The effects of layer properties on shear disturbance propagation in skin

The effects of the stratum corneum and dermis on shear wave propagation along the skin surface was investigated using a mathematical model. The skin was modeled as two distinct viscoelastic layers, one representing the stratum corneum and the other representing the dermis. The layers were supported by a semi-infinite visco-elastic half-space representing the subcutaneous fat. Physical and mechanical properties of the materials in the model were determined from the literature and from our own experimental measurements. Although the stratum corneum is very thin (12-15 microns), results showed that it could have a strong effect on the wave propagation due to its high stiffness relative to the dermis. Results of the analysis are discussed with respect to an experimental procedure used to determine age-related changes in mechanical properties of skin.     

Electromagnetic absorption in a multilayered slab model of tissue under near-field exposure conditions

The electromagnetic energy deposited in a semi-infinite slab model consisting of skin, fat, and muscle layers is calculated for both plane-wave and near-field exposures. The plane-wave spectrum (PWS) approach is used to calculate the energy deposited in the model by fields present due to leakage from equipment using electromagnetic energy. This analysis applies to near-field exposures where coupling of the target to the leakage source can be neglected. Calculations were made for 2,450 MHz, at which frequency the layered slab adequately models flat regions of the human body. Resonant absorption due to layering is examined as a function of the skin and fat thicknesses for plane-wave exposure and as a function of the physical extent of the near-field distribution. Calculations show that for fields that are nearly constant over at least a free-space wavelength, the energy deposition (for the skin, fat, and muscle combination that gives resonant absorption) is equal to or less than that resulting from plane-wave exposure, but is appreciably greater than that obtained for a homogeneous muscle slab model.     

Cupping: from a biomechanical perspective

The effectiveness of the cupping technique, a treatment modality in Traditional Chinese Medicine, in stimulating acupuncture points for pain relief was examined in this paper from a biomechanical perspective. Parametric studies including the effects of vacuum pressure, loading rate, friction coefficient at the cup-skin interface, and size and shape of the cup were carried out using a model based on the finite-element method. The anatomical structures of skin, fat, and muscle were modelled. All the soft-tissue layers were assumed to be nonlinearly elastic and viscoelastic. The rim of the cup was also modelled to study the interaction between cup and skin; the cup rim was assumed to be rigid. The simulation results showed that the stresses in the soft tissue were increased for increasing applied vacuum pressures and that the effects of cupping were mostly limited to the region enclosed by the cup. The simulations also indicated that the magnitude of the applied vacuum may have had direct implications for the severity of bruising of the skin following cupping treatment. Most significantly, the simulation results contradicted the established practice of cup size selection according to the depth of the disorder. Experimental verification of the proposed multi-layered finite-element model is presented. The nature of the bruising inherent to the cupping treatment is also explained by the proposed model.     

Calibration of an orientation sensor for freehand 3D ultrasound and its use in a hybrid acquisition system

Background and Objectives

Liposuction continues to be one of the most popular procedures performed in cosmetic surgery. As the public's demand for body contouring continues, laser lipolysis has been proposed to improve results, minimize risk, optimize patient comfort, and reduce the recovery period. Mathematical modeling of laser lipolysis could provide a better understanding of the laser lipolysis process and could determine the optimal dosage as a function of fat volume to be removed.

Study design/Materials and Methods

An Optical-Thermal-Damage Model was formulated using finite-element modeling software (Femlab 3.1, Comsol Inc). The general model simulated light distribution using the diffusion approximation of the transport theory, temperature rise using the bioheat equation and laser-induced injury using the Arrhenius damage model. Biological tissue was represented by two homogenous regions (dermis and fat layer) with a nonlinear air-tissue boundary condition including free convection. Video recordings were used to gain a better understanding of the back and forth movement of the cannula during laser lipolysis in order to consider them in our mathematical model. Infrared video recordings were also performed in order to compare the actual surface temperatures to our calculations. The reduction in fat volume was determined as a function of the total applied energy and subsequently compared to clinical data reported in the literature.

Results

In patients, when using cooled tumescent anesthesia, 1064 nm Nd:YAG laser or 980 nm diode laser: (6 W, back and forth motion: 100 mm/s) give similar skin surface temperature (max: 41°C). These measurements are in accordance with those obtained by mathematical modeling performed with a 1 mm cannula inserted inside the hypodermis layer at 0.8 cm below the surface. Similarly, the fat volume reduction observed in patients at 6-month follow up can be determined by mathematical modeling. This fat reduction depends on the applied energy, typically 5 cm³ for 3000 J. At last, skin retraction was observed in patients at 6-month follow up. This observation can be easily explained by mathematical modeling showing that the temperature increase inside the lower dermis is sufficient (48–50°C) to induce skin tightening

Discussion and Conclusion

Laser lipolysis can be described by a theoretical model. Fat volume reduction observed in patients is in accordance with model calculations. Due to heat diffusion, temperature elevation is also produced inside the lower reticular dermis. This interesting observation can explain remodeling of the collagenous tissue, with clinically evident skin tightening. In conclusion, while the heat generated by interstitial laser irradiation provides stimulate lipolysis of the fat cells, the collagen and elastin are also stimulated resulting in a tightening in the skin. This mathematical model should serve as a useful tool to simulate and better understand the mechanism of action of the laser lipolysis     

External ultrasonic lipoplasty: an effective method of fat removal and skin shrinkage

External ultrasonic lipoplasty is an effective method for the removal of localized fat and the fat due to moderate obesity. The ultrasound is externally applied and transmitted through the skin surface. The acoustic waves are selectively absorbed by previously injected tumescent fluid and fat. It is the combination of this acoustic wave and ultrasound-induced fluid streaming that facilitates fat removal. Multiple, 2.5- to 3.7-mm incisions are made, through which standard thin (2.3 to 3.5 mm) suction lipectomy cannulae are used to aspirate the emulsified fat and oil. A major advantage of this procedure is that superficial subdermal liposuction can be used safely, which enhances the thoroughness of fat removal and the contraction of the overlying skin. A total of 160 consecutive patients successfully underwent this procedure. Recovery was rapid, and patients returned to full activities within 24 to 48 hours. The skin remained soft, with minimal to no bruising throughout the entire postoperative period. The problems seen with internal ultrasonic liposuction, such as end hits and skin burns, were avoided. The large incisions required for internal ultrasound liposuction were not necessary. Previous models of externally applied ultrasound support current observations of the safety of external ultrasound lipoplasty. Only one small seroma was seen. External ultrasound lipoplasty is a safe, effective, and low-cost method of ultrasound-assisted removal of localized fat and the fat due to moderate obesity. Physician and patient satisfaction is high.     

Large-volume liposuction: a review of 631 consecutive cases over 12 years.

Since the advent of epinephrine-containing wetting solutions and sophisticated fluid management techniques, increasingly larger and larger volumes of liposuction aspirations have been reported. Unfortunately, with these larger volumes of liposuction being routinely performed, greater rates of complications have also been reported, with the worst of these resulting in deaths. In a response to the increasing concerns over the safety of large-volume liposuction, a critical review of the senior author's own series has been performed to evaluate risks and benefits and to recommend guidelines for safe and effective large-volume liposuction. A retrospective chart review was performed on 631 consecutive patients who underwent liposuction procedures of at least 3000 cc total aspirate. All procedures were performed by the same senior surgeon between January of 1986 and March of 1998. Before September of 1996, traditional liposuction techniques were used. After September of 1996, ultrasound-assisted liposuction was performed. The superwet technique of fluid management was employed for all procedures performed after 1991. The particulars of the surgical and anesthetic techniques used are reviewed in the article. Data collection included preoperative patient demographics, preoperative and postoperative weights and measurements, and preoperative and postoperative photographs. Total aspirate volumes, fluid intakes, and fluid outputs were measured, and all complications were tallied. Average follow-up was 1 year.Results showed the majority of patients to be women, aged 17 to 74 years old. Of the preoperative weights, 98.7 percent were within 50 pounds of ideal chart weight. Total aspirate volumes ranged from 3 to 17 liters, with 94.5 percent of these under 10 liters. Fluid balance measurements showed an average of 120 cc/kg positive fluid balance at the end of the procedure, with none of these patients experiencing any significant fluid balance abnormalities. Cosmetic results were good, with a 2- to 6-inch drop from preoperative measurements, depending on the area treated. Ten percent of patients experienced minor skin contour irregularities, with most of these patients not requiring any additional surgical procedures. One year after surgery, 80 percent of patients maintained stable postoperative weights. No serious complications were experienced in this series. The majority of the complications consisted of minor skin injuries and burns, allergic reactions to garments, and postoperative seromas. The more serious complications included four patients who developed mild pulmonary edema and one patient who developed pneumonia postoperatively. These patients were treated appropriately and went on to have uneventful recoveries. The results show that large-volume liposuction can be a safe and effective procedure when patients are carefully selected and when anesthetic and surgical techniques are properly performed. Meticulous fluid balance calculations are necessary to avoid volume abnormalities, and experience is mandatory when performing the largest aspirations. Cosmetic benefits are excellent, and overall complication rates are low.     

An algorithmic approach to upper arm contouring

There has been a renewed interest in upper arm contouring given the recent advances and subsequent patient interest in weight loss. Patients undergoing bariatric surgery are often left with a significant amount of redundant skin and laxity of their upper extremity. Some patients within this group have excess fat in their upper arms with relatively good skin tone, while others have a paucity of excess fat with a significant amount of redundant skin. The optimal treatment for each patient can vary. A clinical algorithm is presented that is designed to select the best method for upper arm contouring based on the aesthetic analysis of the upper arm. Case examples are provided demonstrating results that were obtained by following this algorithm.     

Volume conduction models for surface EMG; confrontation with measurements

Volume conduction models are used to describe and explain recorded motor unit potentials (MUPs). So far it has remained unclear which factors have to be taken into account in a volume conduction model. In the present study, five different models are confronted with measured MUP distributions over the skin surface above the m. biceps brachii generated by MUs at different depths and recorded by small surface electrodes. All model simulations include fibres of finite length. The models differ in the size of the volume conductor (finite/infinite), the number of different layers (1, 2 or 3) and the conductivities of these layers (representing muscle, subcutaneous fat and skin). All measured and simulated MUPs contain a mainly negative propagating wave followed by a positive wave simultaneously present at all electrode positions. The magnitude of the different MUP components relative to each other and as a function of motor unit (MU) and electrode position differ between the models studied and the measurements. All simulated MUPs changed faster with observation distance than the measured MUPs. The three-layer model, in which muscle tissue was surrounded by a subcutaneous fat layer and by a layer of skin resulted in MUPs closest to the measured MUPs.     

The Redox State of Glutathione,Cysteine and Homocysteine in the Extracellular Fluid in the Skin

Glutathione, the most abundant low-molecular weight thiol in the skin, has been shown to protect the skin from both photobiological and chemical injury. The thiols, glutathione in particular, have also been shown to be crucially involved in defence against contact allergens. Since the levels of extracellular thiol concentrations are important determinants of intracellular thiol status, we have compared the normal concentrations and the redox status of the main low-molecular weight thiol components in the extracellular fluid at the dermo-epidermal junction with the corresponding plasma levels. In their sulfhydryl form, all three thiols, i.e. glutathione, cysteine and homocysteine, were more abundant in experimental skin blister fluid than in plasma, as were the free disulfides of glutathione and homocysteine, whereas the free disulfides of cysteine were about the same in blister fluid and in plasma. Protein mixed disulfide levels were higher in plasma than in blister fluid. The present results provide information concerning the extracellular defence in the skin.     

The redox state of glutathione, cysteine and homocysteine in the extracellular fluid in the skin

Glutathione, the most abundant low-molecular weight thiol in the skin, has been shown to protect the skin from both photobiological and chemical injury. The thiols, glutathione in particular, have also been shown to be crucially involved in defence against contact allergens. Since the levels of extracellular thiol concentrations are important determinants of intracellular thiol status, we have compared the normal concentrations and the redox status of the main low-molecular weight thiol components in the extracellular fluid at the dermo-epidermal junction with the corresponding plasma levels. In their sulfhydryl form, all three thiols, i.e. glutathione, cysteine and homocysteine, were more abundant in experimental skin blister fluid than in plasma, as were the free disulfides of glutathione and homocysteine, whereas the free disulfides of cysteine were about the same in blister fluid and in plasma. Protein mixed disulfide levels were higher in plasma than in blister fluid. The present results provide information concerning the extracellular defence in the skin.     

Human amniotic fluid stem cells: a new perspective

The discovery of amniotic fluid stem cells initiated a new and very promising field in stem cell research. In the last four years amniotic fluid stem cells have been shown to express markers specific to pluripotent stem cells, such as Oct-4. Due to their high proliferation potential, amniotic fluid stem cell lineages can be established. Meanwhile, they have been shown to harbor the potential to differentiate into cells of all three embryonic germ layers. It will be a major aim for the future to define the potential of this new source of stem cells for therapies related to specific diseases.     

A study of absorption of energy of the extremely high frequency electromagnetic radiation in the rat skin by various dosimetric methods and approaches

Using experimental and theoretical methods of dosimetry, the energy absorption of extremely high-frequency electromagnetic radiation (EHF EMR) in the skin of laboratory rats was analyzed. Specific absorption rate (SAR) in the skin was determined on the basis of both microthermometric measurements of initial rates of temperature rise in rat skin induced by the exposure and microcalorimetric measurements of specific heat of the skin. Theoretical calculations of SAR in the skin were performed with consideration for dielectric parameters of rat skin obtained from the measurements of the standing wave ratio upon reflection of electromagnetic waves from the skin surface and for the effective area of stationary overheating measured by infrared thermography. A numerical method was developed to determine electromagnetic wave energy reflected, absorbed, and transmitted in the model of flat layers. The algorithm of the method was realized in a computer program and used to calculate SAR in the skin on the basis of the complex dielectric constant of rat skin. The SAR values obtained from experimental measurements, theoretical calculations and numerical analysis are in good mutual correspondence and make about 220-280 W/kg at a frequency of 42.25 GHz and a power of 20 mW at the radiator output. The results obtained can be used for dosimetric supply of biomedical experiments on studying the physicochemical mechanisms of the biological effects of EHF EMR.     

Reflection and penetration depth of millimeter waves in murine skin

Millimeter (mm) wave reflectivity was used to determine murine skin permittivity. Reflection was measured in anesthetized Swiss Webster and SKH1-hairless mice in the 37-74 GHz frequency range. Two skin models were tested. Model 1 was a single homogeneous skin layer. Model 2 included four skin layers: (1) the stratum corneum, (2) the viable epidermis plus dermis, (3) fat layer, and (4) muscle which had infinite thickness. We accepted that the permittivity of skin in the mm wave frequency range results from the permittivity of cutaneous free water which is described by the Debye equation. Using Fresnel equations for reflection we determined the skin parameters best fitting to the reflection data and derived the permittivity of skin layers. The permittivity data were further used to calculate the power density and specific absorption rate profiles, and the penetration depth of mm waves in the skin. In both murine models, mm waves penetrate deep enough into tissue to reach muscle. In human skin, mm waves are mostly absorbed within the skin. Therefore, when extrapolating the effects of mm waves found in animals to humans, it is important to take into account the possible involvement of muscle in animal effects.     

Biomechanical modeling to prevent ischial pressure ulcers

With 300,000 paraplegic persons only in France, ischial pressure ulcers represent a major public health issue. They result from the buttocks? soft tissues compression by the bony prominences. Unfortunately, the current clinical techniques, with – in the best case – embedded pressure sensor mats, are insufficient to prevent them because most are due to high internal strains which can occur even with low pressures at the skin surface. Therefore, improving prevention requires using a biomechanical model to estimate internal strains from skin surface pressures. However, the buttocks? soft tissues? stiffness is still unknown. This paper provides a stiffness sensitivity analysis using a finite element model. Different layers with distinct Neo Hookean materials simulate the skin, fat and muscles. With Young moduli in the range [100–500 kPa], [25–35 kPa], and [80–140 kPa] for the skin, fat, and muscles, respectively, maximum internal strains reach realistic 50 to 60% values. The fat and muscle stiffnesses have an important influence on the strain variations, while skin stiffness is less influent. Simulating different sitting postures and changing the muscle thickness also result in a variation in the internal strains.     

Expanded applications for transconjunctival lower lid blepharoplasty.

There has been a recent upsurge in interest in the transconjunctival approach for lower lid blepharoplasty. Initial reports have focused on the young patient with isolated fat prominence. We describe our experience with transconjunctival lower lid blepharoplasty in 104 patients over the past 2 years. There have been no instances of prolonged lower lid retraction problems, presumably related to leaving the skin, orbicularis, and orbital septum intact. Our experience with expanding the indications for the transconjunctival approach to include patients with fine skin wrinkling as well as frank skin excess has been extremely favorable. We conclude that the skin excess is often more apparent than real, with the skin being necessary to recontour the lower eyelid after fat excision. Although skin excision may be required during the initial procedure or at a later stage, patients with apparent skin excess need not be excluded from consideration for transconjunctival lower lid blepharoplasty.     

Ultrasound tomography of soft tissues and venous vessels in secondary edema of the upper limbs

The paper is concerned with ultrasound investigation that permits obtaining objective data on changes in the thickness, structure, borders and density of soft tissues in upper limb lymphedema. Moderate thickening of the skin and subcutaneous fat with slight thickening of the latter was noted in patients with mild edema. The thickness of the group of muscles at the shoulder level was decreased in each 3rd patient. Thickening of the skin and subcutaneous fat more than 1.5-fold was noted in edema of average severity. In severe edema the skin and subcutaneous tissue got thicker 2-2.5 times and acquired a dense regular spotty pattern. Echogeneity of the skin was reduced, and it often became merged with the subcutaneous fat. Cavities filled in with edematous fluid were found in the zone of maximum edema. Ultrasound phlebography made it possible to determine the state of major veins in upper limb edema and to abandon roentgenocontrast investigation of veins in a majority of cases.     

Evolution of concentration field in a membrane system

This paper deals with the evolution of concentration field at a single membrane system. Concentration field evolution is described by concentration effect of stable boundary layers, which originate in this system. The concentration effect of boundary layers (CBLE) is studied experimentally on the basis concentration profiles obtained from computer analysis of interferometric pictures of near-membrane regions. Besides experimental results, we also report theoretical investigations and numerical calculations of this effect for two models of membranes (an infinite thin wall and the wall of thickness l). Evolution of concentration field at different distances from membrane surface describes accurately the spatio-temporal structure of the concentration boundary layers (CBLs). Results have shown that their spatial structure is fully established and these layers develop diffusively.     

The permeability of nonhuman primate vaginal epithelium: a freeze-fracture and tracer-perfusion study

The lining of the vaginal mucosa in primates is a keratinized stratified squamous epithelium. As in other structurally similar epithelia, one function of the vaginal epithelium is to provide a barrier between the external environment and the underlying tissues. The vaginal lining is aglandular and the source of true vaginal fluid has been suggested to be the intercellular channels of the epithelium. On the other hand, other structurally similar epithelia have been shown to have a barrier to the movement of water-soluble molecules through these channels. In the present study, we have examined the permeability of rhesus monkey vaginal epithelium to lanthanum and horseradish peroxidase. Both tracer molecules penetrated the intercellular channels in the lower layers of the epithelium, but were excluded from the channels at and above the granular layer. Neither tracer penetrated significantly between cells at the free surface of the epithelium and usually did not penetrate between cells in the upper layers to any degree from the cut edges of the biopsy. These results are consistent with tracer studies in other structurally similar epithelia and strongly suggest that the upper layers of vaginal epithelium present a barrier to the movement of water-soluble molecules through the intercellular channel system. Freeze-fracture analysis of the epithelium revealed gap junctions and desmosomes between cells in the lower layers, but the former disappear in the upper layers. Unlike other keratinizing epithelia that have been described, random intramembranous particles do not disappear from the plasma membranes of the fully differentiated cells. Fracture planes through the upper layers reveal particle-free lamellae in the intercellular spaces, supporting the idea that intercellular lipids may be one of the components that limits the permeability of the intercellular spaces in this epithelium.     

SD大鼠皮肤组织病理学观察

目的观察不同日龄SD大鼠皮肤组织学结构。方法10％甲醛固定,行石蜡切片,HE染色。结果新生大鼠皮肤较薄,透明层缺乏,皮脂腺发育良好。6月龄时表皮、真皮和皮下组织明显增厚,毛囊增粗,生长旺盛,毛囊深入皮下脂肪层。24月龄时,大鼠皮脂腺及汗腺萎缩,表皮变薄,真皮成纤维细胞、血管数量减少,弹力纤维变细。结论不同日龄SD大鼠皮肤组织学结构有差异。     

Subcutaneous pseudobursa secondary to suction and surgery

Suction lipectomy has been used throughout the regions of the body to remove vast amounts of subcutaneous fat. The blunt technique allows for a multiplicity of small (4 to 6 mm) channels to be created and the fat removed by suction with little disturbance of the overlying skin, the supporting septa, vessels, or nerves. Abdominolipectomy has been successfully performed for decades, in which large amounts of skin and subcutaneous fat are removed by sharp dissection. The undermining involved in an adbominolipectomy extending from the xiphoid to pubis and laterally to the level of the iliac crest and then supplemented by the suction technique has led to the formation, in some cases, of chronic seromas not relieved by multiple aspirations. Healing and contractions of these seromas causes a deformity of the overlying skin, because it is puckered and drawn upon itself. This results in the formation of a subcutaneous pseudobursa lined by collagen sheets but no epithelial cells. We present 9 patients who have demonstrated this phenomenon. We suggest that in the largest resections, safety is best served by waiting a period of at least 6 weeks between suction and subsequent resection.