Anatomical, imaging and histological observations of the circumferential full-length of superficial fascia structure of the upper limb / 中华整形外科杂志

Objective@#To describe the general and histological features of the full-length superficial fascia of the circumferential upper limb.@*Methods@#Fresh frozen arm specimens were dissected, and then MRI imaging in vivo, enhanced CT angiography and HE histological staining were used to describe the characteristics of the full-length superficial fascia of the circumferential arm and its relationship with important blood vessels.@*Results@#The four typical structures of the superficial fascia of the arm were divided into subcutaneous superficial fat, membrane-like substance, deep fat and deep fascia from superficial to deep. The thickness and stratification, fusion degree and histological characteristics of the superficial fascia of these four layers were obviously different in different levels and regions of the arm. MRI confirmed that the total thickness of superficial fascia gradually decreased from shoulder to wrist. Venography showed that the cephalic vein ran below the second layer of superficial fascia and above the deep fascia. The basilic vein originated from the dorsal vein network of the hand and always lied below the second layer of membranous material until the basilic vein penetrates below the deep fascia of the upper arm.@*Conclusions@#The deep understanding of the circumferential full-length of superficial fascia structure of the upper limb provides an important theoretical basis for improving the surgical safety and fine operation for the Dynamic Arm Circumferential Liposuction.

Application of liposuction in treating the primary end-stage lymphedema of lower extremities / 中华整形外科杂志

Objective@#To investigate outcome and clinical value of liposuction in primary lymphedema of lower extremities.@*Methods@#Thirty patients with primary lymphedema in unilateral lower extremity were recruited in this study from July 2016 to August 2017 in Beijing Shijitan Hospital. There were 13 male and 17 female patients, with the average age of (36±16.3) years. All the patients were underwent liposuction. The volume of hemorrhage and lipid, operation time and the volume changes of affected extremity were recorded. The subjective evaluation of the patients were also proceed. The patients were divided into different groups according to gender, stage and erysipelas history.@*Results@#Total lipid volume is 900-3 900 ml. The hemorrhage volume is 160-1 100 ml during liposuction. The ipsilateral-contralateral percent volume of lower extremity was decreased immediately after surgery (6.6%±10.0%, t=7.050, P=0.000), and 3 months postoperatively (12.2%±10.7%, t=5.365, P=0.000), when compared with preoperative (31.4%±16.4%). However, the percent volume was increased 3 months after surgery, compared to immediately postoperative measurements (t=-2.088, P=0.041). Female patients had more lipid volume and higher liposuction rate than males, whereas male patients show more affected extremities volume before, after and in 3-month follow-up. The hemorrhage volume was also higher in male than female patients. Patients with erysipelas had higher volume of hemorrhage, with lower lipid volume and liposuction rate. Stage Ⅱpatients show higher lipid volume and liposuction rate than stage Ⅲ patients in operation, with lower hemorrhage and affected extremity volume changes in before, after and 3-month follow-up. In subjective assessment, the experienced heaviness and fatigue was alleviated in all patients, while the pain and tightness was increased.@*Conclusions@#Liposuction is an effective therapy for primary lymphedema in lower extremity. It is necessary to combine with other therapies to improve lymph circulation. Patients′ gender, stage and the history of erysipelas are the main influencing factors of operation difficulty and prognosis.

Gynecomastia Treated with Tumescent Liposuction and the Pull-Through Technique / 대한피부과학회지

Gynecomastia is the most common condition affecting the male breast due to enlargement of both ductal and stromal tissue. Growth of the male breast can be manifested at any age, but 40% of cases present in adolescent boys. The condition depends mainly on the balance between serum estrogens and androgens. Gynecomastia represents a source of embarrassment, and optimal correction is difficult to achieve. Numerous methods of gynecomastia repair are available. Our method is a combination of liposuction and the pull-through technique. The purpose of this treatment is to resect excess tissue and restore the normal chest contour with minimal scarring. We report a case of gynecomastia treated with a combination of tumescent liposuction and the pull-through technique.

Comparative Analysis of Tumescent Liposuction according to the Dermal Curettage Level for the Treatment for Axillary Osmidrosis / 대한피부과학회지

BACKGROUND: The efficacy of tumescent liposuction in the treatment of axillary osmidrosis has been widely established. But there have been few studies that have conducted a comparative analysis according to the level of dermal curettage with respect to the efficacy and safety. OBJECTIVE: The aim of this study was to evaluate the clinical efficacy and complications of tumescent liposuction according to the degree of dermal curettage. METHODS: From September 2004 through August 2009, a total of 33 patients with axillary osmidrosis (66 axillae) were included in this study. Twelve patients (24 axillae) were treated by tumescent liposuction with dermal curettage at the level of the mid-dermis (the classical technique group), and the other 21 patients (42 axillae) were treated by tumescent liposuction with dermal curettage at the level of the dermo-subcutis junction (the modified technique group). The preoperative and postoperative disease severity was measured as 0, 1, 2 and 3. The improvement of symptoms was graded by the patient as excellent, good, fair and poor. We also evaluated the postoperative complications, including skin necrosis, scar, hematoma, sensory disturbance and infection. Biopsies of the axillary skin were performed in 7 patients to confirm the level of dermal curettage and the reduction of apocrine glands after treatment. RESULTS: The follow-up ranged from 6 to 60 months. Six months after treatment, 95.8% (23/24) of the axillae in the classical technique group and 95.2% (40/42) of the axillae in the modified technique group had reduced disease severity below 1. Among the 12 patients treated with the classical technique, 11 (91.7%) had excellent to good results, while 95.2% (20/21) of the patients treated with the modified technique had excellent to good results by the patients' own grading. The complications included skin necrosis, scar and hematoma. In the classical technique group and the modified technique group, the incidence of skin necrosis was 12.5% (3/24) and 2.4% (1/42), respectively, the incidence of scar formation was 4.2% (1/24) and 0%, respectively, and the incidence of hematoma was 8.3% (2/24) and 0%, respectively. The postoperative histologic examinations confirmed that the dermal curettage level was at the mid-dermis in the classical technique and at the dermo-subcutis junction in the modified technique. Interestingly, the histologic examination from the classical technique group revealed vacuolar alteration of keratinocytes and partial separation of the dermo-epidermal junction. CONCLUSION: The efficacy of the modified technique is compatible with that of the classical technique, but the modified technique offers fewer complications. So, the modified technique may improve the cosmetic outcome without reducing the treatment efficacy for the patient with axillary osmidrosis.

Treatment of Axillary Hyperhidrosis; Manual Subdermal Excision Combined with the Tumescent Liposuction and Subcutaneous Tissue Shaver

BACKGROUND: Axillary osmidrosis is a distressing problem characterized by unpleasant odor, profuse sweating, and occasional wetting of clothes that may handicap those affected both socially and psychologically. A variety of surgical methods have been developed for the treatment of axillary osmidrosis. OBJECTIVE: To introduce the manual subdermal excision combined with the tumescent liposuction and subcutaneous tissue shaver for axillary osmidrosis. METHODS: Twenty-five patients with axillary osmidrosis were treated by the manual subdermal excision combined with the tumescent liposuction and subcutaneous tissue shaver. RESULTS: Twenty-one(84%) patients had good results, four(16%) fair, and none had a poor result or recurrence. Complications included one case of hematoma, two cases of partial skin necrosis. The wound complication rate was 6.0%(3/50) for the axilla and 12%(3/25) for patients. CONCLUSION: The manual subdermal excision combined with the tumescent liposuction and subcutaneous tissue shaver is effective surgical procedure for the treatment of axillary osmidrosis with a low complication rate and recurrence.