ABSTRACT
INTRODUCTION: Botulinum neurotoxin A (BoNTA) has long been used as a therapeutic agent and has been widely accepted as a cosmetic agent in recent years. It can inhibit function and induce structural changes in skeletal muscle. METHODS: Specimens of fresh dissected human masseter muscle were used to observe the ultrastructural changes that occurred at 6 and 12 months following BoNTA injection. RESULTS: The findings observed were muscle fiber distortion, sarcomere shortening, mitochondrial vacuolar degeneration, glycogen accumulation, and H and M band disruption in the triad of tubules. At 12 months after injection, there was still evidence of degenerative changes in muscle ultrastructure, whereas most organelles exhibited a normal structure. DISCUSSION: Profound ultrastructural and organelle disfiguring changes were observed after BoNTA injection into human masseter muscle. Most changes were transient, however, and were resolved by 12 months after injection. Muscle Nerve 57: 96-99, 2018.
Subject(s)
Botulinum Toxins, Type A/pharmacology , Masseter Muscle/drug effects , Masseter Muscle/ultrastructure , Neuromuscular Agents/pharmacology , Adult , Asian People , Botulinum Toxins, Type A/administration & dosage , Face/anatomy & histology , Female , Glycogen/metabolism , Humans , Injections, Intramuscular , Masseter Muscle/metabolism , Microscopy, Electron , Microtubules/metabolism , Microtubules/pathology , Mitochondria, Muscle/drug effects , Mitochondria, Muscle/ultrastructure , Muscle Fibers, Skeletal/drug effects , Muscle Fibers, Skeletal/ultrastructure , Neuromuscular Agents/administration & dosage , Sarcomeres/drug effects , Sarcomeres/ultrastructure , Surgery, Plastic , Young AdultABSTRACT
Eschar formation is a potential sequela of burn injuries. Definitive management may include escharectomy and eschar debridement. After eschar removal, the wound can be covered with a skin graft or reepithelialization. For prolonged refractory eschar on the fingertips, topical use of rb-bFGF after debridement can achieve an optimal outcome.
ABSTRACT
BACKGROUND: The midfacial width is dominated by the lateral protruding degree of the zygomatic arch. The best way of narrowing the midface is to reduce the arch height and the arc length for patients with an overly curved lateral protruding zygomatic arch. The existing techniques for reduction malarplasty cannot change the degree of curvature of the zygomatic arch. We provide a new technique for efficient midfacial width reduction by multiple osteotomies at different sites on the zygomatic complex and bone resection at the most protruding middle part of the zygomatic arch. The amount of bone resection can be calculated with a simplified geometrical solution according to the desired reduction rate of the arch height. METHODS: A digitalized CT image was used to estimate the arch height and the length of bone for removal from the zygomatic arch. A specific piece of bone was removed from the most protruding point of each zygomatic arch. Greenstick fractures were made at the anterior and posterior roots of the zygomatic arch. The open arches were rotated inwardly until both ends met. RESULT: The arch heights of 1,020 sides of the zygomatic arch were reduced in a range from 3 to 11 mm. All the reduced zygomatic arches were reunited properly and healed solidly. The overall satisfaction rate was high. CONCLUSION: This technique reduces the width of the midface by changing the degree of curvature of the zygomatic arch. The simplified geometrical calculation solutions are helpful in assuring the reunion of the zygomatic arch at a pre-designed lower arc height level after a calculated shortening of the arc length. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Subject(s)
Asian People/statistics & numerical data , Osteotomy/methods , Plastic Surgery Procedures/methods , Zygoma/surgery , Adult , China , Esthetics , Female , Humans , Male , Patient Satisfaction , Radiography , Treatment Outcome , Young Adult , Zygoma/diagnostic imagingABSTRACT
OBJECTIVE: The traditional gracilis musculocutaneous flap is supplied by a branch of deep femoral artery, which enters the muscle in between the upper and middle third of it. So the flap barely reaches the pelvis and perineum region for reconstruction. By exploring the blood supply pattern we tried to rotate the flap Upon at the higher point starting at the obturator foramen in order to let it cover a bigger area. METHODS: anatomical reviewing of the blood supply of the gracilis branches of obturator, medial femoral circumflex and deep femoral arteries. Based on this a new type of longitudinal gracilis musculocutaneous flap supported only by the obturator artery was designed to reach the pelvis, female genitalia, pubic symphysis, inguinal area easily. RESULTS: The new kind of flap has been applied to 9 patients for deformity repairing and tissue replacement in the pelvic and perineal area. All the flaps survived and achieved satisfactory result with 3 months to 3 years' follow up. CONCLUSIONS: Longitudinal gracilis musculocutaneous flaps supplied by the obturator artery can be used as regular musculocutaneous flap clinically.
