Complications and Reevaluation of Indications

One hundred plastic planing operations on the skin by means of a motor-driven wire brush were reviewed. Complications noted were pruritic erythematous eczematous dermatitis on a possible autosensitization basis, hyperpigmentation and milia. These occurred in a small proportion of cases and in no case were they permanent sequelae.Flat postacne scarring is more easily improved than steep “ice-pick” type scars.The planing procedure is contraindicated in the management of certain tumors of the skin, portwine nevi, decorative tattoos, and generalized dermadromes.The psychiatric and emotional impact of the patient''s scarring on his personality is often a great one and the operator must bear in mind that plastic planing is no panacea for a severely neurotic patient. Therefore it is important that patients be carefully selected and that improvement rather than complete cure be stressed.     

Surgical planing of the skin; dichlorotetrafluoro-ethane as a freezing agent

Surgical skin planing is, in the hands of an experienced operator, a safe and highly effective procedure for treating a number of cutaneous defects, most notably pitted acne scars. The operation is facilitated by the use of a new instrument (jet-spray handpiece) which allows the operator to freeze the skin and plane it almost simultaneously, and by a new freezing agent, dichlorotetrafluoro-ethane, which adds to the safety by eliminating the old hazards of inflammability, explosion, and the toxic inhalation of ethyl chloride. The ability to sharply differentiate between keloid and hypertrophic scar is fundamental to surgical skin planing. A hypertrophic scar results from the removal or destruction of the cutaneous appendages (hair follicles, oil and sweat glands and ducts); whereas a keloid is an idiosyncratic response without regard to damage of the appendages.Properly performed surgical planing does not entirely remove these appendages and therefore healing occurs without scarring.     

Congenital dislocation of the hip

In surgical skin planing steel wire brushes have been largely replaced by the less hazardous diamond chip burs or "fraises" and serrated steel wheels. In addition to acne pits and wrinkling, multiple actinic (senile) keratoses are an important indication for planing. Planing provides a nonscarring method for the treatment of existing keratoses, as well as a prophylaxis against skin cancer by replacing the sun-damaged, precancerous epidermis with new epidermal cells derived from the cutaneous adnexa (pilosebaceous and sweat gland units). There are clinical landmarks indicating the depth of planing which can serve as a guide to the operator and can be correlated with microscopic findings. The results of experiments on the comparative effects of refrigerants on animal and human skin indicate that human facial skin can tolerate considerable freezing with ethyl chloride or dichlorotetrafluoroethane (Freon 114) but that mixtures containing large proportions of the much colder dichlorodifluoromethane (Freon 12) may be undesirable. Refreezing an area of the skin in order to perform a more adequate planing is not considered hazardous.THE REGENERATION OF THE SKIN FOLLOWING PLANING HAS THREE COMPONENTS: Epidermal, adnexal and dermal. The cells of the epidermis and the adnexa are equipotential. A knowledge of the anatomy of the acne pit enables the operator to decide which pits can be benefited by planing and which should be excised before planing. The successful treatment of acne pits of the face by planing in patients having keloids elsewhere on the body is reported.     

Dichloro-tetrafluoro-ethane as a Freezing Agent

Surgical skin planing is, in the hands of an experienced operator, a safe and highly effective procedure for treating a number of cutaneous defects, most notably pitted acne scars.The operation is facilitated by the use of a new instrument (jet-spray handpiece) which allows the operator to freeze the skin and plane it almost simultaneously, and by a new freezing agent, dichlorotetrafluoro-ethane, which adds to the safety by eliminating the old hazards of inflammability, explosion, and the toxic inhalation of ethyl chloride.The ability to sharply differentiate between keloid and hypertrophic scar is fundamental to surgical skin planing. A hypertrophic scar results from the removal or destruction of the cutaneous appendages (hair follicles, oil and sweat glands and ducts); whereas a keloid is an idiosyncratic response without regard to damage of the appendages.Properly performed surgical planing does not entirely remove these appendages and therefore healing occurs without scarring.     

Side effects and complications of variable-pulsed erbium:yttrium-aluminum-garnet laser skin resurfacing: extended experience with 50 patients

Recent advances in technology have provided laser surgeons with new options for cutaneous laser resurfacing. Despite its popularity, there is limited information on the short-term and long-term side effects and complications of variable-pulsed erbium:yttrium-aluminum-garnet (erbium:YAG) laser skin resurfacing. The purpose of this study was to prospectively evaluate postoperative wound healing, side effects, and complications of multiple-pass, variable-pulsed erbium:YAG laser skin resurfacing for facial photodamage, rhytides, and atrophic scarring. Fifty consecutive patients with facial photodamage, rhytides, or atrophic scarring were treated with a variable-pulsed erbium:YAG laser. Side effects and complications relating to postoperative healing, erythema, and pigmentary changes were tabulated. Patients were evaluated at postoperative days 3 through 7 and at 1, 3, 6, and 12 months after laser skin resurfacing. The average time for reepithelialization was 5.1 days. Prolonged erythema (>1 month) was observed in three patients (6 percent). Transient hyperpigmentation occurred in 20 patients (40 percent), with an average duration of 10.4 weeks. No cases of hypopigmentation or scarring were seen. In summary, a variable-pulsed erbium:YAG laser can safely be used for the treatment of facial photodamage, rhytides, and atrophic scarring. Although more postoperative erythema is seen after variable-pulsed erbium:YAG laser treatment than is usually produced with a short-pulsed erbium:YAG system, the side-effect profile and recovery period after variable-pulsed erbium:YAG laser skin resurfacing still are more favorable than after multiple-pass carbon dioxide laser skin resurfacing.     

Application of the two-flap method for nasal alar contracture

Reconstruction of the contracted nasal ala has been a very difficult problem for plastic surgeons. Numerous surgical procedures have been reported. However, most operations require multiple stages and leave conspicuous facial scarring and a thick, asymmetrical nostril rim. We have used the two-flap method introduced by Thomson and Sleightholm for isolated naso-ocular clefts, but we have added some modifications to this method: making a deeper backcut into the dome on the mesial side of the contracture and using thinner flaps than were originally used. As a result, we have achieved reasonable symmetry, good color match, appropriate thickness, and no conspicuous facial scarring in every patient.     

Repairing Facial Injury with Refining Plastic Surgery Techniques

The purpose of this study was to evaluate the refining plastic surgery techniques for repairing facial surface injury. For this purpose, 82 patients with facial surface injury were recruited in the study. All wounds were repaired by refining plastic surgery techniques. The wounds were processed by fine wound excision and plastic surgery repair technique. The deep tissue fracture and dislocation were sutured and reduced using 8-0 absorbable suture and the skin wounds were sutured using 8-0 cosmetic suture. The facial injuries showed good rates of healing with fine debridement and fine recovering. The minimum scarring was observed and good cosmetic effect was achieved. We conclude that refining plastic surgery techniques including fine debridement and fine recovering are ideal for the reconstruction of facial injuries.     

Anchor epicanthoplasty combined with out-fold type double eyelidplasty for Asians: do we have to make an additional scar to correct the Asian epicanthal fold?

The epicanthal fold along with a lack of a superior palpebral fold, excessive fat, and laxity of pretarsal skin represent the ethnic characteristics and a traditional sense of beauty in the Asian upper eyelid. But, too prominent an epicanthal fold may ruin an otherwise beautiful eye; furthermore, it becomes a restriction that makes the out-fold type double eyelidplasty, one of the two main types of double eyelidplasty, impossible. If a double eyelid as an out-fold type is desired, a concomitant epicanthoplasty should be performed with the possibility of hypertrophic scarring of the medial canthal area in Asians. To address the Asian epicanthal fold without danger of hypertrophic scarring, the authors developed an anchor epicanthoplasty technique that leaves no additional scar when combined with a double eyelidplasty. This technique is based on the concept of trimming of muscle and soft tissue under the Asian epicanthal fold and downward medial advancement and anchoring of the medial canthal skin to the deep tissue. The technique consists of five procedures based on the assumed causes of the Asian epicanthal fold: (1) augmentation rhinoplasty, (2) downward medial advancement of the medial upper lid skin, (3) removal of the superficial insertion of the medial canthal ligament and selective removal of the orbicularis oculi muscle, (4) subcutaneous contouring of the thick nasal skin, and (5) anchoring of the medial end of the incision to the deep tissue. During the past 12 years (1988 to 1999), 67 anchor epicanthoplasty procedures have been performed. Twenty-eight cases were followed up for more than 3 months, and all of the patients were satisfied with the results. There were only a few minor complications, which could be corrected with minimal revision. As an ancillary procedure to a double eyelidplasty, this anchor epicanthoplasty can reduce the Asian epicanthal fold and make a double fold as an out-fold type without an additional scar. In terms of hypertrophic scarring and compatibility with out-fold type double eyelidplasty, this anchor epicanthoplasty is the best method for correcting Asian epicanthal fold compared with other preexisting procedures. Other advantages of this technique are a wide range of applications and no compromise of medial, canthal skin to interfere with other epicanthoplasty techniques. Some disadvantages of this technique are technical difficulty and the possibility of active bleeding.     

Stress-relaxation and contraction of a collagen matrix induces expression of TGF-beta and triggers apoptosis in dermal fibroblasts.

Extracellular matrix serves as a scaffold for cells and can also regulate gene expression and ultimately cell behaviour. In this study, we compared the effects of three forms of type I collagen matrix, which differed only in their mechanical properties, and plastic on the expression of transforming growth factor-beta1 (TGF-beta1), matrix metalloproteinase-1 (collagenase), and type I collagen and on the growth and survival of human dermal fibroblasts. These effects were correlated with alterations in cell morphology and organization of intracellular actin. Cells in detached or stress-relaxed matrices were spherical, lacked stress fibres, and showed increased TGF-beta1 mRNA compared to the cells in anchored collagen matrices or on plastic, which were polygonal or bipolar and formed stress fibres. The levels of TGF-beta measured by bioassay were higher in detached and stress-relaxed collagen matrices, than in anchored collagen matrices. Cells on plastic contained little or no immunoreactive TGF-beta, while most cells in collagen matrices were stained. The levels of collagenase mRNA were significantly higher in all the collagen matrix cultures compared to those on plastic, but there were no statistically significant differences between them. Levels of mRNA for procollagen type I were not significantly affected by culture in the collagen matrices. Apoptotic fibroblasts were detected by the TUNEL assay in detached (5.7%) and to a lesser extent in stress-relaxed (2.2%) matrices, but none were observed in anchored collagen matrices or on plastic. These results show that alterations in the mechanical properties of matrix can induce the expression of TGF-beta and trigger apoptosis in dermal fibroblasts. They further suggest that inability to reorganize this matrix could be responsible for the maintenance of the fibroproliferative phenotype associated with fibroblasts in hypertrophic scarring.     

Combined erbium:YAG laser resurfacing and face lifting

Facial aging occurs secondary to gravity-induced tissue ptosis and photoaging. Combined face lifting and carbon dioxide laser resurfacing provides a comprehensive one-stage approach to facial rejuvenation but is condemned by many plastic surgeons due to the nonspecific thermal effects of the laser and risk of skin necrosis. Newer high-energy erbium:YAG lasers allow precise tissue ablation with minimal thermal effect. In this study, various facial rejuvenation techniques were combined with simultaneous erbium:YAG laser resurfacing to assess results and complications. A total of 257 patients from Florida, Melbourne, Australia, and Tel Aviv, Israel, underwent combined erbium:YAG laser resurfacing and surgical facial rejuvenation. Various face-lift methods were used, including endoscopic, deep plane, and subcutaneous. Simultaneous, full-facial laser resurfacing was performed using a variety of erbium:YAG lasers. It was found that combined laser resurfacing and face lifting was successful in greater than 95 percent of patients with minimal morbidity. Two patients (1 percent) (both heavy smokers) developed small areas of skin necrosis that healed with minor pigment changes. Five patients (2 percent) developed synechia that was treated with no residual effect. Two additional patients (1 percent) developed temporary ectropion. There were no other cases of scarring, infection, or cosmetically obvious hypopigmentation. Although larger studies are necessary, it seems that the lack of thermal injury from the erbium:YAG laser makes it possible to safely perform laser resurfacing with surgical facial rejuvenation in nonsmokers. However, the authors caution that familiarity with the nuances of erbium:YAG laser resurfacing be obtained before performing combined laser resurfacing and face lifting.     

Wound epithelialization in rats depending on the quantity and orientation of microautotransplants]

Patches of autoskin (0.5 x 1.0 mm) were grafted on a full-thickness rat back skin wound (5.4 cm2). As a result of "island" epithelialization from microautotransplants (MATR), the skin defect underwent repair. It is shown that the advance of the wound re-epithelialization did not depend on MATR number and their orientation in relation to the wound surface. The use of MATR allows to restore the skin defect with the plastic coefficient 1:100. This reduces the deficiency of donor skin at extensive burns.     

The isolated burned palm in children: epidemiology and long-term sequelae

The isolated burn of the palm is a typical injury in young children. Positioning and splinting in small hands is difficult, and long-term sequelae of these injuries are not uncommon. The objective of the present study was to assess the outcome of palm burns and to identify the risk factors for long-term sequelae. All patients admitted to our hospital affected with isolated palm injuries between January of 1988 and January of 1998 were reviewed. In total, 120 pediatric patients were admitted with isolated palm burns; 110 patients (91.7 percent) had partial-thickness burns, and 10 patients (8.3 percent) had full-thickness burns. Only four patients (3.3 percent) required excision and skin autografting, but all patients whose palms were operated on in the acute phase developed burn contractures. Sixteen patients (13.3 percent) developed palmar contractures, and more than half of them (56 percent) required reconstructive procedures. All palm burns that healed in more than 3 weeks developed scarring and sequelae (p<0.05 compared with no sequelae). Pediatric palmar burns are benign injuries with a low incidence of late sequelae. However, flame and contact burns are more prone to develop scarring. Excision and autografting should be performed on wounds that take over 3 weeks to heal, but it does not prevent late sequelae.     

Surgical planing of the skin; evaluation of a method for reducing scars and other defects

Skin defects such as pitted acne scars, unsightly moles and birthmarks, and other disfiguring skin deformities can be effectively corrected with good cosmetic results. This is accomplished as an office procedure by abrading or planing the skin with a rapidly rotating wire brush using a local anesthetic. The treatment does not require hospitalization and is relatively simple and painless.     

Evaluation of a Method for Reducing Scars and Other Defects

Skin defects such as pitted acne scars, unsightly moles and birthmarks, and other disfiguring skin deformities can be effectively corrected with good cosmetic results. This is accomplished as an office procedure by abrading or planing the skin with a rapidly rotating wire brush using a local anesthetic. The treatment does not require hospitalization and is relatively simple and painless.     

Wound healing and scarring after cryosurgery

There are many references in the surgical literature to apparent lack of scarring after cryosurgery. This has been investigated experimentally by comparing the effects on the skin of four freeze-thaw schedules commonly used in clinical practice with those of maximal cryosurgical injury. Absence of damage to collagen is described, and it is proposed that this is an important factor in the often cited lack of scarring. Changes in skin thickness over a 6-month period are described, and obvious scarring after severe injury and long-term dermis thinning after less severe injury are reported. Evidence is presented that epidermal cells and fibroblasts differ in their susceptibility to low-temperature damage.     

Organization of Meissner corpuscles in the glabrous skin of monkey and cat

Reconstructing neural-population responses in the form of spatial event plots assumes that the receptors are organized in a dense linear array. We have found that this assumption is not valid by determining the spatial organization of Meissner corpuscles (MCs) in the glabrous skin of both cat and monkey. The tissue was excised from animals that had been cardiac perfused with 4% paraformaldehyde. One-micrometer plastic sections revealed that the morphology of these receptors is different in the two animal species. However, in both species, they reside in approximately the same place in the dermal pegs of the skin, between the epidermal ridges, and electrophysiologically they both respond to ramp-and-hold stimuli with a rapidly adapting firing pattern. Thus, in this study we will refer to the receptors of the cat as "Meissner-like". In monkey, MCs are located in the dermal papillae between the epidermal limiting and intermediate ridges, forming orderly rows, the contours of which follow the overlying fingerprint. Although the average density of MCs is 45/mm2, they are distributed along the dermal pegs in such a manner as to give rise to three significantly ( p < 0.017) different average distances between corpuscles. We note that "fingerprints" vary in topography across the hand and this is also reflected in the underlying MC arrays. In the cat, these "Meissner-like" receptors display no specific pattern and have a density much lower than in the monkey. Cat glabrous skin does not have "fingerprints". The results emphasize that the spatial organization of tactile receptors must be taken into account when interpreting reconstructed population responses.     

Unusual multisystemic pathology in a sperm whale bull

This report describes an unusual combination of lesions and apparent behavioral abnormalities in a sexually mature sperm whale bull taken in whaling operations off Iceland. Lesions included heavy combative scarring of the head, grossly roughened and thickened skin on the lower left flank, cutaneous maculae, genital papillomatosis, partial duodenal obstruction by plastic debris, colo-rectal obstruction by ambergris, cystic degeneration of the right kidney, and a deeply ulcerative gastric nematodiasis. Sealskin was found in the stomach. Gross and histopathologic observations suggested that the disease complex in this animal may have been related both to habitat degradation and health risks naturally associated with its ecology and age.