Detailed Sonographic Anatomy of Dorsal Hand Augmentation With Hyaluronic Acid and Calcium Hydroxyapatite Fillers

2018 ◽  
Vol 39 (10) ◽  
pp. 1096-1106 ◽  
Author(s):  
Jong Seo Kim
Keyword(s):  
Hyaluronic Acid ◽  
Calcium Hydroxyapatite ◽  
Level Of Evidence ◽  
Left Hand ◽  
Stratum Corneum Hydration ◽  
Dorsal Hand ◽  
Hands On ◽  
Grading Scale ◽  
The Right

Abstract Background Volume restoration using filler in the dorsum of the hand is a simple and effective procedure to improve wrinkles and hide veins and tendons. Currently, calcium-hydroxyapatite (CaHA) filler is the only FDA-accepted material to use in the hand dorsum. However, it is not easy to inject due to swelling and redness. In addition, hand anatomy through sonography is wrongly described in Plastic and Reconstructive Surgery® Journal. Through incorrect marking in sonographic hand anatomy, physicians will conduct erroneous procedures and surgeries. Objectives CaHA filler and hyaluronic acid (HA) filler were both injected into the hand to compare intra-individually the effect of each filler. Through this study, the author introduced detailed and refined sonographic anatomy. Overall, the author identified the correct injection method and depth. Methods In this prospective, intra-individual, comparative study, patients were injected 1 cc of CaHA filler to the left hand and 3 cc (36 mg) of microphasic hyaluronic acid to the right. Outcomes were assessed by Merz hand grading scale, skin bio-parameters, dermascopic finding, and Global Aesthetic Improvement Scale (GAIS) with follow-up at 3, 6, 9, and 12 months. Results The average GAIS score improved in both hands and generally maintained over the course of the study. There was significantly more bruising and swelling in the CaHA-injected hands compared with the HA-injected hands. The skin roughness and appearance improved in both sets of hands on dermascope. The average Trans-Epidermal-Water-Loss decreased and the average Stratum Corneum Hydration increased in HA-injected hands. The biopsy study showed that the HA particles lasted for 9 months. Conclusions The author reestablished sonographic anatomy. Veins and tendons became less apparent after injections. Level of Evidence: 2

“Craniotomy Within Craniotomy” Technique for Safe Resection of an Intracranial Arteriovenous Malformation With Frontal Bony Erosion: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
MirHojjat Khorasanizadeh ◽  
Kristine Ravina ◽  
Aristotelis Filippidis ◽  
Christopher S Ogilvy
Keyword(s):  
Surgical Resection ◽  
Endovascular Embolization ◽  
Acute Onset ◽  
Bone Flap ◽  
Intracranial Arteriovenous Malformation ◽  
Excessive Bleeding ◽  
Left Hand ◽  
The Right ◽  
Venous Varix

Abstract Surgical resection is one option in the treatment of large high-grade brain arteriovenous malformations (AVMs). Resection of AVMs with skull-eroding components can be challenging due to the risk of excessive bleeding from these components during craniotomy and bone flap removal. We present a case of a 25-yr-old woman who presented with an acute onset right-sided frontal headache. She was found to have a large, frontal Spetzler-Martin grade IV AVM with an associated dural AVM. The AVM had caused focal erosions of the right frontal bone by a venous varix traversing the region of the calvarial defect. An elective staged endovascular embolization followed by surgical resection was recommended considering the patient's young age and the large size of the AVM located in a noneloquent area. Given the high risk of intraoperative hemorrhage during the craniotomy portion of the procedure, a “craniotomy within craniotomy” approach was planned. During this approach, a small rectangle of bone, including the portion eroded by the venous varix, was left in place, while the larger bone flap surrounding it was removed for an initial approach to the AVM. The small bony piece was safely removed at later stages of resection once the arterial feeders had been reasonably obliterated. Immediate postoperative catheter angiogram demonstrated good filling of the intracranial vascular territories with no residual AVM. The patient developed mild left facial and left hand weakness postoperatively, which resolved after 2 wk of follow-up. The patient remained neurologically intact on further follow-up.

Interosseous Muscle Pain in the Pianist's Hand: A Description of 27 Cases of Musician's Hand

2007 ◽  
Vol 22 (1) ◽  
pp. 24-25
Author(s):  
Naotaka Sakai
Keyword(s):  
Muscle Weakness ◽  
Muscle Pain ◽  
Deep Part ◽  
Piano Performance ◽  
Medical Problems ◽  
Main Symptom ◽  
Left Hand ◽  
Dorsal Hand ◽  
Right Hand ◽  
The Right

Among 703 professional pianists with medical problems in their hands seen by the author between 1981 and 2000, there were 27 patients who had interosseous muscle pain (23 women, 4 men; mean age, 30 yrs). The main symptom was dorsal hand pain during piano performance, especially when striking the keys with each finger rounded, mainly in the scale technique. Tenderness was noted in the deep part of the dorsal hand in the interosseous muscles, but not along or around the finger extensors. Patients sometimes complained of muscle weakness on abduction of the index, ring, and/or little fingers when performing octaves or chords on the piano keyboard. Resisted abduction and adduction testing of the fingers reproduced the pain which they experienced during or after performance. Pain occurred in the right hand in 10, left hand in 5, and bilaterally in 12. The pain was localized in the 4th and 5th interossei in 15 patients, in the 3rd and 4th in 14 patients; in the 2nd and 3rd in 11 patients; and in the 1st and 2nd in 1 patient.

A Randomized, Blinded, Prospective Clinical Study Comparing Small-Particle Versus Cohesive Polydensified Matrix Hyaluronic Acid Fillers for the Treatment of Perioral Rhytids

2020 ◽  
Author(s):  
Marc A Polacco ◽  
Adam E Singleton ◽  
Teresa Luu ◽  
Corey S Maas
Keyword(s):  
Hyaluronic Acid ◽  
Small Particle ◽  
Prospective Clinical Study ◽  
Level Of Evidence ◽  
Duration Of Effect ◽  
Tyndall Effect ◽  
Multiple Treatments ◽  
The Right ◽  
Double Blinded ◽  
To Receive

Abstract Background Perioral rhytids are a bothersome sign of aging for many patients. Although multiple treatments exist, choosing an optimal modality may be difficult considering that rhytids in this region are fine and the anatomy dynamic. Objectives The authors sought to compare the efficacy and safety as well as patient satisfaction of a small-particle hyaluronic acid filler with 0.3% lidocaine (SP-HAL, Restylane Silk) and cohesive polydensified matrix hyaluronic acid filler (CPM-HA, Belotero Balance) in reducing superficial perioral rhytids. Methods The study was double-blinded, and 48 patients with moderate to severe superficial perioral rhytids were enrolled. Patients were randomized to receive either CPM-HA in the left perioral region and SPHAL in the right or vice versa. Rhytid severity was measured by patients utilizing a linear analog scale, and by investigators utilizing a validated 5-point scale, for 180 days following treatment. Results Both SP-HAL and CPM-HA achieved a reduction in rhytid severity, and neither treatment group returned to baseline after 180 days. Investigator-reported scores for rhytid severity were significantly better for SP-HAL than CPM-HA and remained so at 180 days (P < .05). SP-HAL also proved significantly better for reducing rhytids according to patient scores, although this difference occurred between 120 and 180 days only. Adverse events included rash and mild acne for CPM-HA, and SP-HAL was associated with 1 postinflammatory nodule and 2 occurrences of Tyndall effect. Conclusions Although both SP-HAL and CPM-HA are effective at reducing perioral rhytid severity and have similar safety profiles, SP-HAL possesses a longer duration of effect. Level of Evidence: 2

scholarly journals Endovascular Hyaluronidase Application Through Superselective Angiography to Rescue Blindness Caused by Hyaluronic Acid Injection

2020 ◽  
Author(s):  
Lei Zhang ◽  
Zuyan Luo ◽  
Jian Li ◽  
Zhe Liu ◽  
Hong Xu ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Ophthalmic Artery ◽  
Emergency Situation ◽  
Artery Occlusion ◽  
Left Middle Cerebral Artery ◽  
Level Of Evidence ◽  
Vascular Intervention ◽  
Superselective Angiography ◽  
Sequential Treatments

Abstract Background Blindness is a rare but catastrophic complication of facial hyaluronic acid (HA) injection. Although various means to rescue visual impairment have been employed, no consensus regarding effective treatment has yet been reached. We organized a multidisciplinary team to address this emergency situation by means of endovascular hyaluronidase application. Objectives The aim of this study was to investigate the direct delivery of hyaluronidase to ophthalmic artery occlusion through endovascular cannulation to resolve HA-induced blindness. Methods Four patients with visual impairments caused by HA filler embolization were subjected to sequential treatments. Through superselective angiography, a microcatheter was introduced along a guidewire from the femoral artery to the ophthalmic artery to directly deliver hyaluronidase to the HA embolism. The safety and efficiency of this treatment were systematically analyzed. Results Selective cerebral angiography demonstrated that the endovascular application of hyaluronidase significantly alleviated occlusion in 3 patients. One patient showed slight visual improvement, whereas the other patients showed no improvement in their visual function during a follow-up period of more than 3 months. One patient suffered from cerebral infarction in the left middle cerebral artery during the intervention surgery. Moreover, 2 patients showed multiple lacunar cerebral infarctions after the operation, whereas none exhibited symptoms of hemiplegia during follow-up. Conclusions Although the endovascular application of hyaluronidase could partially recanalize the occluded branches of the ophthalmic artery, it had limited effects on restoring vision. Considering the risks of vascular intervention surgery, this approach should be considered with caution. Level of Evidence: 5

Anterior and posterior ischemic optic neuropathy following liposuction surgery in a previously healthy young woman

2020 ◽  
pp. 112067212096206
Author(s):  
Kaveh Abri Aghdam ◽  
Ali Sadeghi ◽  
Mostafa Soltan Sanjari ◽  
Ali Aghajani ◽  
Saba Gholamalizadeh
Keyword(s):  
Optic Neuropathy ◽  
Vision Loss ◽  
Ischemic Optic Neuropathy ◽  
Laboratory Studies ◽  
Level Of Evidence ◽  
Healthy Young Woman ◽  
Posterior Ischemic Optic Neuropathy ◽  
The Right ◽  
Liposuction Surgery

A previously healthy 28-year-old female developed bilateral painless vision loss, more prominent in the right eye than in the left, following abdominoplasty and liposuction surgery. Laboratory studies showed severe peri- and post-operative anemia. Over a 5-month follow-up, visual function remained decreased but stable in the right eye and improved in the left eye. This is the second reported case of anterior ischemic optic neuropathy in one eye and posterior ischemic optic neuropathy in the other eye after liposuction. Level of evidence: Level VI, case report study.

Nonsurgical Rhinoplasty With the Novel Hyaluronic Acid Filler VYC-25L: Results Using a Nasal Grid Approach

2020 ◽  
Author(s):  
Dario Bertossi ◽  
Luciano Malchiodi ◽  
Massimo Albanese ◽  
Riccardo Nocini ◽  
Pierfrancesco Nocini
Keyword(s):  
Hyaluronic Acid ◽  
The Novel ◽  
Level Of Evidence ◽  
Acid Product ◽  
Nasolabial Angle ◽  
Independent Evaluation ◽  
Injection Quantity ◽  
Grid Approach ◽  
High Degree

Abstract Background Nonsurgical aesthetic treatment of the nose is becoming increasingly popular. VYC-25L is a novel hyaluronic acid product with the high G’ and cohesivity required of a nasal filler. Objectives The authors sought to assess the safety and efficacy of VYC-25L for treatment of the nose utilizing a previously published, grid-based protocol. Methods This was a retrospective, single-center analysis of data from adult patients undergoing treatment of the nose with VYC-25L between February and April 2019 utilizing the grid system as the reference for injection quantity and sequencing. Specific procedures included correction of inadequate projection, deep glabella treatment, correction of a nasal hump, and adjustment of the nasolabial angle and columella. Patients were followed-up for 6 to 9 months. Results A total of 61 patients were included in the analysis (mean age, 32 ± 3 years; n = 45 females [74%]). At 2 weeks posttreatment, a high degree of defect correction was confirmed based on independent evaluation, with all patients scoring 9 or 10 on a 10-point visual analog scale. Fifty-nine of 61 patients (97%) self-assessed the degree of correction as “adequate.” Results were stable at 3- and 6-month follow-up visits. Complications recorded were bruising (n = 15, 25%), asymmetry (n = 2, 3%), and hematoma (n = 1, 2%). All resolved rapidly. There were no cases of infection, bumps, or skin necrosis. Conclusions VYC-25L is safe and efficacious for treatment of the nose, with high levels of patient satisfaction. It has potential to be a valuable tool in nonsurgical rhinoplasty. Level of Evidence: 4

Aesthetic Breast Surgery: What Do the Measurements Reveal?

2019 ◽  
Vol 40 (7) ◽  
pp. 742-752
Author(s):  
Elisa Bolletta ◽  
Ciara Mcgoldrick ◽  
Elizabeth Hall-Findlay
Keyword(s):  
Breast Reduction ◽  
Breast Surgery ◽  
Suprasternal Notch ◽  
Level Of Evidence ◽  
Aesthetic Results ◽  
Measuring Tape ◽  
Nipple Position ◽  
The Right ◽  
Aesthetic Breast

Abstract Background Do plastic surgeons really know what happens to the breast after surgery? We often think that we do, but we have very few measurements to show whether we are on the right track. Objectives Only when the surgeon can predict the changes can she or he achieve consistent outcomes. Measurements lead to understanding; understanding what the measurements show allows us to refine our approach. Methods Consecutive patients in 4 categories were analyzed: breast reduction, mastopexy, augmentation, and mastopexy-augmentation. All procedures were performed by a single surgeon and all measurements were performed by the same surgeon. A standard measuring tape was utilized, and data were collected immediately preoperatively and at each follow-up visit. Only those patients with preoperative and complete 1-year postoperative measurements were included in this review. The parameters measured were clavicle to upper breast border (UBB), UBB to nipple, suprasternal notch (SSN) to nipple, SSN to inframammary fold (IMF), and chest midline to nipple. Results The changes were consistent. The borders of the breast footprint were expanded with the addition of an implant (UBB and IMF) and reduced with the removal of parenchyma (IMF). The existing SSN to nipple position was stretched when volume was added to the breast mound and it remained unchanged from the preoperatively marked position in a breast reduction. Conclusions Although measurements are not necessary to achieve good aesthetic results in breast surgery, surgeons should understand what the measurements show and what happens to the different breast parameters. Level of Evidence: 3

scholarly journals Bilateral Multiple Metacarpal Head Avascular Necrosis: A Case Report

2016 ◽  
Vol 101 (9-10) ◽  
pp. 473-477 ◽  
Author(s):  
Wengang Li ◽  
Biao Liu ◽  
Jun Song ◽  
Yan Liu ◽  
Haoyu Liu ◽  
...  
Keyword(s):  
Avascular Necrosis ◽  
Middle Finger ◽  
Left Hand ◽  
The Third ◽  
Metacarpal Head ◽  
Right Hand ◽  
Satisfactory Clinical Result ◽  
Slight Limitation ◽  
The Right

Avascular necrosis of the metacarpal head is a rare disease. We herein report a case with varying degrees of lesions in the third and fourth metacarpal heads of the right hand and the third metacarpal head of the left hand. The patient was a 37-year-old male right-handed mechanical worker who presented with persistent dull pain in the right hand after labor work for more than a year. The 3 lesions in this patient were treated differently based on their clinical imaging manifestations. The neurologic function of the right hand recovered by the 18-month follow-up; only a slight limitation remained in the right middle finger. This is the first report of 1 patent who received 2 different treatment methods simultaneously and both provided a satisfactory clinical result.

scholarly journals Lymphocutaneous Sporotrichosis during Treatment with Anti-TNF-Alpha Monotherapy

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Francesco Ursini ◽  
Emilio Russo ◽  
Christian Leporini ◽  
Marilena Calabria ◽  
Caterina Bruno ◽  
...  
Keyword(s):  
Sporothrix Schenckii ◽  
Direct Consequence ◽  
Dimorphic Fungus ◽  
Left Hand ◽  
Clinical Syndromes ◽  
Nodular Lesions ◽  
Appropriate Therapy ◽  
The Right ◽  
First Time

Sporotrichosis is an infectious disease caused bySporothrix schenckii, a dimorphic fungus isolated for the first time in 1896 by Benjamin Schenck from a 36-year-old male patient presenting lesions on the right hand and arm. The infection generally occurs by traumatic inoculation of soil, plants, and organic matter contaminated with the fungus. Different clinical syndromes are described as a direct consequence ofS. schenckiiinfection, including lymphocutaneous and disseminated forms, although extracutaneous presentations are reported most frequently in AIDS patients. Here we describe the case of a 57-year-old Caucasian male diagnosed in 2004 with ankylosing spondylitis under stable treatment with adalimumab monotherapy (40 mg every other week). During a routine follow-up visit in March 2013, he presented with multiple nodular lesions arranged in a linear fashion along the left hand and forearm. After diagnostic aspiration of the lesions, lymphocutaneous sporotrichosis was diagnosed and appropriate therapy started.

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