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Zhou X, Yi Y, Liu Z, Zhang Q, Wu Y, Luo X. Clinical efficacy and safety of composite non-cross-linked hyaluronic acid for treating tear trough-lower eyelid bag deformity. J Cosmet Dermatol 2024; 23:2556-2562. [PMID: 38545776 DOI: 10.1111/jocd.16303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/22/2024] [Accepted: 03/17/2024] [Indexed: 07/26/2024]
Abstract
BACKGROUND Tear trough-eye bag deformities may appear in young Asian patients due to the weak support of their facial skeletons. For these patients with better periorbital skin elasticity, the injection may be more suitable than surgery for treating tear trough-lower eyelid bag deformity. AIMS Identify the clinical efficacy and safety of non-cross-linked HA in the treatment of tear trough-lower eyelid bag deformity. METHODS In this study, we analyzed pre- and postinjection photographs of 55 patients treated with non-cross-linked hyaluronic acid (HA) for tear trough-lower eyelid bag deformity. RESULTS The mean [SD] scores of modified Goldberg score suggested that the most significant improvement of preoperative and postoperative scores was in tear trough depression, followed by infraorbital triangular depression, orbital fat prolapse, loss of skin elasticity, and skin transparency. Only transient localized complications were observed, including bruising, swelling, and erythema. There were no serious complications, such as skin necrosis or visual impairment. CONCLUSIONS Our study confirmed the beneficial efficacy and minor complications of composite non-cross-linked HA for the treatment of tear trough-lower eyelid bag deformity.
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Affiliation(s)
- Xiaomei Zhou
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Yi
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zeming Liu
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi Zhang
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yiping Wu
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao Luo
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Kyung H, Park Y, Oh SH, Kim DW, Seo YJ, Song SH. Effects of Midcheek Lift According to Dissection Plane and Range: An Anatomical Study. Aesthet Surg J 2024; 44:473-481. [PMID: 38124346 DOI: 10.1093/asj/sjad378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Midcheek lift has been performed for cosmetic or reconstructive surgery of the lower eyelid. For midcheek lift through the subciliary incision, preperiosteal and subperiosteal dissections are the most often implemented, with good clinical outcomes. However, a comparative assessment of the effects of these 2 methods had not been conducted. OBJECTIVES In this study we compared the effects of midcheek lift according to preperiosteal or subperiosteal plane and range of midfacial dissection. METHODS Forty hemifaces of 20 fresh cadavers were dissected. One side of the hemiface underwent preperiosteal dissection, and the other side underwent subperiosteal dissection. After dissections of 5, 10, 15, 20, and 30 mm and all of the midcheek area from the inferior orbital rim, the length of the elevated lid-cheek junction was measured by placing upward traction on the lateral portion of the lower lid. RESULTS In both methods, the length of the midcheek lift increased as the dissection progressed, and the length of the lift on the lateral side was greater than that on the medial side. The length of the pulled skin in the preperiosteal group was the greatest in most cases. However, in the full dissection cases, the midcheek lift length was not statistically different between the 2 surgical methods, especially on the lateral side. CONCLUSIONS Flap elevation in lower blepharoplasty surgery can be predicted based on the surgical method and dissection range. Implementing a surgical plan that takes this into account can enhance both reconstruction and aesthetic surgery outcomes in the midcheek area.
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Karimi N, Kashkouli MB, Enayatollahi S, Ghahvehchian H, Abdolalizadeh P, Ramadan M. Minced Free Fat Graft Versus Pedicle Fat Flap to Efface Orbital Rim Hollow in Lower Blepharoplasty. Aesthet Surg J 2023; 44:12-19. [PMID: 37463504 DOI: 10.1093/asj/sjad232] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Lower eyelid fat flap repositioning during transconjunctival lower blepharoplasty (TCLB) is a widely accepted technique for preventing postoperative tear trough deformity. Its drawbacks include retraction, limited volume, transcutaneous fixation, and a complex insertion technique. The minced lower eyelid fat graft was introduced to overcome these drawbacks. OBJECTIVES The aim of this study was to compare the outcome of preperiosteal pedicle fat flaps with minced free fat graft in TCLB. METHODS Participants who underwent the pedicle fat flap procedure from April 2019 to April 2020 (Group A) and the minced free fat graft from May 2020 to May 2021 (Group B) with at least 6 months of follow-up were included. Subjective (pain, infraorbital numbness) and objective (chemosis, residual skin wrinkles, hyperpigmentation, tear trough deformity, bumps) postoperative outcomes, satisfaction (visual analogue scale score) at the last follow-up, and reoperation rates were compared. RESULTS There were 142 participants (94% females) with a mean age of 48.4 years (range: 21-71) and a follow-up of 8.2 months (range: 6-36). There were 73 participants in Group A and 69 in Group B, with no significant differences in age (P = .6), sex (P = .7), or follow-up (P = .3). In addition to TCLB, Groups A and B had simultaneous upper eyelid and eyebrow procedures (53% vs 49%, P = .2), lateral canthal plication (77% vs 83%, P = .4), and pinch skin excision (82% vs 88%, P = .3). Groups A and B did not have significant differences in postoperative numbness (6.8% vs 1.4%, P = .2), chemosis (11% vs 10%, P = 1), skin wrinkles (12.3% vs 8.7%, P = .6), hyperpigmentation (1.4% in both groups), bumps (2.7% vs 7.2%, P = .3), tear trough deformity (0.0% in both groups), satisfaction score (97.7% vs 98.1%, P = .4), or reoperation rate (12.3% vs 5.8%, P = .2). CONCLUSIONS The desired aim of fat redistribution in TCLB seems to be equally achievable with minced fat graft and pedicle fat flap techniques. LEVEL OF EVIDENCE: 4
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Glancy SB, Morris HD, Ho VB, Klarmann GJ. Optimal Agents for Visualizing Collagen Tissue Microarchitecture Using Contrast-Enhanced MicroCT. Pharmaceuticals (Basel) 2023; 16:1719. [PMID: 38139845 PMCID: PMC10747128 DOI: 10.3390/ph16121719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Micro-computed tomography (microCT) is a common tool for the visualization of the internal composition of organic tissues. Collagen comprises approximately 25-35% of the whole-body protein content in mammals, and the structure and arrangement of collagen fibers contribute significantly to the integrity of tissues. Collagen type I is also frequently used as a key structural component in tissue-engineered and bioprinted tissues. However, the imaging of collagenous tissues is limited by their inherently low X-ray attenuation, which makes them indistinguishable from most other soft tissues. An imaging contrast agent that selectively alters X-ray attenuation is thus essential to properly visualize collagenous tissue using a standard X-ray tube microCT scanner. This review compares various contrast-enhanced techniques reported in the literature for MicroCT visualization of collagen-based tissues. An ideal microCT contrast agent would meet the following criteria: (1) it diffuses through the tissue quickly; (2) it does not deform or impair the object being imaged; and (3) it provides sufficient image contrast for reliable visualization of the orientation of individual fibers within the collagen network. The relative benefits and disadvantages of each method are discussed. Lugol's solution (I3K), phosphotungstic acid (H3PW12O40), mercury(II) chloride (HgCl2), and Wells-Dawson polyoxometalates came closest to fitting the criteria. While none of the contrast agents discussed in the literature met all criteria, each one has advantages to consider in the context of specific lab capabilities and imaging priorities.
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Affiliation(s)
- Spencer B. Glancy
- San Antonio Uniformed Services Health Education Consortium, San Antonio, TX 78234, USA;
| | - Herman Douglas Morris
- School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA; (H.D.M.); (V.B.H.)
| | - Vincent B. Ho
- School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA; (H.D.M.); (V.B.H.)
- 4D Bio3 Center for Biotechnology, Uniformed Services University, Bethesda, MD 20814, USA
| | - George J. Klarmann
- 4D Bio3 Center for Biotechnology, Uniformed Services University, Bethesda, MD 20814, USA
- The Geneva Foundation, Tacoma, WA 98402, USA
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Gupta LY, Gupta SS, Bamberger JN, Gupta KR. Mini-Incision Direct Festoon Access, Cauterization, and Excision (MIDFACE): A 12-Year Analysis of a Novel Festoon Surgery. Plast Reconstr Surg 2023; 152:987-999. [PMID: 36877611 DOI: 10.1097/prs.0000000000010365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Surgical festoon management often entails aggressive dissection, flaps, unsightly scars, prolonged recovery, and high recurrence rates. The authors present outcomes with subjective and objective evaluation of an office-based, novel, minimally invasive (1-cm incision) festoon repair: mini-incision direct festoon access, cauterization, and excision (MIDFACE). METHODS Charts of 75 consecutive patients from 2007 to 2019 were evaluated. Photographs of 39 patients who met inclusionary criteria were evaluated by three expert physician graders for festoon and incision visibility (339 randomly scrambled preoperative and postoperative photographs taken with and without flash and from four different views: close-up, profile, full-frontal, and worm's eye) using paired t tests and Kruskal-Wallis tests for statistical evaluation. Surveys returned by 37 of 75 patients were evaluated for patient satisfaction and possible contributing factors to festoon formation or exacerbation. RESULTS There were no major complications in the 75 patients who underwent MIDFACE. Physician grading of photographs of 39 patients (78 eyes, 35 women; four men; mean age, 58 ± 7.7 years) demonstrated statistically significant sustained improvement in festoon score postoperatively up to 12 years regardless of view or flash. Incision scores were the same preoperatively and postoperatively, indicating incisions could not be detected by photography. Average patient satisfaction score was 9.5 on a Likert scale of 0 to 10. Possible factors for festoon formation or exacerbation included genetics (51%), pets (51%), prior hyaluronic acid fillers (54%), neurotoxin (62%), facial surgery (40%), alcohol (49%), allergies (46%), and sun exposure (59%). CONCLUSION MIDFACE repair results in sustained improvement of festoons with an office-based, minimally invasive procedure with high patient satisfaction, rapid recovery, and low recurrence. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Tsutsumi M, Nimura A, Tharnmanularp S, Kudo S, Akita K. Posteromedial capsular anatomy of the tibia for consideration of the medial meniscal support structure using a multidimensional analysis. Sci Rep 2023; 13:12030. [PMID: 37491561 PMCID: PMC10368675 DOI: 10.1038/s41598-023-38994-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/18/2023] [Indexed: 07/27/2023] Open
Abstract
Medial meniscal extrusion (MME) is a structural abnormality that leads to early knee osteoarthritis; however, its formation remains debated. For anatomical consideration of the mechanism underlying MME formation, we examined the capsular attachment on the posteromedial tibia and its layered association with the semimembranosus. Fourteen knees of eight body donors were analyzed in this study; six knees were grouped for macroscopic analysis, whereas four knees each were grouped for histological and phosphotungstic acid-enhanced micro-computed tomography analyses. The capsular attachment varied in width according to location and was not distant from the articular cartilage and posterior root. A portion of the posteromedial joint capsule formed the semimembranosus tendinous sheath. The dense fibrous membrane superficial to the semimembranosus, which was continuous from its tendinous sheath, existed as one of the layers of the joint capsule. The aforementioned findings were confirmed in all specimens. Based on the capsular attachment and its layered association with the semimembranosus, the conventional posteromedial knee ligaments may be only a part of the joint capsule divided into two layers by the semimembranosus. If the coordinated action of the joint capsule and semimembranosus partially contributes to the medial meniscus stability, such a structural problem may affect MME formation.
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Affiliation(s)
- Masahiro Tsutsumi
- Inclusive Medical Sciences Research Institute, Morinomiya University of Medical Sciences, 1-26-16 Nankokita, Suminoe-ku, Osaka City, Osaka, 559-8611, Japan.
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Suthasinee Tharnmanularp
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shintarou Kudo
- Inclusive Medical Sciences Research Institute, Morinomiya University of Medical Sciences, 1-26-16 Nankokita, Suminoe-ku, Osaka City, Osaka, 559-8611, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Kabakci AG, Bozkır DM, Cengizler Ç, Sire Eren D, Bozkır MG. Assessing the Rejuvenation Effectiveness of a Hyaluronic Acid and Amino Acid Mixture in the Periorbital Region. Clin Cosmet Investig Dermatol 2023; 16:973-980. [PMID: 37051585 PMCID: PMC10084865 DOI: 10.2147/ccid.s406173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/24/2023] [Indexed: 04/08/2023]
Abstract
Purpose We performed an assessment of the rejuvenation effect of an amino acid and hyaluronic acid mixture in the periorbital area. Methods A total of 23 of the 35 participants completed all application sessions and measurements. These 23 women were aged 30-55 years. A hyaluronic acid and amino acid mixture was injected into the participants' periorbital area. Three sessions of application with 15-day intervals were undertaken. Subjects' age, height, weight, smoking status, and sport participation were recorded. A photonumeric dark circle scale and Fitzpatrick's periorbital wrinkling classification were used for evaluation of dark circles and wrinkles in the periorbital area. Anatomical measurements (height of upper and lower eyelids) were done using ImageJ and a skin-analysis system (Observ 520). Results The 23 women had a mean age of 42.46±9.33 years, mean height 164.46±4.96 cm, and mean weight 63.94±8.26 kg. Before the sessions, the mean heights of the upper eyelids were 1.24±013 cm (right) and 1.21±013 cm (left), while those of the lower eyelids were 0.98±014 cm (right) and 0.97±0.17 cm (left). One month after the third session, mean upper-eyelid heights were 1.30±0.09 cm (right) and 1.28±0.11 cm (left) and lower-eyelid ones 1.02±0.11 cm (right) and 1.02±0.13 cm (left). Dark-circle and wrinkle-scale scores showed significantly positive results between before the sessions and 1 month after the third session. Conclusion A hyaluronic acid and amino acid mixture can be used to rejuvenation of the periorbital area in women aged 30-55 years.
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Affiliation(s)
- Ayse Gul Kabakci
- Department of Anatomy, Faculty of Medicine, Cukurova University, Adana, Turkey
- Correspondence: Ayse Gul Kabakci, Cukurova University, Faculty of Medicine, Department of Anatomy, Sarıçam, Adana, 01250, Turkey, Tel +90 322 338 60 60-3489, Fax +90 322 338 65 72, Email
| | | | - Çağlar Cengizler
- Biomedical Device Technology Program, Vocational School of Health Services, Izmir Democracy University, Izmir, Turkey
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Atiyeh B, Hakim CR, Oneisi A, Ghieh F, Chahine F. Surgical Correction of Tear Trough Deformity (TTD) with Orbicularis Retaining Ligament Release and Volume Augmentation for Periorbital Rejuvenation: Review of the Literature. Aesthetic Plast Surg 2023; 47:199-214. [PMID: 36456652 DOI: 10.1007/s00266-022-03183-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/10/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Tear trough deformity is a hallmark of periorbital aging. It is not, however, an exclusive feature of old age. While protruding orbital fat results in lower lid bags that are traditionally corrected by excision, correction of TTD can constitute a real challenge requiring volume enhancement in addition to addressing prolapse of orbital fat and descent of cheek tissues. Described therapeutic options include minimally invasive soft tissue augmentation with fillers or structural autologous fat transfer as well as invasive surgical procedures concomitantly with lower lid blepharoplasty or other facial rejuvenation procedures. MATERIAL AND METHODS Six eponyms have been used in the literature to describe the condition: (1) naso-jugal fold, (2) naso-jugal groove, (3) naso-jugal ditch, (4) tear trough, (5) tear trough deformity, and (6) tear trough depression. A separate PubMed database search of each of the 6 terms was conducted in addition to an advanced literature and systematic PICO searches to identify all described clinical retrospective or prospective, comparative or simple cohort studies related to surgical correction of TTD. An additional screening of references of retrieved clinical studies was performed to identify any missed reports. RESULTS A total of 435 publications were identified with the initial search. After excluding all none relevant studies, 44 papers were selected for review. 6 additional studies were identified by screening relevant references. CONCLUSION Almost all authors agree on the necessity to release the tear trough retaining ligament together with volume enhancement. Transconjunctival and transcutaneous incisions are reported. Most recommend repositioning of the protruding orbital fat for volume enhancement to mostly subperiosteal, or pre-periosteal pockets. Other reported options include pedicled buccal fat pad transposition, segmental fat grafting, and minced micrografts. Internal as well as external fixation of repositioned fat flaps have been described. Despite lack of solid objective evidence, several of these techniques when properly executed for the proper indication in selected patients are reported to result in a rewarding and long-lasting outcome. Unfortunately, it is difficult to determine the most appropriate technique that would universally yield the most pleasant and harmonious facial contour without creating an unnatural puffy appearance. It remains for the surgeon to identify the safe surgical approach that does not compromise lower eyelid function and achieves the most pleasing aesthetic outcome with the least complications and downtime. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Bishara Atiyeh
- Annals of Burns & Fire Disasters, Plastic & Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christopher-Roland Hakim
- 6th Year Surgical resident in Plastic & Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Ahmad Oneisi
- 7th Year Surgical resident in Plastic & Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Ghieh
- 7th Year Surgical resident in Plastic & Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadel Chahine
- Annals of Burns & Fire Disasters, Plastic & Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Minelli L, Bown RGC, Mu EWH, Whitehead DL, Henderson TH, Lawrence F, Mellor I, Wissemann MI, Brown CP, van der Lei B, Mendelson BC. Enhanced study of facial soft tissues using a novel large scale histology technique. Clin Anat 2023; 36:110-117. [PMID: 35951617 PMCID: PMC10086818 DOI: 10.1002/ca.23943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 12/14/2022]
Abstract
The safety and effectiveness of facial cosmetic surgery procedures are dependent on detailed 3D understanding of the complex surgical anatomy of the face. Traditional, small sample size anatomical dissection studies have limitations in providing definitive clarification of the fascial layers of the face, and especially in their relationship with the facial nerve, and their reaction to surgical manipulation. The objective study of large tissue areas is required to effectively demonstrate the broader architecture. Conventional histology techniques were modified to handle extraordinarily large tissue samples to fulfill this requirement. Full-thickness soft tissue samples (skin to bone) of maximum length 18 cm, width 4 cm, and tissue thickness 1 cm, were harvested from 20 hemifaces of 15 fresh human cadavers (mean age at death = 81 years). After fixation, the samples were processed with an automated processor using paraffin wax for 156 h, sectioned at 30 μm, collected on gelatin-chromium-coated glass slides, stained with a Masson's Trichrome technique and photographed. Using this technique, excellent visualization was obtained of the fascial connective tissue and its relationship with the facial mimetic muscles, muscles of mastication and salivary glands in 73 large histological slides. The resulting slides improved the study of the platysma and superficial musculo-aponeurotic system (SMAS), the spaces and ligaments, the malar fat pad, and the facial nerve in relations to the deep fascia. Additionally, surgically induced changes in the soft-tissue organization were successfully visualized. This technique enables improved insight into the broad structural architecture and histomorphology of large-scale facial tissues.
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Affiliation(s)
- Lennert Minelli
- Melbourne Advanced Facial Anatomy Course (MAFAC), Australasian Society of Aesthetic Plastic Surgeons, Toorak, Australia.,Medical Engineering Research Facility, Queensland University of Technology, Brisbane, Australia.,Department of Plastic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Rory George Charles Bown
- Melbourne Advanced Facial Anatomy Course (MAFAC), Australasian Society of Aesthetic Plastic Surgeons, Toorak, Australia
| | - Erica Wung Hwa Mu
- School of Biomedical Sciences, The University of Queensland, Saint Lucia, Australia
| | | | - Tania Helen Henderson
- Central Analytical Research Facility, Queensland University of Technology, Brisbane, Australia
| | - Felicity Lawrence
- Central Analytical Research Facility, Queensland University of Technology, Brisbane, Australia
| | - Ian Mellor
- Medical Engineering Research Facility, Queensland University of Technology, Brisbane, Australia
| | - Matthew Ian Wissemann
- Medical Engineering Research Facility, Queensland University of Technology, Brisbane, Australia
| | - Cameron Peter Brown
- Medical Engineering Research Facility, Queensland University of Technology, Brisbane, Australia
| | - Berend van der Lei
- Department of Plastic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Bryan Christopher Mendelson
- Melbourne Advanced Facial Anatomy Course (MAFAC), Australasian Society of Aesthetic Plastic Surgeons, Toorak, Australia
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Tsutsumi M, Kudo S, Nimura A, Akita K. Significance of the anatomical relationship between the flexor digitorum longus and sustentaculum tali for reconsideration of the talocalcaneonavicular joint stability mechanism. Sci Rep 2022; 12:15218. [PMID: 36075954 PMCID: PMC9458735 DOI: 10.1038/s41598-022-19543-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/30/2022] [Indexed: 11/09/2022] Open
Abstract
The talocalcaneonavicular joint (TCN-j) is supported by the spring ligament, which has recently been revealed to be part of the joint capsule complex, along with the tendinous sheath of the tibialis posterior and flexor digitorum longus (FDL). Nonetheless, the FDL's role in TCN-j stability has received limited attention. This study aimed to elucidate the positional relationships between the FDL and sustentaculum tali, which comprises the TCN-j. We hypothesized that the FDL runs medial to the sustentaculum tali, and its course significantly changes from the sitting to the standing position. Six ankles from six body donors were investigated, and seven ankles from seven volunteers were assessed using ultrasonography. The FDL was three-dimensionally located inferomedial to the sustentaculum tali. The FDL tendinous sheath was attached to the sustentaculum tali or connected by the tibialis posterior via the tendinous sheath. Based on the in vivo ultrasound image, the FDL location relative to the sustentaculum tali was maintained; however, the curvature of the FDL course was significantly more prominent in standing than in sitting. The FDL force against the bending moment may prevent the excessive eversion of the foot and aid the conventional spring ligament's contribution to TCN-j stability for maintaining the longitudinal arch.
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Affiliation(s)
- Masahiro Tsutsumi
- Inclusive Medical Sciences Research Institute, Morinomiya University of Medical Sciences, 1-26-16 Nankokita, Suminoe-ku, Osaka City, Osaka, 559-8611, Japan. .,Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Shintarou Kudo
- Inclusive Medical Sciences Research Institute, Morinomiya University of Medical Sciences, 1-26-16 Nankokita, Suminoe-ku, Osaka City, Osaka, 559-8611, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Liu J, Huang C, Song B. A graded approach in East Asian personalized lower blepharoplasty: A retrospective study spanning 12 years. Indian J Ophthalmol 2022; 70:3088-3094. [PMID: 35918978 DOI: 10.4103/ijo.ijo_222_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose The aim of the study was to describe a graded approach for assessment and specific treatment, which can achieve satisfactory postoperative result in East Asian personalized lower blepharoplasty. Methods We reviewed 913 patients who underwent lower blepharoplasty from 2008 to 2020. We preoperatively classified patients with different characteristics to provide personalized treatment. Results There were 163 patients with fat herniation but no lower eyelid skin laxity, 259 patients with lower eyelid skin laxity accompanied by mild fat herniation, 313 patients with sagging lower eyelid skin accompanied by mild fat herniation and tear troughs, and a total of 178 patients with sagging skin accompanied by moderate to severe fat herniation and tear troughs. The overall success rate was 97.81%. Postoperative complications included the following: conjunctival chemosis, dry eye symptoms, and more. Conclusion For East Asian patients with different characteristics, we achieved satisfactory postoperative results through accurate preoperative clinical grading and personalized surgical plans. The success of the operation not only depends on correct manipulation during the procedure but also on the surgeon's accurate assessment and full grasp of the anatomy of each patient preoperatively.
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Affiliation(s)
- Jiaxi Liu
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, People's Republic of China
| | - Chen Huang
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, People's Republic of China
| | - Baoqiang Song
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, People's Republic of China
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Loss of Lower Eyelid Bulge after the Reconstruction of Zygomatic Complex Fractures. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4398. [PMID: 35919891 PMCID: PMC9278921 DOI: 10.1097/gox.0000000000004398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/06/2022] [Indexed: 11/25/2022]
Abstract
Background: Surgery for zygomatic complex fractures primarily aims to obtain facial symmetry. We investigated facial symmetry specific to lower eyelid bulges following zygomatic complex fractures approached through the lower eyelid. Methods: Forty-one consecutive patients underwent treatment of zygomatic complex fractures by swinging eyelid approach or subciliary approach. In both approaches, the periosteum was incised 2 mm caudal to the inferior orbital rim and the orbicularis retaining ligament (ORL) was released. The orbital rim periosteum was interruptedly sutured and reconstruction of the orbital septum or ORL was not performed at the time of closure. In cases with a lower eyelid bulge on the nonfractured side, in a frontal photograph 6 months after the operation, the degree of loss of the lower eyelid bulge on the fractured side was classified as either “none,” “mild,” or “severe.” Results: Lower eyelid bulge was present on the nonfractured side in 19 of 41 patients, all of whom were over 50 years old. Loss of lower eyelid bulge was observed on the fractured side in all cases: 15 cases following the swinging eyelid approach (mild/severe; 6/9) and four cases following the subciliary approach (mild/severe; 2/2). Conclusions: In reconstruction after zygomatic complex fractures, lower eyelid bulges were lost in both the swinging eyelid and subciliary approaches in patients over 50 years old. The cause was thought to be an ORL release or an unintended septal reset-like effect.
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Anatomical Characterization of the Tear Trough and the Lid-Cheek Junction: An Iodine Staining Technique Based on High-Resolution Micro-Computed Tomography. Plast Reconstr Surg 2022; 149:646e-654e. [PMID: 35139056 DOI: 10.1097/prs.0000000000008964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The literature presents the tear trough and lid-cheek junction's controversial anatomical explanations. In this study, the authors explored the anatomical characterization of the tear trough deformity and lid-cheek junction. METHODS Twelve human cadaver specimens were obtained from the authors' anatomy department. Iodine staining and high-resolution micro-computed tomography was used to observe the suborbital area's anatomy. Anatomical studies and histologic evaluation were performed. RESULTS The orbicularis retaining ligament is composed of a main septum right on the rim and multiple fibrous septa in the retro-orbicularis plain. The septum arises from the deep fascia of the palpebral part of the orbicularis oculi at approximately the level of the medial corneoscleral limbus, anchors the muscle to the orbital rim, and continues laterally as the lateral orbital thickening at the lateral canthus. Along the lid-cheek junction, multiple fibrous septa emanating from the deep fascia of the orbital part of the orbicularis oculi converge to the above septum. Using three-dimensional simulation, the skin-insert junction between the pre-palpebral part of the orbicularis oculi and pre-orbicularis oculi fibers precisely corresponded with the tear trough and the lid-cheek groove. Anatomical studies and histologic evaluation confirmed these observations. CONCLUSIONS The orbicularis retaining ligament's subtle anatomical features are clearly seen using the approach described. The tear trough and the lid-cheek junction's anatomical characterization is defined by a suborbital ligament-fascia system whose description has implications in designing lower eyelid cosmetic surgery.
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Su Y, Zhong J, Lu S. Corrective treatment for tear trough deformity in a young population utilizing two-dimensional fat injections. J Cosmet Dermatol 2021; 21:564-570. [PMID: 34971470 DOI: 10.1111/jocd.14708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/25/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Tear trough deformity (TTD) is becoming a growing concern for those seeking facial rejuvenation, and various treatment strategies have been reported. Among treatment options is micro-autologous fat injection, which appears to be an effective approach to recontour the tear trough in the young. The study we present here investigated the reliability and effectiveness of two-dimensional fat injections (TDFI) in the treatment of young patients with TTD. METHODS This study evaluated patients with TTD who underwent TDFI between December 2018 and December 2020. The proposed procedure involved ligament releasing and fat injection into the tear trough in two different directions. RESULTS The average age of the 102 enrolled patients was 25.9 ± 3.8 years. Significant improvement and maintenance of TTD were observed during the follow-up period (13.2 months average) with no major complications being observed. Improvement of dark cycles and enhanced aegyo sal were observed. Patient satisfaction based upon self-administered post-procedure questionnaires disclosed that 58.8% were very satisfied, 38.2% were satisfied, and 2.9% neutral with the results. CONCLUSIONS Two-dimensional fat injections is an effective and reliable method with high satisfaction and low risk of complication. Long-term results demonstrated its utility for young-type TTD.
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Affiliation(s)
- Yongsheng Su
- Department of Burn and Plastic Surgery, The People's Hospital of Baoan Shenzhen Affiliated with Shenzhen University, Shenzhen, China
| | - Jieguang Zhong
- Department of Plastic and Aesthetic Surgery, Boyan Beauty Hospital, Guangzhou, China
| | - Shurong Lu
- Department of Burn and Plastic Surgery, The People's Hospital of Baoan Shenzhen Affiliated with Shenzhen University, Shenzhen, China
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Three-dimensional anatomy of the Denonvilliers' fascia after micro-CT reconstruction. Sci Rep 2021; 11:21759. [PMID: 34741081 PMCID: PMC8571354 DOI: 10.1038/s41598-021-01106-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/15/2021] [Indexed: 12/29/2022] Open
Abstract
An understanding of the anatomy of the Denonvilliers’ fascia is essential for successful surgical outcomes for patients with rectal cancer in the mid- to lower regions, especially near the seminal vesicles and prostate in males. Whether the correct surgical plane during a total mesorectal excision should be anterior or posterior to the Denonvilliers’ fascia is currently under debate. This study aimed to investigate the Denonvilliers’ fascia using micro-computed tomography (micro-CT) to acquire three-dimensional images nondestructively for assessments of the relationship between the Denonvilliers’ fascia, the mesorectal fascia, and neurovascular bundles to elucidate the correct anterior total mesorectal excision plane. Eight specimens were obtained bilaterally from four fresh human cadavers. Four specimens were stained with phosphotungstic acid to visualize the soft tissue, and micro-CT images were obtained; the other four specimens were stained with Masson’s trichrome to visualize connective tissue. Micro-CT images corroborate that the Denonvilliers’ fascia consists of a multilayered structure that separates the rectum from the seminal vesicles and the prostate. Specimens stained with Masson’s trichrome showed that the urogenital neurovascular bundle located at the posterolateral corner of the prostate is separated from the mesorectum by the Denonvilliers’ fascia. For the preservation of autonomic nerves necessary for urogenital function and optimal oncologic outcomes in patients with rectal cancer, a successful mesorectal excision requires a dissection plane posterior to the Denonvilliers’ fascia.
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Bernardini FP, Casabona G, Alfertshofer MG, Frank K, Moellhoff N, Gotkin RH, Davidovic K, Voropai D, Valli A, Cotofana S. Soft tissue filler augmentation of the orbicularis retaining ligament to improve the lid-cheek junction. J Cosmet Dermatol 2021; 20:3446-3453. [PMID: 34679226 DOI: 10.1111/jocd.14495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/27/2021] [Accepted: 09/16/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The orientation of facial ligaments changes with increasing age due to the loss of bony support. Soft tissue filler injections placed in close proximity to facial ligaments can alter their orientation to help achieve an improved and younger aesthetic appearance. OBJECTIVE To assess the anatomic and aesthetic effects of a standardized injection with soft tissue filler placed directly inferior to the orbicularis retaining ligament in the infraorbital region. METHODS A total of 163 patients with signs of infraorbital aging were treated with a standardized soft tissue filler injection into and in close proximity to the orbicularis retaining ligament (ORL). 2D frontal images of the infraorbital region were rated by eleven blinded and independent raters with regards to the aesthetic appearance of the infraorbital region before and after the standardized injection treatment. RESULTS The aesthetic appearance of the entire infraorbital region (lid-cheek junction) was rated before and after the treatment. The severity of the tear trough (medial aspect of the infraorbital region) as well as the hollowing of the lateral aspect of the infraorbital region also was rated before and after the treatment. Aesthetic improvement was statistically significant when evaluated by the blinded raters, the treating physician, and the patients. All the results were "very much improved" compared to baseline. CONCLUSION The effectiveness of this injection technique is thought to be due to the strategic placement of soft tissue filler that helps to reposition facial ligaments that have changed their orientation during the aging process.
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Affiliation(s)
| | | | - Michael G Alfertshofer
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - Konstantin Frank
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - Nicholas Moellhoff
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | | | - Kristina Davidovic
- Department of Radiology, & Medical School, University of Belgrade, Serbia
| | | | | | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Cho TH, Kim SH, O J, Kwon HJ, Kim KW, Yang HM. Anatomy of the thoracic paravertebral space: 3D micro-CT findings and their clinical implications for nerve blockade. Reg Anesth Pain Med 2021; 46:699-703. [PMID: 33990438 DOI: 10.1136/rapm-2021-102588] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND A precise anatomical understanding of the thoracic paravertebral space (TPVS) is essential to understanding how an injection outside this space can result in paravertebral spread. Therefore, we aimed to clarify the three-dimensional (3D) structures of the TPVS and adjacent tissues using micro-CT, and investigate the potential routes for nerve blockade in this area. METHODS Eleven embalmed cadavers were used in this study. Micro-CT images of the TPVS were acquired after phosphotungstic acid preparation at the mid-thoracic region. The TPVS was examined meticulously based on its 3D topography. RESULTS Micro-CT images clearly showed the serial topography of the TPVS and its adjacent spaces. First, the TPVS was a very narrow space with the posterior intercostal vessels very close to the pleura. Second, the superior costotransverse ligament (SCTL) incompletely formed the posterior wall of the TPVS between the internal intercostal membrane and vertebral body. Third, the retro-SCTL space broadly communicated with the TPVS via slits, costotransverse space, intervertebral foramen, and erector spinae compartment. Fourth, the costotransverse space was intersegmentally connected to the adjacent retro-SCTL space. CONCLUSIONS A non-destructive, multi-sectional approach using 3D micro-CT more comprehensively demonstrated the real topography of the intricate TPVS than previous cadaver studies. The posterior boundary and connectivity of the TPVS provides an anatomical rationale for the notion that paravertebral spread can be achieved with an injection outside this space.
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Affiliation(s)
- Tae-Hyeon Cho
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Shin Hyung Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Jehoon O
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Hyun-Jin Kwon
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Ki Wook Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Hun-Mu Yang
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea (the Republic of) .,Surgical Anatomy Education Centre, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
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Graf R, Pace D. Tear Trough Treatment with Orbicularis Oculi Muscle Suspension. Aesthetic Plast Surg 2021; 45:546-553. [PMID: 32856103 DOI: 10.1007/s00266-020-01922-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Blepharoplasty is a very requested surgery for aesthetic rejuvenation of the eyes with grateful results. Lower blepharoplasty involving a variety of different techniques can be considered to refresh the oculopalpebral area. The approach of the treatment of the tear trough as releasing the tear trough ligament and plication of orbicularis oculi muscle in the palpebral portion to fill the tear trough concavity is essential in our surgical technique demonstrated here. METHODS From July 2014 to January 2020, 435 patients were submitted to blepharoplasty surgery for rejuvenation of the eyes. Lower blepharoplasty was performed with releasing of the tear trough ligament and suspension and fixation of the palpebral part of the orbicularis oculi muscle in the medial part of orbital bone corresponding to the tear trough area. The follow-up was 12 months. RESULTS Patient satisfaction was high, and no complications were observed. Ten patients (2.2%) needed the addition of hyaluronic acid fillers in the tear trough 12 months after the surgery. CONCLUSION We conclude that the use of the orbicularis oculi muscle suspension improves the long-term aesthetic results for the tear trough and the technique is easy to perform. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Ramesh S, Goldberg RA, Wulc AE, Brackup AB. Observations on the Tear Trough. Aesthet Surg J 2020; 40:938-947. [PMID: 31760423 DOI: 10.1093/asj/sjz345] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The tear trough is a prominent structure of the midface. Many surgical and nonsurgical techniques have been devised to efface this feature. OBJECTIVES The aim of this study was to define an aesthetically pleasing tear trough and understand the effect of various surgical procedures on its appearance. METHODS We undertook a retrospective review of "ideal" subjects (ie, young men and women as well as male and female models) as well as surgical patients undergoing lower blepharoplasty with fat excision, fat transposition, erbium laser resurfacing of the eyelids and midface, or endoscopic midface lifting. Marginal reflex distance-2, lower eyelid length, and nasojugal fold depth were measured and analyzed for all patients. RESULTS The nasojugal fold was significantly less prominent in ideal female models than in all other groups (P < 0.0001). Lower eyelid length was significantly shorter after fat excisional lower blepharoplasty, laser resurfacing, and midface lift (P < 0.0001), and did not change after fat transpositional lower blepharoplasty. Postsurgical reduction in lower eyelid length was significantly less with fat transpositional lower blepharoplasty than in all other groups (P < 0.0001). The nasojugal fold was significantly effaced after all types of procedures (P < 0.0001), but was significantly more effaced after fat transpositional lower blepharoplasty (P < 0.01) than after all other procedures. CONCLUSIONS A slight, medial tear trough is present in youth in many patients. The clinical tear trough is a virtual topographic structure distinct from the anatomic tear trough ligament and can be altered in a variety of ways. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | | | - Allan Edward Wulc
- Scheie Eye Institute, Division of Oculoplastics, Philadelphia, PA
- Clinical Associate Professor of Otolaryngology, Temple University Hospital, Philadelphia, PA
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Peng HLP, Peng JH. Treating the tear trough-eye bag complex: Treatment targets, treatment selection, and injection algorithms with case studies. J Cosmet Dermatol 2020; 19:2237-2245. [PMID: 32716132 DOI: 10.1111/jocd.13622] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/04/2020] [Accepted: 07/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The tear trough is a commonly requested area for aesthetic correction, but is difficult to treat well, especially when concurrent with other deformities such as eye bags. There are multiple possible treatment methods for the tear trough and eye bag, such as surgery and hyaluronic acid (HA) filler injection, with the latter gaining popularity in recent years. AIMS To explore tear trough and eye bags etiology, describe the process for treatment selection, outline possible contraindications for filler injection, and expand upon the previously published atrophy-bulging-laxity (ABL) system of tear trough classification and treatment algorithm, with special focus on tear troughs complicated with eye bags. METHODS Six major etiologies of the eye bag were described, and three main contraindications for HA injection were outlined. Three useful tests (snap test, push test, lift test) to aid in treatment selection were described. A comprehensive treatment algorithm was developed to counteract each etiology: "Lifting" injections at the zygoma and anteromedial cheek help counteract senescent or congenital bone deficiency; "Supporting" injections into the anteromedial cheek fat pads help counteract fat atrophy or prolapse; and "Volumization" injections directly at the deformity help smooth out structural grooves or troughs. RESULTS Patients with pronounced eye bags and tear troughs were treated according to this algorithm and obtained good, long-lasting outcomes. CONCLUSIONS Tear troughs complicated with eye bags can be successfully classified and treated with the ABL system and the additional procedures described by this report.
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Affiliation(s)
- Hsien-Li Peter Peng
- P-Skin Professional Clinic, Kaohsiung City, Taiwan.,Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jui-Hui Peng
- Kaohsiung Chang-Gung Memorial Hospital, Kaohsiung City, Taiwan
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Cotofana S, Gotkin RH. Reply: The Functional Anatomy of the Deep Facial Fat Compartments: A Detailed Imaging-Based Investigation. Plast Reconstr Surg 2020; 145:871e-872e. [PMID: 32221248 DOI: 10.1097/prs.0000000000006707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Sebastian Cotofana
- Division of Anatomy, Department of Medical Education, Albany Medical College, Division of Plastic Surgery, Department of Surgery, Albany Medical Center, Albany, N.Y
| | - Robert H Gotkin
- Division of Anatomy, Department of Medical Education, Albany Medical College, Division of Plastic Surgery, Department of Surgery, Albany Medical Center, Albany, N.Y
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23
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Cho TH, Kim SH, Won SY, O J, Kwon HJ, Won JY, Yang HM. Interfascicular septum of the calcaneal tunnel and its relationship with the plantar nerves: A cadaveric study. Clin Anat 2019; 32:877-882. [PMID: 30945342 DOI: 10.1002/ca.23381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 03/31/2019] [Accepted: 04/02/2019] [Indexed: 11/07/2022]
Abstract
The relationship between the plantar nerves and internal fascial structure of the calcaneal tunnel is clinically important to alleviate pain of the sole. The study aimed to investigate the three-dimensional (3D) anatomy of the calcaneal tunnel and its internal fascial septal structure by using microcomputed tomography (mCT) with a phosphotungstic acid preparation, histologic examination, and ultrasound-guided simulation. Twenty-one fixed cadavers and three fresh-frozen cadavers (13 men and 11 women, mean age 82.1 years at death) were used in this study. The 3D images of the calcaneal tunnel harvested by mCT were analyzed in detail. Modified Masson trichrome staining and serial sectional dissection after ultrasound-guided injection were conducted to verify the 3D anatomy. Within the calcaneal tunnel, the interfascicular septum (IFS) commenced proximal to the malleolar-calcaneal line and distal to the bifurcation of the tibial nerve into the plantar nerves. The medial and lateral plantar nerves were separated by the IFS, which divided the calcaneal tunnel into two compartments. The plantar nerves were ramified into two or three branches within each compartment. The IFS terminated around the talocalcaneonavicular joint, and the plantar nerves traveled into the sole. Clinical manipulation of the plantar nerves should be performed in consideration of the fact that they are clearly separated by the IFS. Clin. Anat. 32:877-882, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Tae-Hyeon Cho
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Shin Hyung Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Yoon Won
- Department of Occupational Therapy, Semyung University, Jecheon, Republic of Korea
| | - Jehoon O
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Jin Kwon
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Yeon Won
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hun-Mu Yang
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Republic of Korea.,Surgical Anatomy Education Centre, Yonsei University College of Medicine, Seoul, Republic of Korea
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