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De la Cruz J, Benzecry Almeida D, Silva Marques M, Ramina R, Fortes Kubiak RJ. Elucidating the Mechanisms of Pulsed Radiofrequency for Pain Treatment. Cureus 2023; 15:e44922. [PMID: 37814752 PMCID: PMC10560583 DOI: 10.7759/cureus.44922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 10/11/2023] Open
Abstract
Pulsed radiofrequency is a well-documented treatment option for multiple painful conditions where pulses of energy are delivered close to neural elements. Since its earliest adoption, this technique has gained increasing acceptance as a minimally invasive procedure, and new applications are evolving. Studies have shown microscopic and biochemical changes that reflect beneficial effects; however, the exact mechanism of action is not yet completely understood. To redress this paucity, 11,476 articles of scientific relevance published between 1980 and November 2022 were mined through a search of the PubMed database, arriving at 49 studies both in animals and humans. In general, the experimental studies examined have shown that pulsed radiofrequency induces multiple changes with antinociceptive and neuromodulatory effects. These modifications include changes in neural and glial cells, synaptic transmission, and perineural space. Studies also reveal that pulsed radiofrequency regulates inflammatory responses, cellular signaling proteins, and the expression of genes related to pain transmission, acting in biological processes in structures such as myelin, mitochondria, axons, glial cells, connective tissue, regulation of proteins, ion channels, and neurotransmitters.
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Affiliation(s)
| | | | | | - Ricardo Ramina
- Neurological Surgery, Neurological Institute of Curitiba, Curitiba, BRA
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2
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Eleroui M, Feki A, Hamzaoui A, Kammoun I, Bouhamed M, Boudawara O, Ben Ayed I, Ben Amara I. Preparation and characterization of a novel hamada scoparia polysaccharide composite films and evaluation of their effect on cutaneous wound healing in rat. Int J Pharm 2021; 608:121056. [PMID: 34464667 DOI: 10.1016/j.ijpharm.2021.121056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 12/24/2022]
Abstract
This work was intended to prepare biodegradable and edible films from polysaccharide extracted from Hammada scoparia leaves (named PSP) and reinforced by poly (vinyl alcohol) (PVA). Four films with different ratios of PSP/PVA: P1 (70:30), P2 (50:50), FP3 (30:70) and pure PVA (100 % PVA) were prepared and characterized in terms of structural (FT-IR), physical (Thickness, solubility and swelling index), optical and thermal properties (TGA). The antioxidant activities of different films were determined in vitro and evaluated in vivo through the examination of wound healing capability. Data revealed that the film P1 displayed the highest antioxidant activity in vitro and accelerated significantly the wound healing, after sixteen days of treatment, attested by higher wound appearance scores and a higher content of collagen (765.924 ± 4.44 mg/g of tissue) confirmed by histological examination, when compared with control, CYTOL CENTELLA® and pure PVA-treated groups. Overall, these results demonstrated that PSP/PVA based films exhibited a higher wound healing potential confirmed with the high antioxidant activities in vitro.
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Affiliation(s)
- Malek Eleroui
- Laboratory of Enzyme Engineering and Microbiology, National Engineering School in Sfax, University of Sfax, B.P. 1173, 3038 Sfax, Tunisia
| | - Amal Feki
- Laboratory of Enzyme Engineering and Microbiology, National Engineering School in Sfax, University of Sfax, B.P. 1173, 3038 Sfax, Tunisia
| | - Asma Hamzaoui
- Laboratory of Enzyme Engineering and Microbiology, National Engineering School in Sfax, University of Sfax, B.P. 1173, 3038 Sfax, Tunisia
| | - Intissar Kammoun
- Laboratory of Enzyme Engineering and Microbiology, National Engineering School in Sfax, University of Sfax, B.P. 1173, 3038 Sfax, Tunisia
| | - Marwa Bouhamed
- Laboratory of Anatomopathology, CHU Habib Bourguiba, University of Sfax, 3029 Sfax, Tunisia
| | - Ons Boudawara
- Laboratory of Anatomopathology, CHU Habib Bourguiba, University of Sfax, 3029 Sfax, Tunisia
| | | | - Ibtissem Ben Amara
- Laboratory of Enzyme Engineering and Microbiology, National Engineering School in Sfax, University of Sfax, B.P. 1173, 3038 Sfax, Tunisia.
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3
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Hernández-Bule ML, Toledano-Macías E, Naranjo A, de Andrés-Zamora M, Úbeda A. In vitro stimulation with radiofrequency currents promotes proliferation and migration in human keratinocytes and fibroblasts. Electromagn Biol Med 2021; 40:338-352. [PMID: 34315307 DOI: 10.1080/15368378.2021.1938113] [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] [Indexed: 10/20/2022]
Abstract
Capacitive-resistive electric transfer (CRET) therapies have been proposed as strategies for regeneration of cutaneous tissue lesions. Previous studies by our group have shown that intermittent stimulation with 448 kHz CRET currents at subthermal densities promotes in vitro proliferation of human stem cells involved in tissue regeneration. The present study investigates the effects of the in vitro exposure to these radiofrequency (RF) currents on the proliferation and migration of keratinocytes and fibroblasts, the main cell types involved in skin regeneration. The effects of the electric stimulation on cell proliferation and migration were studied through XTT and wound closure assays, respectively. The CRET effects on the expression and location of proteins involved in proliferation and migration were assessed by immunoblot and immunofluorescence. The obtained results reveal that electrostimulation promotes proliferation and/or migration in keratinocytes and fibroblasts. These effects would be mediated by changes observed in the expression and location of intercellular adhesion proteins such as β-catenin and E-cadherin, of proteins involved in cell-to-substrate adhesion such as vinculin, p-FAK and the metalloproteinase MMP-9, and of other proteins that control both processes: MAP kinases p-p38, p-JUNK and p-ERK1/2. These responses could represent a mechanism underlying the promotion of normotrophic wound regeneration induced by CRET. Indeed, electric stimulation would favor completion of granulation tissue formation prior to the closure of the outer tissue layers, thus preventing abnormal wound cicatrization or chronification.
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Affiliation(s)
| | - Elena Toledano-Macías
- Servicio de Bioelectromagnetismo, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Aida Naranjo
- Departamento de Ingeniería Eléctrica, Escuela Técnica Superior de Ingeniería y Diseño Industrial, Universidad Politécnica de Madrid, Madrid, Spain
| | - Marina de Andrés-Zamora
- Departamento de Ingeniería Eléctrica, Escuela Técnica Superior de Ingeniería y Diseño Industrial, Universidad Politécnica de Madrid, Madrid, Spain
| | - Alejandro Úbeda
- Servicio de Bioelectromagnetismo, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
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Della Rocca DG, Murtaza G, Di Biase L, Akella K, Krishnan SC, Magnocavallo M, Mohanty S, Gianni C, Trivedi C, Lavalle C, Forleo GB, Natale VN, Tarantino N, Romero J, Gopinathannair R, Patel PJ, Bassiouny M, Del Prete A, Al-Ahmad A, Burkhardt JD, Gallinghouse GJ, Sanchez JE, Doshi SK, Horton RP, Lakkireddy D, Natale A. Radiofrequency Energy Applications Targeting Significant Residual Leaks After Watchman Implantation: A Prospective, Multicenter Experience. JACC Clin Electrophysiol 2021; 7:1573-1584. [PMID: 34330671 DOI: 10.1016/j.jacep.2021.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/14/2021] [Accepted: 06/04/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the efficacy of radiofrequency (RF) energy applications targeting the atrial side of a significant residual leak in patients with acute and chronic evidence of incomplete percutaneous left atrial appendage (LAA) occlusion. BACKGROUND RF applications have been proved to prevent recanalization of intracranial aneurysms after coil embolization, thereby favoring complete sealing. From a mechanistic standpoint, in vitro and in vivo experiments have demonstrated that RF promotes collagen deposition and tissue retraction. METHODS Forty-three patients (mean age 75 ± 7 years mean CHA2DS2-VASc score 4.6 ± 1.4, mean HAS-BLED score 4.0 ± 1.1) with residual leaks ≥4 mm after Watchman implantation were enrolled. Procedural success was defined as complete LAA occlusion or presence of a mild or minimal (1- to 2-mm) peridevice leak on follow-up transesophageal echocardiography (TEE), which was performed approximately 45 days after the procedure. RESULTS RF-based leak closure was performed acutely after Watchman implantation in 19 patients (44.2%) or scheduled after evidence of significant leaks on follow-up TEE in 24 others (55.8%). The median leak size was 5 mm (range: 4-7 mm). On average, 18 ± 7 RF applications per patient (mean maximum contact force 16 ± 3 g, mean power 44 ± 2 W, mean RF time 5.1 ± 2.5 minutes) were performed targeting the atrial edge of the leak. Post-RF median leak size was 0 mm (range: 0-1 mm). A very low rate (2.3% [n = 1]) of major periprocedural complications was observed. Follow-up TEE revealed complete LAA sealing in 23 patients (53.5%) and negligible residual leaks in 15 (34.9%). CONCLUSIONS RF applications targeting the atrial edge of a significant peri-Watchman leak may promote LAA sealing via tissue remodeling, without increasing complications. (RF Applications for Residual LAA Leaks [REACT]; NCT04726943).
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Affiliation(s)
| | - Ghulam Murtaza
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Krishna Akella
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | | | - Michele Magnocavallo
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Department of Cardiovascular/Respiratory Diseases, Nephrology, Anesthesiology, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Carlo Lavalle
- Department of Cardiovascular/Respiratory Diseases, Nephrology, Anesthesiology, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giovanni B Forleo
- Department of Cardiology, Azienda Ospedaliera-Universitaria "Luigi Sacco," Milan, Italy
| | - Veronica N Natale
- Department of Pediatrics, Charlotte R. Bloomberg Children's Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nicola Tarantino
- Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jorge Romero
- Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Philip J Patel
- Eisenhower Desert Cardiology Center, Rancho Mirage, California, USA
| | - Mohamed Bassiouny
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | | | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | | | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Shephal K Doshi
- Cardiology Division, Pacific Heart Institute, Santa Monica, California
| | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Interventional Electrophysiology, Scripps Clinic, La Jolla, California, USA; Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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5
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Kanapathy M, Hachach-Haram N, Bystrzonowski N, Becker DL, Mosahebi A, Richards T. Epidermal graft encourages wound healing by down-regulation of gap junctional protein and activation of wound bed without graft integration as opposed to split-thickness skin graft. Int Wound J 2021; 18:332-341. [PMID: 33751815 PMCID: PMC8244016 DOI: 10.1111/iwj.13536] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 01/07/2023] Open
Abstract
Wound coverage by split-thickness skin graft (SSG) and epidermal graft (EG) shortens healing time, with comparable outcomes. However, the healing mechanism of EG is not as well understood as SSG. The difference in the healing mechanisms of EG and SSG was investigated using gap junctional proteins, proliferative marker, and cytokeratin markers. Paired punch biopsies were taken from the wound edge and wound bed from patients undergoing EG and SSG at weeks 0 and 1 to investigate wound edge keratinocyte migratory activities (connexins 43, 30, and 26), wound bed activation (Ki67), and the presence of graft integration to the wound bed (cytokeratins 14 and 6). Twenty-four paired biopsies were taken at weeks 0 and 1 (EG, n = 12; SSG, n = 12). Wound edge biopsies demonstrated down-regulation of connexins 43 (P = .023) and 30 (P = .027) after EG, indicating accelerated healing from the wound edge. At week 1, increased expression of Ki67 (P < .05) was seen after EG, indicating activation of cells within the wound bed. Keratinocytes expressing cytokeratins 6 and 14 were observed on all wounds treated with SSG but were absent at week 1 after EG, indicating the absence of graft integration following EG. Despite EG and SSG both being autologous skin grafts, they demonstrate different mechanisms of wound healing. EG accelerates wound healing from the wound edges and activates the wound bed despite not integrating into the wound bed at week 1 post-grafting as opposed to SSG, hence demonstrating properties comparable with a bioactive dressing instead of a skin substitute.
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Affiliation(s)
- Muholan Kanapathy
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - Nadine Hachach-Haram
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - Nicola Bystrzonowski
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - David L Becker
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Institute of Medical Biology, A*Star, Immunos, Biomedical Grove, Singapore
| | - Afshin Mosahebi
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - Toby Richards
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
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Park JU, Jeong SH, Song EH, Song J, Kim HE, Kim S. Acceleration of the healing process of full-thickness wounds using hydrophilic chitosan-silica hybrid sponge in a porcine model. J Biomater Appl 2018; 32:1011-1023. [PMID: 29357774 DOI: 10.1177/0885328217751246] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In this study, we evaluated the surface characterization of a novel chitosan-silica hybridized membrane and highlighted the substantial role of silica in the wound environment. The chemical coupling of chitosan and silica resulted in a more condensed network compared with pure chitosan, which was eventually able to stably maintain its framework, particularly in the wet state. In addition, we closely observed the wound-healing process along with the surface interaction between chitosan-silica and the wound site using large-surface-area wounds in a porcine model. Our evidence indicates that chitosan-silica exerts a synergetic effect of both materials to promote a remarkable wound-healing process. In particular, the silica in chitosan-silica accelerated wound closure including wound contraction, and re-epithelialization via enhancement of cell recruitment, epidermal maturity, neovascularization, and granulation tissue formation compared with pure chitosan and other commercial dressing materials. This advanced wound dressing material may lead to effective treatment for problematic cutaneous wounds and can be further applied for human skin regeneration.
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Affiliation(s)
- Ji-Ung Park
- 1 Department of Plastic and Reconstructive Surgery, 26725 Seoul National University , Boramae Hospital, Seoul, Republic of Korea
| | - Seol-Ha Jeong
- 2 Department of Materials Science and Engineering, 26725 Seoul National University , Seoul, Republic of Korea
| | - Eun-Ho Song
- 2 Department of Materials Science and Engineering, 26725 Seoul National University , Seoul, Republic of Korea
| | - Juha Song
- 3 School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
| | - Hyoun-Ee Kim
- 2 Department of Materials Science and Engineering, 26725 Seoul National University , Seoul, Republic of Korea.,4 Biomedical Implant Convergence Research Center, Advanced Institutes of Convergence Technology, Republic of Korea
| | - Sukwha Kim
- 5 Department of Plastic and Reconstructive Surgery, 37990 Seoul National University College of Medicine , Republic of Korea
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7
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Gungor S, Aiyer R. A Case of Spinal Cord Stimulator Recharging Interruption in Wound Healing. Neuromodulation 2017; 20:675-677. [PMID: 28671743 DOI: 10.1111/ner.12631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/13/2017] [Accepted: 05/20/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To illustrate the obstacles and problems with electrical fields (EFs) in treatment and management of skin wounds. Unlike the literature that gives evidence for EF promoting wound healing, there is relatively little research to illustrate the interference of wound healing with EFs. MATERIALS AND METHODS This is a case report of a patient who underwent spinal cord stimulator implantation, and presented with delayed wound healing postoperatively. Postoperative workup for infection was negative. Spinal cord stimulator was programmed to use higher frequencies than traditional settings, which required recharging the pulse generator daily. There was spontaneous improvement of the clinical presentation resulting in adequate wound healing after changing the programming to less frequent recharging requirements. RESULTS In our case, despite the presence of clinical signs similar to a surgical site infection, the wound healing was most likely interrupted and delayed secondary to the electric field generated due to the frequent recharges of the pulse generator. CONCLUSIONS It is possible that EF can also negatively impact healing of a wound, and thus should be a consideration to clinicians when a delay in proper wound healing is encountered postoperatively. Therefore, in the postoperative period, when the wound healing is most active, we recommend avoiding programs that require frequent pulse generator recharges.
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Affiliation(s)
- Semih Gungor
- Division of Pain Medicine, Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY
| | - Rohit Aiyer
- Department of Psychiatry - Hofstra Northwell Health - Staten Island University Hospital, Staten Island, NY, USA
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Complementary Effects of Negative-Pressure Wound Therapy and Pulsed Radiofrequency Energy on Cutaneous Wound Healing in Diabetic Mice. Plast Reconstr Surg 2017; 139:105-117. [DOI: 10.1097/prs.0000000000002909] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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9
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Effects of the Ultra-High-Frequency Electrical Field Radiofrequency Device on Mouse Skin: A Histologic and Molecular Study. Plast Reconstr Surg 2016; 138:248e-255e. [PMID: 27465186 DOI: 10.1097/prs.0000000000002364] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Radiofrequency technology is one of the most recently developed methods for noninvasive skin tightening and facial contouring, and works by generating thermal energy in the deep dermis. Although clinical improvements have been reported using radiofrequency devices, there are few histologic and molecular studies about the mechanisms of dermal collagen remodeling. The authors investigated the histologic effects of an ultra-high-frequency electrical field (40.68 MHz) radiofrequency device (Polargen) on collagen remodeling in hairless mouse skin and evaluated its relative molecular mechanism. METHODS The radiofrequency was applied to the dorsal skin of hairless mice three times per week for 2 weeks. At 21 days after initial treatment, treated skin and nontreated control skin samples were excised for semiquantitative analysis of histologic features, including collagen. The authors also checked the mRNA expression levels of collagen type 1, transforming growth factor (TGF)-β, matrix metalloproteinase-1, vascular endothelial growth factor, tumor necrosis factor-α, and interleukin-1. RESULTS Histologic examination revealed epidermal hyperplasia, increased collagen staining, and fat atrophy in treated skin area compared with the nontreated skin area. In addition, mRNA expression of collagen type І, TGF-β, and vascular endothelial growth factor in radiofrequency-treated areas was significantly increased compared with that in untreated control areas (p < 0.05, p < 0.05, and p < 0.01, respectively). CONCLUSIONS These results suggest that the device may facilitate replacement of subcutaneous fat tissue with new collagen in association with the increased mRNA levels in TGF-β and vascular endothelial growth factor. Therefore, this device may effectively reduce adipose tissue and achieve facial contouring in addition to skin tightening.
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Chuang J, Barnes C, Wong BJF. Overview of Facial Plastic Surgery and Current Developments. Surg J (N Y) 2016; 2:e17-e28. [PMID: 28824978 PMCID: PMC5553462 DOI: 10.1055/s-0036-1572360] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 01/05/2016] [Indexed: 11/01/2022] Open
Abstract
Facial plastic surgery is a multidisciplinary specialty largely driven by otolaryngology but includes oral maxillary surgery, dermatology, ophthalmology, and plastic surgery. It encompasses both reconstructive and cosmetic components. The scope of practice for facial plastic surgeons in the United States may include rhinoplasty, browlifts, blepharoplasty, facelifts, microvascular reconstruction of the head and neck, craniomaxillofacial trauma reconstruction, and correction of defects in the face after skin cancer resection. Facial plastic surgery also encompasses the use of injectable fillers, neural modulators (e.g., BOTOX Cosmetic, Allergan Pharmaceuticals, Westport, Ireland), lasers, and other devices aimed at rejuvenating skin. Facial plastic surgery is a constantly evolving field with continuing innovative advances in surgical techniques and cosmetic adjunctive technologies. This article aims to give an overview of the various procedures that encompass the field of facial plastic surgery and to highlight the recent advances and trends in procedures and surgical techniques.
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Affiliation(s)
- Jessica Chuang
- Beckman Laser Institute and Medical Clinic, University of California Irvine, Irvine, California
| | - Christian Barnes
- Beckman Laser Institute and Medical Clinic, University of California Irvine, Irvine, California.,Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Irvine, California
| | - Brian J F Wong
- Beckman Laser Institute and Medical Clinic, University of California Irvine, Irvine, California.,Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Irvine, California
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11
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Li Y, Zhang J, Xu Y, Han Y, Jiang B, Huang L, Zhu H, Xu Y, Yang W, Qin C. The Histopathological Investigation of Red and Blue Light Emitting Diode on Treating Skin Wounds in Japanese Big-Ear White Rabbit. PLoS One 2016; 11:e0157898. [PMID: 27347879 PMCID: PMC4922561 DOI: 10.1371/journal.pone.0157898] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/07/2016] [Indexed: 11/18/2022] Open
Abstract
The biological effects of different wavelengths of light emitting diode (LED) light tend to vary from each other. Research into use of photobiomodulation for treatment of skin wounds and the underlying mechanisms has been largely lacking. We explored the histopathological basis of the therapeutic effect of photobiomodulation and the relation between duration of exposure and photobiomodulation effect of different wavelengths of LED in a Japanese big-ear white rabbit skin-wound model. Skin wound model was established in 16 rabbits (three wounds per rabbit: one served as control, the other two wounds were irradiated by red and blue LED lights, respectively). Rabbits were then divided into 2 equal groups based on the duration of exposure to LED lights (15 and 30 min/exposure). The number of wounds that showed healing and the percentage of healed wound area were recorded. Histopathological examination and skin expression levels of fibroblast growth factor (FGF), epidermal growth factor (EGF), endothelial marker (CD31), proliferating cell nuclear antigen (Ki67) and macrophagocyte (CD68) infiltration, and the proliferation of skin collagen fibers was assessed. On days 16 and 17 of irradiation, the healing rates in red (15 min and 30 min) and blue (15 min and 30 min) groups were 50%, 37.5%, 25% and 37.5%, respectively, while the healing rate in the control group was 12.5%. The percentage healed area in the red light groups was significantly higher than those in other groups. Collagen fiber and skin thickness were significantly increased in both red light groups; expression of EGF, FGF, CD31 and Ki67 in the red light groups was significantly higher than those in other groups; the expression of FGF in red (30 min) group was not significantly different from that in the blue light and control groups. The effect of blue light on wound healing was poorer than that of red light. Red light appeared to hasten wound healing by promoting fibrous tissue, epidermal and endothelial cell proliferation. An increase in the exposure time to 30 min did not confer any additional benefit in both red and blue light groups. This study provides a theoretical basis for the potential therapeutic application of LED light in clinical settings.
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Affiliation(s)
- Yanhong Li
- Key Laboratory of Human Diseases Comparative Medicine, Ministry of Health, Institute of Medical Laboratory Animal Science, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Human Diseases Animal Models, State Administration of Traditional Chinese Medicine, Peking Union Medicine College, Beijing, China
| | - Jigang Zhang
- The General Hospital of the PLA Rocket Force, Department of Dermatology, Beijing, China
| | - Yanfeng Xu
- Key Laboratory of Human Diseases Comparative Medicine, Ministry of Health, Institute of Medical Laboratory Animal Science, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Human Diseases Animal Models, State Administration of Traditional Chinese Medicine, Peking Union Medicine College, Beijing, China
| | - Yunlin Han
- Key Laboratory of Human Diseases Comparative Medicine, Ministry of Health, Institute of Medical Laboratory Animal Science, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Human Diseases Animal Models, State Administration of Traditional Chinese Medicine, Peking Union Medicine College, Beijing, China
| | - Binbin Jiang
- The General Hospital of the PLA Rocket Force, Department of Dermatology, Beijing, China
| | - Lan Huang
- Key Laboratory of Human Diseases Comparative Medicine, Ministry of Health, Institute of Medical Laboratory Animal Science, Chinese Academy of Medical Sciences, Beijing, China
| | - Hua Zhu
- Key Laboratory of Human Diseases Comparative Medicine, Ministry of Health, Institute of Medical Laboratory Animal Science, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Human Diseases Animal Models, State Administration of Traditional Chinese Medicine, Peking Union Medicine College, Beijing, China
| | - Yuhuan Xu
- Key Laboratory of Human Diseases Comparative Medicine, Ministry of Health, Institute of Medical Laboratory Animal Science, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Human Diseases Animal Models, State Administration of Traditional Chinese Medicine, Peking Union Medicine College, Beijing, China
| | - Weiling Yang
- The General Hospital of the PLA Rocket Force, Department of Dermatology, Beijing, China
- * E-mail: (CQ); (WLY)
| | - Chuan Qin
- Key Laboratory of Human Diseases Comparative Medicine, Ministry of Health, Institute of Medical Laboratory Animal Science, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Human Diseases Animal Models, State Administration of Traditional Chinese Medicine, Peking Union Medicine College, Beijing, China
- * E-mail: (CQ); (WLY)
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12
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Kumaran B, Watson T. Radiofrequency-based treatment in therapy-related clinical practice – a narrative review. Part I: acute conditions. PHYSICAL THERAPY REVIEWS 2015. [DOI: 10.1179/1743288x15y.0000000016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Kao HK, Hsu HH, Chuang WY, Chang KP, Chen B, Guo L. Experimental study of fat grafting under negative pressure for wounds with exposed bone. Br J Surg 2015; 102:998-1005. [PMID: 25974177 DOI: 10.1002/bjs.9826] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 01/27/2015] [Accepted: 03/09/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND The combination of fat grafting and negative pressure (VAC) therapy represents a synergistic interaction of all essential components for wound healing. The aim of this experimental study was to determine whether it could promote healing of wounds with exposed bone. METHODS Full-thickness wounds with denuded bone in Sprague-Dawley rats were treated with either polyurethane foam dressing, fat grafting alone, polyurethane foam dressing with VAC, or polyurethane foam dressing with VAC combined with a single, or two administrations of fat graft. Wound healing kinetics, tissue growth, cell proliferation (Ki-67) and angiogenesis (platelet endothelial cell adhesion molecule 1 and α-smooth muscle actin) were investigated. Messenger RNA levels related to angiogenesis (vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (b-FGF)), profibrosis (platelet-derived growth factor A and transforming growth factor β), adipocyte expression (fatty acid-binding protein (FABP) 4 and peroxisome proliferator activated receptor γ), and extracellular matrix remodelling (collagen I) were measured in wound tissues. RESULTS Wounds treated by VAC combined with fat grafting were characterized by cell proliferation, neoangiogenesis and maturation of functional blood vessels; they showed accelerated granulation tissue growth over the denuded bone compared with VAC- or foam dressing-treated wounds. Fat grafting alone over denuded bone resulted in complete necrosis. Expression of angiogenesis markers (VEGF and b-FGF) and adipocyte expression factors (FABP-4) was upregulated in wounds treated with VAC combined with fat grafting. CONCLUSION Fat grafting with VAC therapy may represent a simple but effective clinical solution for a number of complex tissue defects, and warrants testing in clinical models. SURGICAL RELEVANCE The combination of fat grafting and vacuum therapy represents a synergistic interaction of regenerative cells, hospitable wound matrix and stimulating micromechanical forces. It could accelerate complex wound healing through cell proliferation, neoangiogenesis and maturation of functional blood vessels. The efficacy of a multimodal wound healing approach is established in this experimental model; it could easily be translated into clinical trials of treatment for difficult wounds.
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Affiliation(s)
- H-K Kao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - H-H Hsu
- Kidney Research Centre, Department of Nephrology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - W-Y Chuang
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - K-P Chang
- Department of Otolaryngology and Head Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - B Chen
- Department of Plastic Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.,Department of Reparative and Reconstructive Surgery, Second Affiliated Hospital of Kunming Medical University, Burn Institute of Yunnan Province, Kunming, China
| | - L Guo
- Department of Plastic Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
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Stocchero M, Gobbato L, De Biagi M, Bressan E, Sivolella S. Pulsed electromagnetic fields for postoperative pain: a randomized controlled clinical trial in patients undergoing mandibular third molar extraction. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:293-300. [DOI: 10.1016/j.oooo.2014.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 11/25/2014] [Indexed: 11/29/2022]
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Collagen Synthesis Modulated in Wounds Treated by Pulsed Radiofrequency Energy. Plast Reconstr Surg 2013; 131:490e-498e. [DOI: 10.1097/prs.0b013e3182827636] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- Meir D. Hershcovitch
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David B. Hom
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Uraloğlu M, Livaoğlu M, Agdoğan Ö, Mungan S, Alhan E, Karaçal N. An evaluation of five different dressing materials on split-thickness skin graft donor site and full-thickness cutaneous wounds: an experimental study. Int Wound J 2012; 11:85-92. [PMID: 22943661 DOI: 10.1111/j.1742-481x.2012.01071.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The objective of this study was to investigate the healing effect of five different products on split-thickness skin graft (STSG) donor sites and full-thickness cutaneous wounds (FTCWs) using an occlusive dressing model. Six groups were included: 1 control and 5 experimental groups, with a total of 24 rats, using an occlusive dressing model. STSG donor sites and FTCWs were established in two separate areas, to the right and left on the animals' backs. Wound sites were dressed with one of the following materials: fine mesh gauze, microporous polysaccharide hemosphere (MPH), clinoptilolite, alginate, hydrogel or biosynthetic wound dressing (Biobran(®) ). These materials were compared in terms of healing rate, healing quality and histopathological findings. Occlusive dressings were applied to each wound on days 0, 3, 5, 7, 10 and 14. Area measurements were taken using images of each dressing. The alginate and clinoptilolite groups gave the best healing rate results for both STSG donor sites (P = 0·003) and FTCWs (P = 0·003). MPH came third in each group. The alginate group produced better results in terms of healing quality criteria, followed by hydrogel, MPH, clinoptilolite and Biobran(®) , in that order. Statistically significant results were obtained in all groups compared to the control group (P < 0·0007). Rapid and good healing quality for both the STSG donor sites and FTCWs were obtained with alginate. Healing with clinoptilolite and MPH was rapid, but poor quality, while slower but good healing quality was obtained with hydrogel. Slower and worse quality healing was obtained with Biobran(®) .
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Affiliation(s)
- Muhammet Uraloğlu
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, TurkeyDepartment of Pathology, Faculty of Medicine, Karadeniz Technical University, Trabzon, TurkeyDepartment of General Surgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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Egemen O, Ozkaya O, Ozturk MB, Sen E, Akan M, Sakiz D, Aygit C. The biomechanical and histological effects of diabetes on tendon healing: experimental study in rats. J Hand Microsurg 2012; 4:60-4. [PMID: 24293952 DOI: 10.1007/s12593-012-0074-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 07/16/2012] [Indexed: 01/13/2023] Open
Abstract
The aim of this study was to investigate the biomechanical and histological perspectives of healing of Achilles tendon in diabetic rats and compare the results with non-diabetic subjects. Fifty four adult Wistar Albino rats weighing 300-350 g were used throughout the study. Six animals were excluded from the study and replaced. Rats were randomly assigned to either the experimental or the control group comprised of 24 rats in each. Diabetes was induced in experimental group with streptozotocin. 3 days after the induction of diabetes, both Achilles tendons were transected 5 mm proximal to their insertions to the calcaneal bone and repaired by using 6/0 polypropylene sutures with modified Kessler method. At weeks 2, 4 and 6, eight rats from each group were euthanized. Left Achilles tendons including the repair site were prepared for histological evaluation and right legs were prepared for mechanical testing. When compared to control group, diabetic animals displayed a lower peak force for failure in each of the second, fourth and sixth week. The differences between the groups in each week were found to be significant in statistical assessments (p < 0.05). Histologic assessment revealed that the diabetic animals had significantly less amount of fibroblast proliferation and lymphocyte infiltration compared to the control group. There is significant delay in tendon strength at the end of week 2, 4 and 6 postoperatively in the diabetic rats. Therefore diabetic individuals require specific postoperative follow up and rehabilitation procedures.
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Affiliation(s)
- Onur Egemen
- Plastic and Reconstructive Surgery Department, Okmeydani Education and Reserch Hospital, Istanbul, Turkey ; Atakoy 4. Kisim, TO 80 Blok, 34158 Bakirkoy, Istanbul Turkey
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Rawe IM, Lowenstein A, Barcelo CR, Genecov DG. Control of postoperative pain with a wearable continuously operating pulsed radiofrequency energy device: a preliminary study. Aesthetic Plast Surg 2012; 36:458-63. [PMID: 22037572 DOI: 10.1007/s00266-011-9828-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 09/29/2011] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pulsed radiofrequency energy (PRFE) has long been reported to have a therapeutic effect on postoperative pain. In this study, a portable, wearable, low-energy-emitting PRFE therapy device was used to determine the control of postoperative pain after breast augmentation surgery. METHODS The study enrolled 18 healthy women who underwent breast augmentation purely for aesthetic considerations. Postoperative pain after surgery was assessed with a 0- to 10-point visual analog scale (VAS). Baseline pain scores were taken at completion of the operation, and the patients were randomly assigned coded PRFE devices that were either active or placebo devices. For 7 days, VAS scores were recorded twice daily (a.m. and p.m.). Medication use also was logged for 7 days. The PRFE devices were left in place and in continuous operation for the 7 days of the study. RESULTS All the patients tolerated the PRFE therapy well, and no side effects were reported. The VAS scores for the active group were significantly lower on postoperative day 1. By day 7, the baseline VAS remaining in the active group was 7.9% versus 38% in the placebo group. Together with lower VAS scores, narcotic pain medication use was lower in the patient group that received PRFE therapy. CONCLUSION Postoperative pain is significantly lower with PRFE therapy. According to the findings, PRFE therapy in this form is an excellent, safe, drug-free method of postoperative pain control.
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Rawe IM, Vlahovic TC. The use of a portable, wearable form of pulsed radio frequency electromagnetic energy device for the healing of recalcitrant ulcers: a case report. Int Wound J 2011; 9:253-8. [PMID: 21933346 DOI: 10.1111/j.1742-481x.2011.00853.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Pulsed radio frequency energy (PRFE) has successfully been used to treat diabetic and venous stasis ulcers. In this case report, a lightweight wearable form of a PFRE device was evaluated and used to treat three diabetic foot ulcers and one venous stasis ulcer. The ulcers were present on the four patients for more than 3 months and had failed to heal after conventional treatment. A lightweight battery-powered, wearable form of PRFE device was introduced as a treatment and used 6-8 hours per day for a period of 6 weeks. All patients after 1 week of therapy showed improvement and wound size was seen to decrease. Patient 1 had a venous stasis ulcer, and reported significant pain relief after 2 weeks treatment. Patients 2 and 3 achieved complete healing after 3 weeks treatment, and patients 1 and 4 had a 95% and 88% reduction in wound size, respectively, after the 6-week study period. Both these patients continued to complete healing using the PRFE device after the 6-week study period. PRFE treatment delivered in the form of a wearable lightweight patch appears to offer promise in the treatment of recalcitrant chronic wounds.
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Affiliation(s)
- Ian M Rawe
- Bioelectronics Corporation, Frederick, MD 21704, USA.
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