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Henry G, Auersvald A, Auersvald LA, Ospital C, Boucher F, Mojallal A. Skin Perfusion After Hemostatic Net: An Anatomic and Radiologic Study in a Cadaver Model. Aesthet Surg J 2024; 44:245-253. [PMID: 37675581 DOI: 10.1093/asj/sjad286] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/16/2023] [Accepted: 09/06/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The hemostatic net is a recent technique initially developed to reduce the occurrence of postoperative hematomas following facelift procedures. Its applications have expanded to include skin redraping, deep plane fixation, and other areas beyond the face. However, no experimental study has investigated its effect on skin blood supply. OBJECTIVES The aim of this study was to analyze facial skin vascularization after applying a hemostatic net to fresh cadavers. METHODS Fourteen hemifaces from fresh adult cadavers were examined. The study model involved a deep plane facelift procedure with the use of a hemostatic net. The first step, involving 4 hemifaces, included dissections and two-/three-dimensional angiographies by digital microangiography and computed tomography scan, respectively. The purpose was to evaluate the influence of the hemostatic net on vascular perfusion. The second step involved a sequential dye perfusion study performed on 10 other hemifaces that underwent facelift procedures with the hemostatic net to determine its impact on skin perfusion. RESULTS The anatomic and radiologic techniques enabled visualization of skin, and showed the arterial system reaching the subdermal vascular plexus and branching between the vascular territories, without interference from the net. The sequential dye perfusion study showed staining after injection in each facelift flap, with comparable coloration distributions before and after the application of the net. CONCLUSIONS The hemostatic net did not affect the skin blood supply, correlating with no clinical increases in ischemia and necrosis rates in the facelift flap. This study provides additional evidence supporting the safety of the hemostatic net in clinical practice. LEVEL OF EVIDENCE: 5
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Features of the ultrastructure of the skin of white rats 30 days after modeling of portal hypertension. CURRENT ISSUES IN PHARMACY AND MEDICAL SCIENCES 2022. [DOI: 10.2478/cipms-2022-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Abstract
The problem of skin repair under the conditions of systemic increased pressure in microvessels has a great importance. This is due to the fact that each year the incidence of this pathology has seen an increase during different operations, including plastic surgery. As the compensatory and reparative mechanisms occurring in the skin affected by vascular hyperbaria are still unidentified, the aim of the study was to investigate the features of the ultrastructure of the skin of white rats 30 days after modeling of portal hypertension. Objects of the study were anterior abdominal wall biopsies for electron microscopy research.
Our work demonstrated that the skin in intact animals (control group) was of typical structure before the beginning of the experiment and 30 days after a sham operation. Following 30 days modeling of portal hypertension, the ultrastructure of the epidermis was found to be intact, only slight thickening of the horny layer was revealed. However, in the basal epidermocytes, signs of crypts formation by cytolemma were revealed. Moreover, in the epidermocytes of the spinous and granular layers, the mitochondria, endoplasmic reticulum channels and ribosomes were almost non-evident. In addition, in the cytoplasm of the fibroblasts, a moderate amount of freely located ribosomes and a moderate number of polymorphic mitochondria were detected, while the lumens of the capillaries of the papillary layer of the dermis were narrowed. We also saw that the swelling of the cytoplasm in endothelial cells resulted in the narrowing of the microvessels lumen. What is more, the subendothelial zone was expanded – which is indicative of endothelial desquamation. Beyond the aforementioned, the nuclei of the endothelial cells were well contoured and had signs of chromatin condensation. Endothelial cells with signs of apoptosis were detected as well.
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Hashem AM, Couto RA, Surek C, Swanson M, Zins JE. Facelift Part II: Surgical Techniques and Complications. Aesthet Surg J 2021; 41:NP1276-NP1294. [PMID: 33558887 DOI: 10.1093/asj/sjab081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although previous publications have reviewed face and necklift anatomy and technique from different perspectives, seldom were the most relevant anatomical details and widely practiced techniques comprehensively summarized in a single work. As a result, the beginner is left with a plethora of varied publications that require sorting, rearrangement, and critical reading. A recent survey of US plastic surgery residents and program directors disclosed less facility with facelift surgery compared with aesthetic surgery of the breast and trunk. To this end, 4 of the widely practiced facelift techniques (ie, minimal access cranial suspension-lift, lateral-SMASectomy, extended-SMAS, and composite rhytidectomy) are described in an easy review format. The highlights of each are formatted followed by a summary of complications. Finally, the merits and limitations of these individual techniques are thoroughly compared and discussed. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Ahmed M Hashem
- Department of Plastic Surgery at Cairo University, Cairo, Egypt
| | | | | | - Marco Swanson
- Department of Plastic Surgery at Case Western University, Cleveland, OH, USA
| | - James E Zins
- Department of Plastic Surgery at Cleveland Clinic Foundation, Cleveland, OH, USA
- Facial Surgery co-section editor for Aesthetic Surgery Journal
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Tiourin E, Barton N, Janis JE. Methods for Minimizing Bleeding in Facelift Surgery: An Evidence-based Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3765. [PMID: 34395151 PMCID: PMC8360447 DOI: 10.1097/gox.0000000000003765] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/24/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Bleeding and hematoma remain leading causes of postoperative complications and unsatisfactory patient outcomes in facelift surgery. Several methods have been implemented, and continue to be developed, to minimize bleeding in facelift surgery. These methods include perioperative blood pressure management, compression dressings, drains, tissue sealants, wetting solution infiltrate, and tranexamic acid. METHODS An evidence-based review of methods used to minimize bleeding in facelift surgery was conducted using the PubMed database according to PRISMA guidelines. Included studies were evaluated for the effects of implemented methods on bleeding outcomes in facelift surgery. Recommendations for each method evaluated were determined based on the amount, level, and heterogeneity of included studies. RESULTS Thirty-six studies were included in the evidence-based review. Effective strategies to reduce the time to hemostasis, postoperative drainage volume, and hematoma rate included perioperative blood pressure management, tissue sealants, and tranexamic acid. While the use of drains or wetting solution infiltrate did not demonstrate to significantly influence bleeding outcome measures, these methods may provide other advantages to facelift surgery. Compression dressings have not demonstrated a significant effect on facelift outcome measures. CONCLUSIONS Perioperative medical management of blood pressure, tissue sealants, and tranexamic acid are most effective in facilitating hemostasis and preventing postoperative hematoma in facelift surgery.
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Affiliation(s)
- Ekaterina Tiourin
- From the University of California, Irvine School of Medicine, Irvine, Calif
| | - Natalie Barton
- Department of Plastic Surgery, University of California, Irvine Medical Center, Orange, Calif
| | - Jeffrey E. Janis
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Abdelwahab M, Patel PN, Most SP. The Use of Indocyanine Green Angiography for Cosmetic and Reconstructive Assessment in the Head and Neck. Facial Plast Surg 2020; 36:727-736. [PMID: 33368129 DOI: 10.1055/s-0040-1721113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Reconstructive procedures in the head and neck can be a surgical challenge owing to the complex anatomical and physiological structure. Different locoregional and microvascular flaps are used for various defects to improve both function and cosmesis. Subjective clinical findings have been the mainstay for perfusion monitoring; however, areas of borderline perfusion are much more difficult to assess clinically. Multiple technologies that offer objective perfusion assessment have been developed to improve surgical outcomes. Indocyanine green (ICG) angiography has gained popularity owing to its minimal invasiveness and increased sensitivity and specificity in assessing flap perfusion particularly in the head and neck. It has been extensively used in free flaps, pedicled flaps (including nasal reconstruction), facelift procedures, random flaps, skull base reconstruction, and pharyngocutaneous fistula prediction. Its perioperative use has provided valuable qualitative and quantitative data that aid our understanding of flap hemodynamics. Clinically, this impacted decision-making in flap design, harvest, inset, and precocious salvage interventions. Though increased cost and intraoperative time could be limitations, cost-effectiveness studies have supported its use, particularly in high-risk individuals. Limitations include the lack of standardized dosing and consistent methodology agreement for data analysis. Future studies should involve larger cohorts and multi-institute studies to overcome such limitations.
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Affiliation(s)
- Mohamed Abdelwahab
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, California.,Department of Otolaryngology - Head & Neck Surgery, Mansoura University, Faculty of Medicine, Mansoura, Egypt
| | - Priyesh N Patel
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Sam P Most
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, California
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Swanson E. Clinical Evaluation of 225 Sub-SMAS Facelifts with No Temporal Incision. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2640. [PMID: 32309087 PMCID: PMC7159970 DOI: 10.1097/gox.0000000000002640] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/18/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite their name, "short scar" procedures leave scars in the temples and the postauricular scar often requires extension. Redraping the orbicularis muscle for periorbital rejuvenation increases the risk of facial nerve injury. This retrospective cohort study was undertaken to clinically evaluate a surgical approach that eliminates the temporal incision. METHODS A sub-superficial musculoaponeurotic system (SMAS) facelift was used, incorporating a triple-vector platysmaplasty and fat injection for periorbital rejuvenation. From 2009 to 2019, 225 consecutive outpatients underwent a sub-SMAS facelift with a triple-vector (superior, lateral, medial) platysmaplasty, either alone or in combination with fat injection, laser resurfacing, blepharoplasties, endoscopic forehead lift, and other cosmetic procedures. Release of the retaining ligaments optimized SMAS mobilization. A temporal incision was not used. Fat (mean volume 32 ml) was injected into the undissected subcutaneous tissue plane. The mean follow-up time was 28 months. RESULTS The most frequent complication was a neuropraxia (7.6%), usually affecting a frontal nerve branch, and always temporary. Two deep venous thromboses were detected by ultrasound surveillance. No significant correlation was detected between complications and age, sex, body mass index, smoking history, or a previous facelift. Sixteen patients (7%) returned for a secondary facelift (mean interval, 3.5 years). CONCLUSIONS A sub-SMAS facelift and triple-vector platysmaplasty with fat injection combine effective neckline rejuvenation with facial volume restoration. Avoiding a temporal incision eliminates a telltale scar. Orbicularis preservation avoids additional dissection, possibly reducing the risk of neuropraxia. Fat injection provides a net increase in facial volume. Long-term measurement studies are recommended.
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Swanson E. Lessons Learned from a National Cosmetic Surgery Insurance Database. Aesthet Surg J 2016; 36:NP171-2. [PMID: 26895956 DOI: 10.1093/asj/sjv258] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eric Swanson
- Dr Swanson is a plastic surgeon in private practice in Leawood, KS
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Gupta V, Winocour J, Yeslev M, Shack RB, Grotting JC, Higdon KK. Response to "Lessons Learned from a National Cosmetic Surgery Insurance Database". Aesthet Surg J 2016; 36:NP173-6. [PMID: 26895957 PMCID: PMC4784529 DOI: 10.1093/asj/sjv274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2015] [Indexed: 12/18/2022] Open
Affiliation(s)
- Varun Gupta
- Drs Gupta and Higdon are Assistant Professors, Dr Winocour is a Plastic Surgery Fellow, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Yeslev is a Plastic Surgeon, Southeast Permanente Medical Group, Atlanta, GA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Julian Winocour
- Drs Gupta and Higdon are Assistant Professors, Dr Winocour is a Plastic Surgery Fellow, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Yeslev is a Plastic Surgeon, Southeast Permanente Medical Group, Atlanta, GA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Max Yeslev
- Drs Gupta and Higdon are Assistant Professors, Dr Winocour is a Plastic Surgery Fellow, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Yeslev is a Plastic Surgeon, Southeast Permanente Medical Group, Atlanta, GA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - R Bruce Shack
- Drs Gupta and Higdon are Assistant Professors, Dr Winocour is a Plastic Surgery Fellow, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Yeslev is a Plastic Surgeon, Southeast Permanente Medical Group, Atlanta, GA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - James C Grotting
- Drs Gupta and Higdon are Assistant Professors, Dr Winocour is a Plastic Surgery Fellow, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Yeslev is a Plastic Surgeon, Southeast Permanente Medical Group, Atlanta, GA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - K Kye Higdon
- Drs Gupta and Higdon are Assistant Professors, Dr Winocour is a Plastic Surgery Fellow, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Yeslev is a Plastic Surgeon, Southeast Permanente Medical Group, Atlanta, GA. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
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