with CO(2) and abdominal wall lift laparoscopy. METHODS: The study subjects comprised 360 mice distributed into the following four groups: group 1, n = 72 (controls); group 2, n = 96 (open surgery), 2-3 cm laparotomy, with abdominal cavity exposed to the air for 30 min; group 3, n = 96, CO(2) laparoscopy (5 mmHg pneumoperitoneum) for 30 min; group 4, n = 96, wall lift laparoscopy for 30 min. Intraabdominal contamination in the four groups was induced with 1 ml of E. coli suspension (1 x 10(4) CFU/ml) 10 min before abdomen closure. Peritoneal fluid and blood samples were obtained 1.5, 3, 24, and 72 h after surgery, and TNF, IL-1, and IL-6 were measured (via ELISA), as well as quantitative culture. RESULTS: The number of CFU (colony-forming units) obtained in peritoneal fluid and positive blood culture rates were significantly lower in the laparoscopic groups than in the open group. IL-1 peritoneal levels were significantly lower after 24 h and 72 h in the laparoscopy groups. IL-6 levels decreased sharply in the laparoscopy groups at 24 h and 72 h. There were no differences between the two types of laparoscopy models (CO(2) and wall lift). CONCLUSIONS: Peritoneal response to sepsis is better preserved after laparoscopy than after open surgery. CO(2) does not seem to influence bacterial growth. According to these findings, laparoscopy entails less local trauma and better preserved intraabdominal conditions.

Animals↗

PubMed1999

Hand-assisted laparoscopic distal gastrectomy with abdominal wall-lift method.

We performed a hand-assisted laparoscopic resection of the distal stomach for treatment of gastric cancer with use of an abdominal wall-lift method. The surgeon's left hand, which was inserted through a right lower quadrant incision, was extremely useful in accomplishing D2 lymph node dissection, application of a pursestring instrument, and approximation of a circular stapler to carry out a Billroth I anastomosis. Abdominal wall-lift enabled us to perform the gastrectomy without any concern about gas leakage. The combination of the wall-lift method and hand assistance seems to further enlarge the possibilities of laparoscopic procedures, especially in gastrointestinal surgery.

Adenocarcinoma↗

PubMed1991

Arm lift strength in work space.

This study was conducted to determine arm strength values for isometric and isokinetic efforts around the human trunk. Thirty-eight normal young adults (20 male and 18 female) performed a total of 19 tasks. These consisted of one self-selected optimum posture with upright stance and elbows bent at 90 degrees , designated as standard posture for isometric test. In addition, isometric testing was done sagittally symmetrical 30 degrees and 60 degrees lateral planes at half-, three-quarters- and full-reach distances at knuckle height. The isokinetic tests were done between knuckle height and shoulder height in postures identical to isometric tests. The sequence of these tasks was randomised. The peak strength in standard posture was invariably lower than the peak strength at half-reach in isometric condition in all three planes for both sexes with the exception of one condition among females (60 degrees lateral plane, half-reach isometric). Peak and average arm lift strengths of males were significantly higher than those of females (p < 0.01) and ranged between 44% and 71%. For both sexes isometric strength was significantly higher than isokinetic strength (p < 0.01). The peak and average strengths in the sagittal plane were invariably higher than those of asymmetric postures, with one exception among females. With increasing reach distance the strength declined significantly for all conditions among both genders (p < 0.01). The ANOVA showed that the gender, mode of lifting, postural symmetry and reach of lifting, in addition to affecting the peak and average strength individually (p < 0.01), had significant 2-way and 3-way interactions (p < 0.01). All strength values were inter-correlated (p < 0.01). The regressions predicting peak and average strengths from anthropometric characteristics and sagittal plane strengths accounted for 63% to 89% of all variance and were highly significant (p < 0.01).

Journal Article↗

PubMed1993

Simultaneous hybridization and subsequent colour detection of subgingival bacterial DNA on colony lifts.

This paper reports the development of a protocol allowing hybridization and detection of DNA fixed to nylon colony lifts from up to three species of bacteria simultaneously. Half ml samples of serial dilutions of pure cooked-meat broth (CMB) cultures of Capnocytophaga ochracea, Actinobacillus actinomycetemcomitans and Prevotella intermedia were grown on trypticase soy blood agar (TSBA) plates for 7 days in an anaerobic chamber. From the same CMBs a further set of dilutions was completed that contained all three species. Samples from these dilutions produced mixed-growth TSBA plates following anaerobic incubation for 7 days. After incubation, colony counts on pure-growth TSBA plates were enumerated by colony counter. Colony counts of C. ochracea, A. actinomycetemcomitans and P. intermedia on mixed-growth TSBA plates were enumerated by nylon colony lift, simultaneous hybridization with non-isotopic whole chromosomal DNA probes and alkaline phosphatase substrates generating three colours. The results indicate that the protocol correctly identified and differentiated between the three species on mixed-growth TSBA plates. The proportions of each species and mean total colony count expected by counting pure plates were in agreement with the proportions of each species and total colony counts enumerated by DNA probes on mixed growth plates. The development of simultaneous hybridization and multicolour detection will result in improved data recovery from dental plaque samples, in addition to reducing the cost and labour required in current colony-lift protocols, without affecting the specificity or sensitivity of the probes used.

Aggregatibacter actinomycetemcomitans↗

PubMed1984

Model for static lifting: relationship of loads on the spine and the knee.

An experimental study based on a trigonometric, anthropometric model, was conducted on thirty-five healthy subjects to determine the relationship between knee and back forces during symmetric sagittal plane lifting. Total joint reaction forces for the knee and the back, along with their compressive and shear components, were calculated for each subject, as a function of the knee, back and ankle angles. The shear component was significantly higher in females than in males; the compressive component was significantly higher in males. Strong inverse correlations were found between the back and the knee forces on all subjects. Strong correlations were also found between subject anthropometry and minimum and maximum joint reaction forces. The magnitudes of both back and knee joint reaction forces should be considered in recommending the lift type and position, based upon individual worker anthropometry, and size and weight of the load to be lifted.

Adolescent↗

PubMed1985

A biomechanical model of the lumbosacral joint during lifting activities.

A biomechanical model of the lumbosacral region was constructed for the purpose of systematically studying the combined stresses and strains on the local ligaments, muscles and disc tissue during sagittal plane two-handed lifting. The model was validated in two ways. The first validation was a comparison of experimental study results with model predictions. In general predictions compared very reasonably with observed values of several authors with the exception of strain predictions on the articular ligaments. Second, a sensitivity analysis was performed over a wide range of lifting tasks. The predicted stress/strain values followed anticipated patterns and were of reasonable magnitudes. On the basis of the results of the sensitivity analysis it was concluded that typical lifting tasks can lead to excessive disc compressive forces, muscle moment generation requirements, and possibly lumbodorsal fascia strains. Conversely, annulus rupture of a healthy disc due to overstrain appears very unlikely.

Biomechanical Phenomena↗

PubMed1988

Isometric and isokinetic back and arm lifting strengths: device and measurement.

This study was conducted to measure isometric (static) and isokinetic (dynamic) back and arm lifting strengths at 20, 60 and 100 cm s-1 of young adults. Ten male and ten female volunteers without a history of back pain participated. The isokinetic lifting task was achieved by controlled motorized dynamic strength tester (DST). A regression analysis and analysis of variance was carried out on the strength data. The peak static strength values were significantly greater from the peak dynamic strength values. The peak dynamic strength was inversely related to the speed of motion. There were significant differences between the dynamic strengths at different stages of lift.

Adult↗

PubMed1996

Validation of two 3-D segment models to calculate the net reaction forces and moments at the L(5)/S(1) joint in lifting.

The purpose of this study was to examine the validity and sensitivity of two three-dimensional segment models to estimate the net reaction forces and moments at the L(5)/S(1) joint. The two dynamic three-dimensional multisegment models, applied to lifting activities, were a lower body model and an upper body model. Three healthy male subjects participated in this study. The asymmetrical task consisted of lifting a load of 9.6 kg in a normal speed condition and in a fast condition. Results from the two models in terms of joint reaction forces and joint reaction moments at L(5)/S(1) were compared and were then used to validate them. The correlation between the reaction moments from both models were generally above 0.95 and the root mean square (RMS) differences were generally below 10 Nm but could reach 38 Nm. Similar trends were observed in the sensitivity analysis. A proportion of the error was attributable to errors in the segment accelerations because of an increase in the RMS differences between the models with an increase in lifting speed. The use of the lower body model seemed to present some advantages over the upper body model because of the nature of the task analysed which did not require large accelerations from the lower part of the body.

Journal Article↗

PubMed2005

Short scar face-lift with the use of fibrin sealant.

Fibrin sealants have been used in surgical procedures for decades. This article focuses on the short scar face-lift and the applicability of Tisseel fibrin sealant, or "tissue glue," in expediting the healing process in a series of consecutive patients undergoing face-lift surgery. The evolution of the face-lift incision into the short scar and the adjunctive use of the Tisseel fibrin sealant have both resulted in faster recovery.

Fibrin Tissue Adhesive↗

PubMed2005

Omega incision face-lift approach and SMAS rotation advancement flap in parotidectomy for prevention of contour deficiency and conspicuous scars affecting the neck.

To overcome the disadvantages after the surgical removal of tumours of the parotid gland, especially the depressed facial deformity and conspicuous cervical scar formation subsequent to parotid surgery, we have concentrated on omega face-lift incision in combination with an SMAS rotation advancement flap for the last several years using a lazy omega incision. Nine patients (3 male and 6 female) ranging in age from 43 to 68 years (mean age: 56.3 years) fulfilled the selection criterion of having a clinically benign discrete parotid lump with a benign preoperative fine needle cytology result. Parotidectomy was performed using the modified omega face-lift incision in conjunction with the rotation advancement SMAS flap. All patients underwent follow-up every 3 months in the first year. During the follow-up, the patients were specifically asked about their satisfaction with the post-operative appearance and whether they would consent to the operation again. The vascularized SMAS rotation advancement flap is clinically simple to perform and provides satisfactory cosmetic and functional results in patients undergoing conservative parotidectomy. There are no drawbacks in the use of modified face-lift incision to remove tumours of the parotid gland.

Adult↗

PubMed2005

On hydrodynamics of drag and lift of the human arm.

The work presents results on drag and lift measurement conducted in a low speed wind tunnel on a replica of the entire human arm. The selected model positions were identical to those during purely rotational front crawl stroke in quasi-static conditions. A computational fluid dynamics model using Fluent showed close correspondence with the experimental results and confirmed the suitability of low speed wind tunnel for the drag and lift measurement in quasi-static conditions. The obtained profiles of the hydrodynamic forces were similar to the dynamic data presented in an earlier study suggesting that shape drag is a major contributing factor in propulsive force generation. The aim of this study was to underline the importance of the entire arm analysis, the elbow angle and a newly defined angle of attack representing the angle of shoulder rotation. It was found that both the maximum value of the drag force at 160 degrees elbow flexion angle and the momentum generated by it exceed the respective magnitudes for the fully extended arm. The latter is underlined by a prolonged plateau of near maximum drag that was obtained at shoulder angle range of 50-140 degrees suggesting that optimal arm configuration in terms of propulsive force generation requires elbow flexion. Furthermore it was found that drag trend is not consistent with the widely assumed and used sinus wave profile. A gap in the existing experimental research was filled as for the first time the entire arm lift and drag was measured across the entire stroke range.

Air Movements↗

PubMed2005

Bony press-fit closure of oro-antral fistulas: a technique for pre-sinus lift repair and secondary closure.

PURPOSE: To evaluate the use of intra-oral bone grafts for closing chronic oro-antral fistulas (OAFs), for providing a sound basis for subsequent conventional sinus lifting and for preserving the teeth adjacent to OAFs. PATIENTS AND METHODS: Twenty-one patients with oro-antral fistulas of variable origin were treated with monocortical bone blocks harvested from the retromolar or interforaminal regions of the mandible. The preoperative treatment, the surgical procedure for both hard and soft tissue closure, and the postoperative management are reviewed in detail. RESULTS: Press-fit closure for repair of the bony sinus floor was sufficient in 17 patients. Four of them needed additional internal fixation. In all 21 patients adequate closure of the fistulas was obtained, although 3 patients (14.3%) developed wound dehiscences at the grafted sites, which healed by secondary intention. Meanwhile, 3 patients underwent successful sinus lifting. CONCLUSION: The use of monocortical bone grafts harvested at intra-oral donor sites is a safe and easy technique for repairing defects of the maxilla, especially OAFs in need of secondary closure. It provides a sound basis for subsequent conventional sinus lifting and preserves the teeth adjacent to OAFs.

Adult↗

PubMed2001

The influence of supporting the Oxylog instrument on estimated maximal aerobic capacity during a step test and heart rate in a lifting test.

This study investigated the influence of wearing, an Oxylog mask and heart rate monitor while the Oxylog instrument was supported in a stand versus that of wearing the Oxylog mask, heart rate monitor, and the Oxylog instrument, on oxygen consumption (VO2) and heart rate response during a graduated submaximal step test protocol. Also, the predicted maximal aerobic capacities ( VO2max) produced by the two graduated step tests were compared. In addition, differences in the working heart rates in a submaximal lifting test were analyzed in two lifting tests, one with the participant wearing the Oxylog mask, heart rate monitor, and Oxylog instrument and the other required the participant to only wear a heart monitor. Seventeen experienced male manual materials handlers participated in the study, and each treatment was seen by each participant in a randomized Latin Square design. Results from the two investigations indicate that there was no significant difference in the estimated maximal oxygen consumption (p = 0.1384) and no significant difference in the heart rate between the two lift tests. The analysis did show that the 4th stage (participants reaching their physiological limits) of the step tests indicated a statistically significant difference (p = 0.0259 for oxygen consumption, and p = 0.0465 for heart rate).

Analysis of Variance↗

PubMed1978

The two-stage face lift.

Skin under tension with "creep", i.e. stretch. This probably accounts for the fact that by far the commonest postoperative complaint of face-lift patients is of inadequate lift. Creep occurs within a few hours of the operation but is at first masked by postoperative oedema. At the second stage half as much or more skin as was excised on the first occasion may be re-excised. The conservative face-lift incision which spares the sideburns is the most conventient for the 2-stage operation.

Face↗

PubMed2003

Comparison of ultrastructure, tight junction-related protein expression and barrier function of human corneal epithelial cells cultivated on amniotic membrane with and without air-lifting.

PURPOSE: To evaluate the usefulness of the air-lifting technique for culturing corneal limbal epithelial cells on amniotic membrane (AM) for use in ocular surface reconstruction. A cultured sheet that has a good barrier function should be better for this purpose. In corneal epithelium, tight junctions (TJ) play a vital role in the barrier function. The TJ complex includes the integral transmembrane proteins occludin and the claudins, and some membrane-associated proteins such as ZO-1. In this paper, we investigated the barrier function and the expression of TJ related proteins. METHODS: Corneal limbal epithelium obtained from donor corneas and cultivated on acellular AM was divided into two groups. These were the non-air-lifting (Non-AL) group, which was continuously submerged in medium, and the air-lifting (AL) group, which was submerged in medium for 3 weeks, then exposed to air by lowering the medium level. Morphology and the permeability to horseradish peroxidase (HRP) were determined by electron microscopy. Tight junction (TJ)-related protein and mRNA expression changes were assessed by immunoblotting and reverse transcription-polymerase chain reaction. RESULTS: The cultures of both groups formed 4-5-layer-thick, well-stratified epithelium. The AL cultures had tightly packed epithelial cells with all the HRP/diaminobenzidine (DAB) reaction product accumulated on the apical surface of the superficial cells. The Non-AL culture, by contrast, had more loosely packed epithelial cells with larger intercellular spaces. The HRP/DAB reaction product penetrated the intercellular space to a depth of 3-4 cell layers. Statistically, there was a significant difference in intercellular spaces and desmosome count in the superficial cells between the groups. With AL, TJ-related proteins localized at the apical portion of the lateral membrane. TJ-related protein and mRNA amounts were not changed by AL while claudin subtype expression became more consistent and closer to that of in vivo corneal epithelium. CONCLUSIONS: The AL technique reduces intercellular spaces in the superficial cells and promotes the formation of the barrier function. It is useful in culturing corneal epithelial cells for use in ocular surface reconstruction.

Amnion↗