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Pham TT, Heidari AE, Hong EM, Steward E, Qu Y, Chen LY, Dunn BS, Seo SH, Syed A, Dilley K, Lee L, Hutchison DM, Hansen KD, Patel U, Kim S, Hill MG, Wong BJF. Electrochemical Lipolysis Induces Adipocyte Death and Fat Necrosis: In Vivo Pilot Study in Pigs. Plast Reconstr Surg 2024; 153:334e-347e. [PMID: 37163479 DOI: 10.1097/prs.0000000000010645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Current minimally invasive fat reduction modalities use equipment that can cost thousands of U.S. dollars. Electrochemical lipolysis (ECLL), using low-cost battery and electrodes (approximately $10), creates acid/base within fat (width, approximately 3 mm), damaging adipocytes. Longitudinal effects of ECLL have not been studied. In this pilot study, the authors hypothesize that in vivo ECLL induces fat necrosis, decreases adipocyte number/viability, and forms lipid droplets. METHODS Two female Yorkshire pigs (50 to 60 kg) received ECLL. In pig 1, 10 sites received ECLL, and 10 sites were untreated. In pig 2, 12 sites received ECLL and 12 sites were untreated. For ECLL, two electrodes were inserted into dorsal subcutaneous fat and direct current was applied for 5 minutes. Adverse effects of excessive pain, bleeding, infection, and agitation were monitored. Histology, live-dead (calcein, Hoechst, ethidium homodimer-1), and morphology (Bodipy and Hoechst) assays were performed on day 0 and postprocedure days 1, 2, 7, 14 (pig 1 and pig 2), and 28 (pig 2). Average particle area, fluorescence signal areas, and adipocytes and lipid droplet numbers were compared. RESULTS No adverse effects occurred. Live-dead assays showed adipocyte death on the anode on days 0 to 7 and the cathode on days 1 to 2 (not significant). Bodipy showed significant adipocyte loss at all sites ( P < 0.001) and lipid droplet formation at the cathode site on day 2 ( P = 0.0046). Histology revealed fat necrosis with significant increases in average particle area at the anode and cathode sites by day 14 (+277.3% change compared with untreated, P < 0.0001; +143.4%, P < 0.0001) and day 28 (+498.6%, P < 0.0001; +354.5%, P < 0.0001). CONCLUSIONS In vivo ECLL induces fat necrosis in pigs. Further studies are needed to evaluate volumetric fat reduction. CLINICAL RELEVANCE STATEMENT In vivo ECLL induces adipocyte death and fat necrosis. ECLL has the potential to be utilized in body fat contouring.
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Affiliation(s)
- Tiffany T Pham
- From the Beckman Laser Institute & Medical Clinic
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, School of Medicine
| | - Andrew E Heidari
- From the Beckman Laser Institute & Medical Clinic
- Department of Biomedical Engineering
| | - Ellen M Hong
- From the Beckman Laser Institute & Medical Clinic
| | | | - Yueqiao Qu
- From the Beckman Laser Institute & Medical Clinic
- Department of Biomedical Engineering
| | - Lily Y Chen
- From the Beckman Laser Institute & Medical Clinic
| | - Brandyn S Dunn
- From the Beckman Laser Institute & Medical Clinic
- Otolaryngology-Head and Neck Surgery, University of California, Irvine, School of Medicine
| | - Soo Hong Seo
- Department of Dermatology, Korea University, College of Medicine
| | - Adeela Syed
- Department of Developmental and Cell Biology, University of California, Irvine
| | | | - Lauren Lee
- From the Beckman Laser Institute & Medical Clinic
| | | | | | - Urja Patel
- From the Beckman Laser Institute & Medical Clinic
| | - Sehwan Kim
- Beckman Laser Institute-Korea, Dankook University
| | | | - Brian J F Wong
- From the Beckman Laser Institute & Medical Clinic
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, School of Medicine
- Departments of Surgery
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Zhu Y, Zhou X, Peng X, Li H, Wang H, Guo Z, Xiong Y, Xu J, Ni X, Qi X. 1064nm Nd:YAG laser promotes chondrocytes regeneration and cartilage reshaping by upregulating local estrogen levels. JOURNAL OF BIOPHOTONICS 2024; 17:e202300443. [PMID: 38041518 DOI: 10.1002/jbio.202300443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/23/2023] [Accepted: 11/26/2023] [Indexed: 12/03/2023]
Abstract
Cartilage is frequently used as a scaffolds for repairing and reconstructing body surface organs. However, after successful plastic surgery, transplanted cartilage scaffolds often exhibit deformation and absorption over time. To enhance the shaping stability of cartilage scaffolds and improve patients' satisfaction after reconstructions, we employed the ear folding models in New Zealand rabbits to confirm whether the 1064nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser could promote cartilage reshaping. There was an increase in collagen and aromatase (Cyp19) expression within the ear cartilage after laser treatment. Moreover, we have found that the Cyp19 inhibitor can inhibit the laser's effect on cartilage shaping and reduce collagen and Cyp19 expression. The overall findings suggest that treatment with 1064nm Nd:YAG laser irradiation can enhance estrogen levels in local cartilage tissues by upregulating Cyp19 expression in chondrocytes through photobiomodulation, thereby promoting the proliferation and collagen secretion of chondrocytes to improve cartilage reshaping and stability.
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Affiliation(s)
- Yingjie Zhu
- Department of Plastic & Aesthetic Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, People's Republic of China
| | - Xueqing Zhou
- Department of Plastic & Aesthetic Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, People's Republic of China
| | - Xieling Peng
- Department of Plastic & Aesthetic Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, People's Republic of China
| | - Hantao Li
- Department of Plastic & Aesthetic Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, People's Republic of China
| | - Hongshun Wang
- Department of Plastic & Aesthetic Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, People's Republic of China
| | - Ziwei Guo
- Department of Plastic & Aesthetic Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, People's Republic of China
| | - Yang Xiong
- Department of Plastic & Aesthetic Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, People's Republic of China
| | - Jiaqi Xu
- Department of Plastic & Aesthetic Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, People's Republic of China
| | - Xiangrong Ni
- Department of Plastic & Aesthetic Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, People's Republic of China
| | - Xiangdong Qi
- Department of Plastic & Aesthetic Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, People's Republic of China
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Park AC, Chan CK, Hutchison DM, Patel U, Hong EM, Steward E, Dilley KK, Sterritt NL, Kim S, Hill MG, You JS, Wong BJF. In vivo electrochemical lipolysis of fat in a Yucatan pig model: A proof of concept study. Lasers Surg Med 2023; 55:135-145. [PMID: 36511512 DOI: 10.1002/lsm.23620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/01/2022] [Accepted: 11/26/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Traditional fat contouring is now regularly performed using numerous office- based less invasive techniques. However, some limitations of these minimally invasive techniques include high cost or limited selectivity with performing localized contouring and reduction of fat. These shortcomings may potentially be addressed by electrochemical lipolysis (ECLL), a novel approach that involves the insertion of electrodes into tissue followed by application of a direct current (DC) electrical potential. This results in the hydrolysis of tissue water creating active species that lead to fat necrosis and apoptosis. ECLL can be accomplished using a simple voltage-driven system (V-ECLL) or a potential-driven feedback cell (P-ECLL) both leading to water electrolysis and the creation of acid and base in situ. The aim of this study is to determine the long-lasting effects of targeted ECLL in a Yucatan pig model. METHODS A 5-year-old Yucatan pig was treated with both V-ECLL and P-ECLL in the subcutaneous fat layer using 80:20 platinum:iridium needle electrodes along an 8 cm length. Dosimetry parameters included 5 V V-ECLL for 5, 10, and 20 minutes, and -1.5 V P-ECLL, -2.5 V P-ECLL, -3.5 V P-ECLL for 5 minutes. The pig was assessed for changes in fat reduction over 3 months with digital photography and ultrasound. After euthanasia, tissue sections were harvested and gross pathology and histology were examined. RESULTS V-ECLL and P-ECLL treatments led to visible fat reduction (12.1%-27.7% and 9.4%-40.8%, respectively) and contour changes across several parameters. An increased reduction of the superficial fat layer occurred with increased dosimetry parameters with an average charge transfer of 12.5, 24.3, and 47.5 C transferred for 5 V V-ECLL for 5, 10, and 20 minutes, respectively, and 2.0, 11.5, and 24.0 C for -1.5 V P-ECLL, -2.5 V P-ECLL, -3.5 V P-ECLL for 5 minutes, respectively. These dose-dependent changes were also evidenced by digital photography, gross pathology, ultrasound imaging, and histology. CONCLUSIONS ECLL results in selective damage and long-lasting changes to the adipose layer in vivo. These changes are dose-dependent, thus allowing for more precise contouring of target areas. P-ECLL has greater efficiency and control of total charge transfer compared to V-ECLL, suggesting that a low-voltage potentiostat treatment can result in fat apoptosis equivalent to a high-voltage DC system.
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Affiliation(s)
- Asher C Park
- Beckman Laser Institute & Medical Clinic, University of California-Irvine, Irvine, California, USA
| | - Carmen K Chan
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of California-Irvine, Orange, California, USA
| | - Dana M Hutchison
- Beckman Laser Institute & Medical Clinic, University of California-Irvine, Irvine, California, USA
| | - Urja Patel
- Beckman Laser Institute & Medical Clinic, University of California-Irvine, Irvine, California, USA
| | - Ellen M Hong
- School of Medicine, Hackensack Meridian, Nutley, New Jersey, USA
| | - Earl Steward
- Department of Surgery, School of Medicine, University of California-Irvine, Orange, California, USA
| | - Katelyn K Dilley
- Beckman Laser Institute & Medical Clinic, University of California-Irvine, Irvine, California, USA
| | - Naya L Sterritt
- Department of Biomedical Engineering, University of California-Irvine, Irvine, California, USA
| | - Sehwan Kim
- Department of Biomedical Engineering, Beckman Laser Institute, Korea, Dankook University, Cheonan-si, Chungnam, Republic of Korea
| | - Michael G Hill
- Department of Chemistry, Occidental College, Los Angeles, California, USA
| | - Joon S You
- eLysis Inc., Laguna Niguel, California, USA
| | - Brian J F Wong
- Beckman Laser Institute & Medical Clinic, University of California-Irvine, Irvine, California, USA.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of California-Irvine, Orange, California, USA.,Department of Biomedical Engineering, University of California-Irvine, Irvine, California, USA
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Dilley KK, Borden PA, Qu Y, Heidari AE, Prasad KR, Li Y, Sun CH, Chen Z, Kim S, Hill MG, Wong BJF. Potential-Driven Electrochemical Clearing of Ex Vivo Alkaline Corneal Injuries. Transl Vis Sci Technol 2022; 11:32. [PMID: 35061010 PMCID: PMC8787648 DOI: 10.1167/tvst.11.1.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose Corneal chemical injuries (CCI) obscure vision by opacifying the cornea; however, current treatments may not fully restore clarity. Here, we investigated potential-driven electrochemical treatment (P-ECT) to restore clarity after alkaline-based CCI in ex vivo rabbit corneas and examined collagen fiber orientation changes using second harmonic generation (SHG). Methods NaOH was applied to the corneas of intact New Zealand white rabbit globes. P-ECT was performed on the opacified cornea while optical coherence tomography (OCT) imaging (∼35 frames per second) was simultaneously performed. SHG imaging evaluated collagen fiber structure before NaOH application and after P-ECT. Irrigation with water served as a control. Results P-ECT restored local optical clarity after NaOH exposure. OCT imaging shows both progression of NaOH injury and the restoration of clarity in real time. Analysis of SHG z-stack images show that collagen fibril orientation is similar between control, NaOH-damaged, and post-P-ECT corneas. NaOH-injured corneas flushed with water (15 minutes) show no restoration of clarity. Conclusions P-ECT may be a means to correct alkaline CCI. Collagen fibril orientation does not change after NaOH exposure or P-ECT, suggesting that no irreversible matrix level fiber changes occur. Further studies are required to determine the mechanism for corneal clearing and to ascertain the optimal electrical dosimetry parameters and electrode designs. Translational Relevance Our findings suggest that P-ECT is a potentially effective, low-cost treatment for alkaline CCI.
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Affiliation(s)
- Katelyn K Dilley
- Beckman Laser Institute & Medical Clinic, University of California-Irvine, Irvine, CA, USA.,Department of Biomedical Engineering, University of California-Irvine, Irvine, CA, USA
| | - Pamela A Borden
- Beckman Laser Institute & Medical Clinic, University of California-Irvine, Irvine, CA, USA.,Department of Biomedical Engineering, University of California-Irvine, Irvine, CA, USA
| | - Yueqiao Qu
- Beckman Laser Institute & Medical Clinic, University of California-Irvine, Irvine, CA, USA.,Department of Biomedical Engineering, University of California-Irvine, Irvine, CA, USA
| | - Andrew E Heidari
- Beckman Laser Institute & Medical Clinic, University of California-Irvine, Irvine, CA, USA.,Department of Biomedical Engineering, University of California-Irvine, Irvine, CA, USA
| | - Karthik R Prasad
- Beckman Laser Institute & Medical Clinic, University of California-Irvine, Irvine, CA, USA.,School of Medicine, University of California-Irvine, Irvine, CA, USA
| | - Yan Li
- Beckman Laser Institute & Medical Clinic, University of California-Irvine, Irvine, CA, USA.,Department of Biomedical Engineering, University of California-Irvine, Irvine, CA, USA
| | - Chung Ho Sun
- Beckman Laser Institute & Medical Clinic, University of California-Irvine, Irvine, CA, USA
| | - Zhongping Chen
- Beckman Laser Institute & Medical Clinic, University of California-Irvine, Irvine, CA, USA.,Department of Biomedical Engineering, University of California-Irvine, Irvine, CA, USA
| | - Sehwan Kim
- Beckman Laser Institute-Korea, Department of Biomedical Engineering, Dankook University, Cheonan-si, Chungnam, Republic of Korea
| | - Michael G Hill
- Department of Chemistry, Occidental College, Los Angeles, CA, USA
| | - Brian J F Wong
- Beckman Laser Institute & Medical Clinic, University of California-Irvine, Irvine, CA, USA.,Department of Biomedical Engineering, University of California-Irvine, Irvine, CA, USA.,Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, School of Medicine, Orange, CA, USA
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5
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Heidari AE, Hong EM, Park A, Pham TT, Steward E, Chen LY, Qu Y, Dunn BS, Seo SH, Patel U, Dilley K, Hakimi AA, Syed A, Kim S, Hill MG, You JS, Wong BJF. Exploring feedback-controlled versus open-circuit electrochemical lipolysis in ex vivo and in vivo porcine fat: A feasibility study. Lasers Surg Med 2022; 54:157-169. [PMID: 34412154 PMCID: PMC8770526 DOI: 10.1002/lsm.23466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Minimally invasive fat sculpting techniques are becoming more widespread with the development of office-based devices and therapies. Electrochemical lipolysis (ECLL) is a needle-based technology that uses direct current (DC) to electrolyze tissue water creating acid and base in situ. In turn, fat is saponified and adipocyte cell membrane lysis occurs. The electrolysis of water can be accomplished using a simple open-loop circuit (V-ECLL) or by incorporating a feedback control circuit using a potentiostat (P-ECLL). A potentiostat utilizes an operational amplifier with negative feedback to allow users to precisely control voltage at specific electrodes. To date, the variation between the two approaches has not been studied. The aim of this study was to assess current and charge transfer variation and lipolytic effect created by the two approaches in an in vivo porcine model. METHODS Charge transfer measurements from ex vivo V-ECLL and P-ECLL treated porcine skin and fat were recorded at -1 V P-ECLL, -2 V P-ECLL, -3 V P-ECLL, and -5 V V-ECLL each for 5 min to guide dosimetry parameters for in vivo studies. In follow-up in vivo studies, a sedated female Yorkshire pig was treated with both V-ECLL and P-ECLL across the dorsal surface over a range of dosimetry parameters, including -1.5 V P-ECLL, -2.5 V P-ECLL, -3.5 V P-ECLL, and 5 V V-ECLL each treated for 5 min. Serial biopsies were performed at baseline before treatment, 1, 2, 7, 14, and 28 days after treatment. Tissue was examined using fluorescence microscopy and histology to compare the effects of the two ECLL approaches. RESULTS Both V-ECLL and P-ECLL treatments induced in-vivo fat necrosis evident by adipocyte membrane lysis, adipocyte denuclearization, and an acute inflammatory response across a 28-day longitudinal study. However, -1.5 V P-ECLL produced a smaller spatial necrotic effect compared to 5 V V-ECLL. In addition, 5 V V-ECLL produced a comparable necrotic effect to that of -2.5 V and -3.5 V P-ECLL. CONCLUSIONS V-ECLL and P-ECLL at the aforementioned dosimetry parameters both achieved fat necrosis by adipocyte membrane lysis and denuclearization. The -2.5 V and -3.5 V P-ECLL treatments created spatially similar fat necrotic effects when compared to the 5 V V-ECLL treatment. Quantitatively, total charge transfer between dosimetry parameters suggests that -2.5 V P-ECLL and 5 V V-ECLL produce comparable electrochemical reactions. Such findings suggest that a low-voltage closed-loop potentiostat-based system is capable of inducing fat necrosis to a similar extent compared to that of a higher voltage direct current system.
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Affiliation(s)
- Andrew E. Heidari
- Beckman Laser Institute & Medical Clinic, University of California - Irvine, CA 92612, USA,Department of Biomedical Engineering, University of California - Irvine, Irvine, CA 92697, USA
| | - Ellen M. Hong
- Beckman Laser Institute & Medical Clinic, University of California - Irvine, CA 92612, USA
| | - Asher Park
- Beckman Laser Institute & Medical Clinic, University of California - Irvine, CA 92612, USA
| | - Tiffany T. Pham
- Beckman Laser Institute & Medical Clinic, University of California - Irvine, CA 92612, USA
| | - Earl Steward
- Department of Surgery, University of California - Irvine, School of Medicine, Orange, CA 92868, USA
| | - Lily Y. Chen
- Beckman Laser Institute & Medical Clinic, University of California - Irvine, CA 92612, USA
| | - Yueqiao Qu
- Beckman Laser Institute & Medical Clinic, University of California - Irvine, CA 92612, USA,Department of Biomedical Engineering, University of California - Irvine, Irvine, CA 92697, USA
| | - Brandyn S. Dunn
- Beckman Laser Institute & Medical Clinic, University of California - Irvine, CA 92612, USA,Department of Otolaryngology - Head and Neck Surgery, University of California - Irvine, School of Medicine, Orange, CA 92868, USA
| | - Soo Hong Seo
- Beckman Laser Institute & Medical Clinic, University of California - Irvine, CA 92612, USA,Department of Dermatology, Korea University, College of Medicine, Seoul, 02841, Republic of Korea
| | - Urja Patel
- Beckman Laser Institute & Medical Clinic, University of California - Irvine, CA 92612, USA,Department of Biomedical Engineering, University of California - Irvine, Irvine, CA 92697, USA
| | - Katelyn Dilley
- Beckman Laser Institute & Medical Clinic, University of California - Irvine, CA 92612, USA,Department of Biomedical Engineering, University of California - Irvine, Irvine, CA 92697, USA
| | - Amir A. Hakimi
- Beckman Laser Institute & Medical Clinic, University of California - Irvine, CA 92612, USA
| | - Adeela Syed
- Department of Developmental and Cell Biology, University of California - Irvine, CA 92697, USA
| | - Sehwan Kim
- Beckman Laser Institute-Korea, Department of Biomedical Engineering, Dankook University, Cheonan-si, Chungnam 31116, Republic of Korea
| | - Michael G. Hill
- Department of Chemistry, Occidental College, Los Angeles, CA 90041, USA
| | | | - Brian J. F. Wong
- Beckman Laser Institute & Medical Clinic, University of California - Irvine, CA 92612, USA,Department of Biomedical Engineering, University of California - Irvine, Irvine, CA 92697, USA,Department of Otolaryngology - Head and Neck Surgery, University of California - Irvine, School of Medicine, Orange, CA 92868, USA
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Arora G, Arora S. Rejuvenating earlobe esthetics with dermal fillers. J Cosmet Dermatol 2021; 21:2788-2792. [PMID: 34687587 DOI: 10.1111/jocd.14552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/11/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The external ear plays a significant aesthetic role in the appearance of the face. Chronological and extrinsic aging effects on the ear lobe get further pronounced since routine surgical aesthetic procedures for the face do not address these morphological changes. Ear adornment with jewelry and piercings further cause sagging of the ear lobe and stretch the ear piercing. Dermal fillers offer a viable option for ear lobe rejuvenation by increasing its volume and addressing the morphological changes with minimal adverse effects or downtime associated with surgery. AIMS The authors aim to review the choice of dermal fillers used for ear lobule correction. The anatomy and its implications on techniques used for ear lobe rejuvenation are elaborated in this article based on the authors experience and reported literature. METHODS All patients who had received ear lobe fillers were evaluated, treated and followed up. Literature review of experience of treating patients with hyaluronic acid fillers for ear lobule correction and their rejuvenation was reviewed. RESULTS Hyaluronic acid fillers are a quick and easy method to restore the youthfulness and aesthetic ideals of the ear lobe. They address all the parameters of aging, volume deficit, reduction in the number and depth of creases and improvement in the number of wrinkles which surgical correction may not address. They can also be used for prejuvenation in younger populations expected to wear heavier ear jewelry. The results are immediate, long-lasting and the side effects and downtime are minimal.
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Affiliation(s)
- Gulhima Arora
- Department of Dermatology, Mehektagul Dermaclinic, New Delhi, India
| | - Sandeep Arora
- Department of Dermatology, Army College of Medical Sciences & Base Hospital, Delhi Cantonment, India
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Hong EM, Pham TT, Seo S, Moy WJ, Borden P, Hansen K, Kim S, Mo JH, Wong BJF. Electrochemical Therapy of In Vivo Rabbit Cutaneous Tissue. Laryngoscope 2021; 131:E2196-E2203. [PMID: 33666252 DOI: 10.1002/lary.29461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/12/2021] [Accepted: 02/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To examine the acid-base and histological changes in in vivo rabbit cutaneous tissue after electrochemical therapy. STUDY DESIGN In vivo rabbit tissue study. METHODS The shaved skin on the backs of female Oryctolagus cuniculi were assigned to treatments with or without tumescence with normal saline. Two platinum-needle electrodes were inserted into each treatment area and connected to a direct current (DC) power supply. Voltage (3-5 V) was varied and applied for 5 minutes. The wound-healing process was monitored via digital photography and ultrasonography until euthanasia at day 29. Treatment areas were biopsied, and specimens were sectioned through a sagittal midline across both electrode insertion sites. Samples were then evaluated utilizing light microscopy (hematoxylin and eosin, Masson's Trichrome, and Picrosirius red). RESULTS Treatment sites developed mild inflammation that dissipated at lower voltages or became scabs at higher voltages. Ultrasonography demonstrated acoustic shadowing with spatial spread that increased with increasing voltage application. The 4- and 5-V sites treated with saline had localized areas of increased tissue density at day 29. Although specimens treated with 3 V did not look significantly different from control tissue, 4- and 5-V samples with and without saline tumescence had finer, less-organized collagen fibers and increased presence of fibrocytes and inflammatory infiltrates. CONCLUSIONS Electrochemical therapy caused localized injury to in vivo rabbit cutaneous tissue, prompting regenerative wound repair. With future development, this technology may offer precise, low-cost rejuvenation to restore the functionality and appearance of dermal scars and keloids. LEVEL OF EVIDENCE NA Laryngoscope, 131:E2196-E2203, 2021.
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Affiliation(s)
- Ellen M Hong
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California, U.S.A
| | - Tiffany T Pham
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California, U.S.A
| | - Soohong Seo
- Department of Dermatology, Korea University Anam Hospital, Seoul, South Korea
| | - Wesley J Moy
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California, U.S.A
| | - Pamela Borden
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California, U.S.A
| | - Kyle Hansen
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California, U.S.A
| | - Sehwan Kim
- Department of Biomedical Engineering, School of Medicine, Dankook University, Cheonan, Republic of Korea.,Beckman Laser Institute Korea, Dankook University, Cheonan-si, Chungnam, Republic of Korea
| | - Ji-Hun Mo
- Beckman Laser Institute Korea, Dankook University, Cheonan-si, Chungnam, Republic of Korea.,Department of Otorhinolaryngology, School of Medicine, Dankook University, Chenoan, Republic of Korea
| | - Brian J F Wong
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California, U.S.A.,Department of Biomedical Engineering, University of California-Irvine, Irvine, California, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, School of Medicine, Orange, California, U.S.A
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8
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Nguyen TD, Hu AC, Protsenko DE, Wong BJF. Effects of electromechanical reshaping on mechanical behavior of exvivo bovine tendon. Clin Biomech (Bristol, Avon) 2020; 73:92-100. [PMID: 31958703 DOI: 10.1016/j.clinbiomech.2020.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/26/2019] [Accepted: 01/13/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Electromechanical reshaping is a novel, minimally invasive means to induce mechanical changes in connective tissues, and has the potential to be utilized in lieu of current orthopedic therapies that involve tendons and ligaments. Electromechanical reshaping delivers an electrical current to tissues while under mechanical deformation, causing in situ redox changes that produce reliably controlled and spatially limited mechanical and structural changes. In this study, we examine the feasibility of altering Young's modulus and inducing a shape deformation using an ex vivo bovine Achilles tendon model. METHODS Tendon was mechanically deformed in two different modes: (1) elongation to assess for tensile modulus and (2) compression to assess for compressive modulus. Electromechanical reshaping was applied to tendon specimens via flat plate platinum electrodes (6 V, 3 min) while simultaneously under mechanical strain for 15 min. FINDINGS In elongation mode, post-electromechanical reshaping samples demonstrated a significant decrease in Young's modulus compared to pretreatment samples (66.02 and 45.12 MPa, respectively, p < 0.0049). In compression mode, posttreatment samples illustrated a significant shape change, with an increase in diameter (10.62 to 11.36 mm, p < 0.05) and decrease in thickness (4.13 to 3.62 mm, p < 0.05). INTERPRETATION Results demonstrated a tissue softening effect without lengthening deformation during elongation, and a shortening effect without compromising compressive stiffness during compression. Electromechanical reshaping's reliable, low-cost, and efficacious methodology in inducing mechanical and structural connective tissue modifications illustrates a potential for future alternative orthopedic applications. Future studies will optimize and refine electromechanical reshaping to address clinically relevant geometries and methods such as needle techniques.
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Affiliation(s)
- Tony D Nguyen
- Department of Physical Medicine and Rehabilitation, University of California, Irvine, Orange, CA, USA; Beckman Laser Institute, University of California, Irvine, CA, USA.
| | - Allison C Hu
- Beckman Laser Institute, University of California, Irvine, CA, USA; Department of Otolaryngology, Head and Neck Surgery, University of California, Irvine, Orange, CA, USA; Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA.
| | - Dmitry E Protsenko
- Beckman Laser Institute, University of California, Irvine, CA, USA; Department of Otolaryngology, Head and Neck Surgery, University of California, Irvine, Orange, CA, USA; Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA.
| | - Brian J F Wong
- Beckman Laser Institute, University of California, Irvine, CA, USA; Department of Otolaryngology, Head and Neck Surgery, University of California, Irvine, Orange, CA, USA; Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA.
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9
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Hu AC, Hong EM, Toubat O, Sivoraphonh R, Barnes C, Moy WJ, Krasieva TB, Wong BJF. Multiphoton Microscopy of Collagen Structure in Ex Vivo Human Skin Following Electrochemical Therap
y. Lasers Surg Med 2019; 52:196-206. [DOI: 10.1002/lsm.23094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Allison C. Hu
- School of MedicineUniversity of CaliforniaIrvine California 92617
- Beckman Laser Institute and Medical ClinicUniversity of CaliforniaIrvine California 92612
- Department of Biomedical EngineeringUniversity of CaliforniaIrvine California 92617
| | - Ellen M. Hong
- Beckman Laser Institute and Medical ClinicUniversity of CaliforniaIrvine California 92612
- Department of Biomedical EngineeringUniversity of CaliforniaIrvine California 92617
| | - Omar Toubat
- Keck School of Medicine of USCLos Angeles California 90033
| | - Ryan Sivoraphonh
- Beckman Laser Institute and Medical ClinicUniversity of CaliforniaIrvine California 92612
- Department of Biomedical EngineeringUniversity of CaliforniaIrvine California 92617
| | - Christian Barnes
- Beckman Laser Institute and Medical ClinicUniversity of CaliforniaIrvine California 92612
- Department of Biomedical EngineeringUniversity of CaliforniaIrvine California 92617
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CaliforniaIrvine, Orange California 92868
| | - Wesley J. Moy
- Beckman Laser Institute and Medical ClinicUniversity of CaliforniaIrvine California 92612
- Department of Biomedical EngineeringUniversity of CaliforniaIrvine California 92617
| | - Tatiana B. Krasieva
- Beckman Laser Institute and Medical ClinicUniversity of CaliforniaIrvine California 92612
| | - Brian J. F. Wong
- Beckman Laser Institute and Medical ClinicUniversity of CaliforniaIrvine California 92612
- Department of Biomedical EngineeringUniversity of CaliforniaIrvine California 92617
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CaliforniaIrvine, Orange California 92868
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Guo F, Yu X, Sun Z, Pan B, Jiang H. [Preliminary study on microdissection needle-assisted ear cartilage reshaping in vivo rabbit models]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:601-605. [PMID: 31090355 DOI: 10.7507/1002-1892.201807032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To preliminarily investigate morghological changes of rabbits reshaping ear cartilage assisted by microdissection needle and explore feasibility of new therapy for ear deformity. Methods The bilateral ears of 5 male New Zealand rabbits (aged, 5-6 months) were fixed maintaining the curvature and randomly divided into 2 groups (5 ears in each group). The ears were stimulated by microdissection needle in experimental group and were not treated with stimulation in control group. The skin reaction in the experimental group was observed immediately and at 4 weeks after stimulation. Then, the fixtures were removed at 4 weeks, and the shapes of the ears were observed. The cartilages were harvested from the ears to examined morphological changes after HE staining, and measured the chondrocyte layer thickness. Results All rabbits survived until the end of the experiment. The skin has healed completely after 4 weeks in experimental group. After removing fixtures, the ears in the two groups all maintained certain forms momentarily; while 24 hours later, the ears in the control group mostly recovered original form, and the ears in the experimental group still maintained certain molding form until 8 weeks. HE staining showed there were smooth cartilage and uniform distribution of cells in the control group; the matrix staining was basically consistent; and the skin was normal appearance with epidermis, dermis, and cartilage of normal aspect. But the proliferation of chondrocyte with more layers of cells were observed in the experimental group. In addition, there were degeneration and injury of cartilage cells and connective tissue with necrotic cells and inflammatory cells at needle insertion sites. The chondrocyte layer thickness was (385.714±2.027) μm in the control group and (1 594.732±1.872) μm in the experimental group, there was significant difference between the two groups ( t=-759.059, P=0.000). Conclusion Rabbit ear cartilage can be effectively reshaped by microdissection needle. Proliferation of chondrocyte and changes in matrix can be found during the reshaping process.
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Affiliation(s)
- Fengfeng Guo
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100144, P.R.China
| | - Xiaobo Yu
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100144, P.R.China
| | - Zhongyang Sun
- Department of Plastic Surgery, Beijing Hospital, Beijing, 100730, P.R.China
| | - Bo Pan
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100144, P.R.China
| | - Haiyue Jiang
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100144,
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11
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Punj P, Chong HP, Cundy TP, Lodge M, Woods R. Otoplasty techniques in children: a comparative study of outcomes. ANZ J Surg 2018; 88:1071-1075. [PMID: 29740979 DOI: 10.1111/ans.14386] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/05/2017] [Accepted: 12/07/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Numerous otoplasty techniques have been described in the literature to correct prominent ears; however, few have focused on the complication rates. We reviewed our experience aiming to assess peri-operative care requirements and complication rates. METHOD We conducted a retrospective review of 207 otoplasty procedures performed in 119 patients over a 5-year period (2009-2014) at the Women's and Children's Hospital, Adelaide. Information pertaining to demographic details, length of stay, otoplasty technique and complications (early and late) were obtained. RESULTS In the study period, 97% of the 119 patients had an overnight stay. There was an early complication of 2.2% (return to theatre for bleeding) in the modified Chongchet technique and 0.9% (wound infection) in the Mustarde technique. Late complications included suture extrusion (1.9%) with the Mustarde technique and hypertrophic scarring (2.2%) in the modified Chongchet technique. The recurrence rate requiring revision following modified Chongchet technique was 10% and Mustarde technique was 2.9%. The Mustarde otoplasty technique was associated with a slightly lower antiemetic requirement than the Chongchet technique (3.2 versus 14.3%, P = 0.032). Both techniques had comparable opioid analgesic requirement of 30-35% post-operatively (P = 0.248). CONCLUSION Our results are comparable to the huge variation in available literature. We note the higher revision rate following modified Chongchet technique. Both techniques had a low and acceptable rate of post-operative analgesia and antiemetic requirement. We are considering either otoplasty technique as a day surgery procedure within our unit with the provision of adequate patient support as a safe and economical advance.
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Affiliation(s)
- Puvesh Punj
- Department of Plastic and Reconstructive Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Hsu Phie Chong
- Department of Plastic and Reconstructive Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Thomas P Cundy
- Department of Plastic and Reconstructive Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Michelle Lodge
- Department of Plastic and Reconstructive Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Roger Woods
- Department of Plastic and Reconstructive Surgery, Women's and Children's Hospital, Adelaide, South Australia, Australia
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12
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Moy WJ, Su E, Chen JJ, Oh C, Jing JC, Qu Y, He Y, Chen Z, Wong BJF. Association of Electrochemical Therapy With Optical, Mechanical, and Acoustic Impedance Properties of Porcine Skin. JAMA FACIAL PLAST SU 2017; 19:502-509. [PMID: 28654968 DOI: 10.1001/jamafacial.2017.0341] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The classic management of burn scars and other injuries to the skin has largely relied on soft-tissue transfer to resurface damaged tissue with local tissue transfer or skin graft placement. In situ generation of electrochemical reactions using needle electrodes and an application of current may be a new approach to treat scars and skin. Objective To examine the changes in optical, mechanical, and acoustic impedance properties in porcine skin after electrochemical therapy. Design, Setting, and Participants This preclinical pilot study, performed from August 1, 2015, to November 1, 2016, investigated the effects of localized pH-driven electrochemical therapy of ex vivo porcine skin using 24 skin samples. Platinum-plated needle electrodes were inserted into fresh porcine skin samples. A DC power supply provided a voltage of 4 to 5 V with a 3-minute application time. Specimens were analyzed using optical coherence tomography, optical coherence elastography, and ultrasonography. Ultrasonography was performed under 3 conditions (n = 2 per condition), optical coherence tomography was performed under 2 conditions (n = 2 per condition), and optical coherence elastography was performed under 2 conditions (n = 2 per condition). The remaining samples were used for the positive and negative control groups (n = 10). Exposures Platinum-plated needle electrodes were inserted into fresh porcine skin samples. A DC power supply provided a voltage of 4 to 5 V with a 3-minute application. Main Outcomes and Measures Tissue softening was observed at the anode and cathode sites as a result of electrochemical modification. Volumetric changes were noted using each optical and acoustic technique. Results A total of 24 ex vivo porcine skin samples were used for this pilot study. Optical coherence tomography measured spatial distribution of superficial tissue changes around each electrode site. At 4 V for 3 minutes, a total volumetric effect of 0.47 mm3 was found at the anode site and 0.51 mm3 at the cathode site. For 5 V for 3 minutes, a total volumetric effect of 0.85 mm3 was found at the anode site and 1.05 mm3 at the cathode site. Conclusions and Relevance Electrochemical therapy is a low-cost technique that is on par with the costs of suture and scalpel. The use of electrochemical therapy to create mechanical and physiologic changes in tissue has the potential to locally remodel the soft-tissue matrix, which ultimately may lead to an inexpensive scar treatment or skin rejuvenation therapy. Level of Evidence NA.
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Affiliation(s)
- Wesley J Moy
- Beckman Laser Institute and Medical Clinic, University of California, Irvine.,Department of Biomedical Engineering, University of California, Irvine
| | - Erica Su
- Beckman Laser Institute and Medical Clinic, University of California, Irvine
| | - Jason J Chen
- Beckman Laser Institute and Medical Clinic, University of California, Irvine
| | - Connie Oh
- Beckman Laser Institute and Medical Clinic, University of California, Irvine
| | - Joe C Jing
- Beckman Laser Institute and Medical Clinic, University of California, Irvine.,Department of Biomedical Engineering, University of California, Irvine
| | - Yueqiao Qu
- Beckman Laser Institute and Medical Clinic, University of California, Irvine.,Department of Biomedical Engineering, University of California, Irvine
| | | | - Zhongping Chen
- Beckman Laser Institute and Medical Clinic, University of California, Irvine.,Department of Biomedical Engineering, University of California, Irvine
| | - Brian J F Wong
- Beckman Laser Institute and Medical Clinic, University of California, Irvine.,Department of Biomedical Engineering, University of California, Irvine.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of California, Irvine
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13
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Manuel CT, Tjoa T, Nguyen T, Su E, Wong BJF. Optimal Electromechanical Reshaping of the Auricular Ear and Long-term Outcomes in an In Vivo Rabbit Model. JAMA FACIAL PLAST SU 2017; 18:277-84. [PMID: 27101542 DOI: 10.1001/jamafacial.2016.0166] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The prominent ear is a common external ear anomaly that is usually corrected through surgery. Electromechanical reshaping (EMR) may provide the means to reshape cartilage through the use of direct current (in milliamperes) applied percutaneously with needle electrodes and thus to reduce reliance on open surgery. OBJECTIVE To determine the long-term outcomes (shape change, cell viability, and histology) of a more refined EMR voltage and time settings for reshaping rabbit auricle. DESIGN, SETTING, AND SUBJECTS The intact ears of 14 New Zealand white rabbits were divided into 2 groups. Group 1 received 4 V for 5 minutes (5 ears), 5 V for 4 minutes (5 ears), or no voltage for 5 minutes (control; 4 ears). Group 2 received an adjusted treatment of 4 V for 4 minutes (7 ears) or 5 V for 3 minutes (7 ears). A custom mold with platinum electrodes was used to bend the pinna and to perform EMR. Pinnae were splinted for 6 months along the region of the bend. Rabbits were killed humanely and the ears were harvested the day after splint removal. Data were collected from March 14, 2013, to July 8, 2014, and analyzed from August 29, 2013, to March 1, 2015. MAIN OUTCOMES AND MEASURES Bend angle and mechanical behavior via palpation were recorded through photography and videography. Tissue was sectioned for histologic examination and confocal microscopy to assess changes to microscopic structure and cell viability. RESULTS Rabbits ranged in age from 6 to 8 months and weighed 3.8 to 4.0 g. The mean (SD) bend angles were 81° (45°) for the controls and, in the 5 EMR groups, 72° (29°) for 4 V for 4 minutes, 101° (19°) for 4 V for 5 minutes, 78° (18°) for 5 V for 3 minutes, and 126° (21°) for 5 V for 4 minutes. At 5 V, an increase in application time from 3 to 4 minutes provided significant shape change (78° [18°] and 126° [21°], respectively; P = .003). Pinnae stained with hematoxylin-eosin displayed localized areas of cell injury and fibrosis in and around electrode insertion sites. This circumferential zone of injury (range, 1.3-2.1 mm) corresponded to absence of red florescence on the cell viability assay. CONCLUSIONS AND RELEVANCE In this in vivo study, EMR produces shape changes in the intact pinnae of rabbits. A short application of 4 V or 5 V can achieve adequate reshaping of the pinnae. Tissue injury around the electrodes is modest in spatial distribution. This study provides a more optimal set of EMR variables and a critical step toward evaluation of EMR in clinical trials. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Cyrus T Manuel
- Beckman Laser Institute, University of California, Irvine
| | - Tjoson Tjoa
- Department of Otolaryngology, University of California, Irvine3Massachusetts Eye & Ear Infirmary, Boston
| | - Tony Nguyen
- Beckman Laser Institute, University of California, Irvine
| | - Erica Su
- Beckman Laser Institute, University of California, Irvine
| | - Brian J F Wong
- Beckman Laser Institute, University of California, Irvine2Department of Otolaryngology, University of California, Irvine
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14
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Gandy JR, Foulad A, Chao KK, Wong BJF. Injectable chondroplasty: Enzymatic reshaping of cartilage grafts. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:217-220. [PMID: 28209412 DOI: 10.1016/j.anorl.2016.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 04/17/2016] [Accepted: 05/24/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE/HYPOTHESIS To develop an injection-based enzymatic technique that selectively softens cartilage tissue for reshaping cartilaginous structures in the head and neck. MATERIALS AND METHODS Two groups were formed using fresh rabbit ears: (1) whole rabbit ear group; (2) composite graft group (2.5mm×3.0cm specimens sectioned from the central region of the pinna). Subperichondrial injections using three enzymes (hyaluronidase, pronase, and collagenase II) in sequence were performed for the experimental specimens from both groups. In the control specimens, phosphate buffered saline was injected in a similar fashion. The whole ear specimens were then photographed while held upright in the anatomical vertical position to evaluate for buckling, which corresponds to the integrity of the cartilage. In addition, backlight photography was performed for all specimens to further evaluate the effect of the enzymes, such that increased light intensity represents increased cartilage digestion. RESULTS The application of the digestive enzymes resulted in marked reduction of cartilage tissue matrix resiliency, while preserving overlying skin layers. Enzymatically treated whole pinnae buckled at the site where enzymes were delivered. Backlit images revealed increased local light intensity at the regions of digestion. There was no obvious destruction of the overlying skin upon visual inspection. CONCLUSIONS This study demonstrates the feasibility of injectable chondroplasty as a potential alternative method to conventional surgery for auricular cartilage reshaping. Sequential injection of hyaluronidase, pronase, and collagenase II into the subperichondrial space can be performed to digest and soften cartilage structure with minimal involvement of surrounding tissue. Future studies will need to include chondrocyte viability testing and optimization of delivery techniques.
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Affiliation(s)
- J R Gandy
- Division of facial plastic surgery, department of otolaryngology, head and neck surgery, university of California Irvine, 101, The City Drive, CA 92668 Orange, United States; Beckman Laser institute and medical clinic, university of California Irvine, 1002, Health Sciences Road East, CA 92612 Irvine, United States
| | - A Foulad
- Division of facial plastic surgery, department of otolaryngology, head and neck surgery, university of California Irvine, 101, The City Drive, CA 92668 Orange, United States; Beckman Laser institute and medical clinic, university of California Irvine, 1002, Health Sciences Road East, CA 92612 Irvine, United States
| | - K K Chao
- Beckman Laser institute and medical clinic, university of California Irvine, 1002, Health Sciences Road East, CA 92612 Irvine, United States; Department of radiation oncology, Epic Care, 400, Taylor Boulevard, Suite 102, CA 94523 Pleasant Hill, United States
| | - B J F Wong
- Division of facial plastic surgery, department of otolaryngology, head and neck surgery, university of California Irvine, 101, The City Drive, CA 92668 Orange, United States; Beckman Laser institute and medical clinic, university of California Irvine, 1002, Health Sciences Road East, CA 92612 Irvine, United States; Department of Biomedical Engineering, university of California Irvine, CA 92612 Irvine, United States.
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15
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Monitoring of Biological Changes in Electromechanical Reshaping of Cartilage Using Imaging Modalities. BIOMED RESEARCH INTERNATIONAL 2016; 2016:7089017. [PMID: 28053987 PMCID: PMC5178334 DOI: 10.1155/2016/7089017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/29/2016] [Accepted: 10/05/2016] [Indexed: 12/23/2022]
Abstract
Electromechanical reshaping (EMR) is a promising surgical technique used to reshape cartilage by direct current and mechanical deformation. It causes local stress relaxation and permanent alterations in the shape of cartilage. The major advantages of EMR are its minimally invasive nature and nonthermal electrochemical mechanism of action. The purpose of this study is to validate that EMR does not cause thermal damage and to observe structural changes in post-EMR cartilage using several imaging modalities. Three imaging modality metrics were used to validate the performance of EMR by identifying structural deformation during cartilage reshaping: infrared thermography was used to sense the temperature of the flat cartilages (16.7°C at 6 V), optical coherence tomography (OCT) was used to examine the change in the cartilage by gauging deformation in the tissue matrix during EMR, and scanning electron microscopy (SEM) was used to show that EMR-treated cartilage is irregularly arranged and the thickness of collagen fibers varies, which affects the change in shape of the cartilage. In conclusion, the three imaging modalities reveal the nonthermal and electromechanical mechanisms of EMR and demonstrate that use of an EMR device is feasible for reshaping cartilage in a minimally invasive manner.
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Gandy JR, Lemieux B, Foulad A, Wong BJF. Modular Component Assembly Approach to Microtia Reconstruction. JAMA FACIAL PLAST SU 2016; 18:120-7. [PMID: 26720326 DOI: 10.1001/jamafacial.2015.1838] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Current methods of microtia reconstruction include carving an auricular framework from the costal synchondrosis. This requires considerable skill and may create a substantial defect at the donor site. OBJECTIVE To present a modular component assembly (MCA) approach that minimizes the procedural difficulty with microtia repair and reduces the amount of cartilage to a single rib. DESIGN, SETTING, AND PARTICIPANTS Ex vivo study and survey. A single porcine rib was sectioned into multiple slices using a cartilage guillotine, cut into components outlined by 3-dimensional printed templates, and assembled into an auricular scaffold. Electromechanical reshaping was used to bend cartilage slices for creation of the helical rim. Chondrocyte viability was confirmed using confocal imaging. Ten surgeons reviewed the scaffold constructed with the MCA approach to evaluate aesthetics, stability, and clinical feasibility. The study was conducted from June 5 to December 18, 2014. MAIN OUTCOMES AND MEASURES The primary outcome was creation of a modular component assembly method that decreases the total amount of rib needed for scaffold construction, as well as overall scaffold acceptability. The surgeons provided their assessments through a Likert-scale survey, with responses ranging from 1 (disagree with the statement) to 5 (agree with the statement). Thus, a higher score represents that the surgeon agrees that the scaffold is structurally and aesthetically acceptable and feasible. RESULTS An auricular framework with projection and curvature was fashioned from 1 rib. The 10 surgeons who participated in the survey indicated that the MCA scaffold would meet minimal aesthetic and anatomic acceptability. When embedded under a covering, the region of the helix and antihelix of the scaffold scored significantly higher on the assessment survey than that of an embedded alloplast implant (mean [SD], 4.6 [0.97] vs 3.5 [1.27]; P = .007). Otherwise, no significant difference was found between the embedded MCA and alloplast implants (4.42 [0.48] vs 3.87 [0.41]; P = .13). Cartilage prepared with electromechanical reshaping was viable. CONCLUSIONS AND RELEVANCE This study demonstrates that 1 rib can be used to create an aesthetic and durable framework for microtia repair. Precise assembly and the ability to obtain thin, uniform slices of cartilage were essential. This cartilage-sparing MCA approach may be an alternative to classic techniques. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Jessica R Gandy
- Medical student, School of Medicine, University of California-Irvine, Irvine2Beckman Laser Institute and Medical Clinic, University of California-Irvine, Irvine
| | - Bryan Lemieux
- Medical student, School of Medicine, University of California-Irvine, Irvine2Beckman Laser Institute and Medical Clinic, University of California-Irvine, Irvine
| | - Allen Foulad
- Beckman Laser Institute and Medical Clinic, University of California-Irvine, Irvine3Department of Otolaryngology, Head and Neck Surgery, University of California-Irvine, Orange
| | - Brian J F Wong
- Beckman Laser Institute and Medical Clinic, University of California-Irvine, Irvine3Department of Otolaryngology, Head and Neck Surgery, University of California-Irvine, Orange4Department of Otolaryngology, Head and Neck Surgery, University of California-
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17
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Affiliation(s)
- Sachin S. Pawar
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - Cody A. Koch
- Koch Facial Plastic Surgery and Spa, West Des Moines, Iowa
| | - Craig Murakami
- Division of Facial Plastic Surgery, Department of Otolaryngology–Head and Neck Surgery, Virginia Mason Medical Center, Seattle, Washington
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18
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Hussain S, Manuel CT, Protsenko DE, Wong BJF. Electromechanical reshaping of ex vivo porcine trachea. Laryngoscope 2015; 125:1628-32. [PMID: 25692713 DOI: 10.1002/lary.25189] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 12/26/2014] [Accepted: 01/12/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The trachea is a composite cartilaginous structure particularly prone to various forms of convexities. Electromechanical reshaping (EMR) is an emerging technique used to reshape cartilaginous tissues by applying electric current in tandem with imposed mechanical deformation to achieve shape change. In this study, EMR was used to reshape tracheal cartilage rings to demonstrate the feasibility of this technology as a potentially minimally invasive procedure to alter tracheal structure. STUDY DESIGN Controlled laboratory study using ex vivo porcine tracheae. METHODS The natural concavity of each porcine tracheal ring was reversed around a cork mandrel. Two pairs of electrodes were inserted along the long axis of the tracheal ring and placed 1.5 millimeters from the midline. Current was applied over a range of voltages (3 volts [V], 4V, and 5V) for either 2 or 3 minutes. The degree of EMR-induced reshaping was quantified from photographs using digital techniques. Confocal imaging with fluorescent live and dead assays was conducted to determine viability of the tissue after EMR. RESULTS Specimens that underwent EMR for 2 or 3 minutes at 4V or 5V were observed to have undergone significant (P < .05) reshaping relative to the control. Viability results demonstrated that EMR reshaping occurs at the expense of tissue injury, although the extent of injury is modest relative to conventional techniques. CONCLUSION EMR reshapes tracheal cartilage rings as a function of voltage and application time. It has potential as a minimally invasive and cost-efficient endoscopic technology to treat pathologic tracheal convexities. Given our findings, consideration of EMR for use in larger ex vivo tracheal segments and animal studies is now plausible.
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Affiliation(s)
- Syed Hussain
- Beckman Laser Institute, University of California Irvine, Irvine, U.S.A
| | - Cyrus T Manuel
- Beckman Laser Institute, University of California Irvine, Irvine, U.S.A
| | | | - Brian J F Wong
- Beckman Laser Institute, University of California Irvine, Irvine, U.S.A.,Department of Biomedical Engineering, 3120 Natural Sciences II, University of California Irvine, Irvine, U.S.A.,Department of Otolaryngology, Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
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19
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Kuan EC, Hamamoto AA, Manuel CT, Protsenko DE, Wong BJF. In-depth analysis of pH-dependent mechanisms of electromechanical reshaping of rabbit nasal septal cartilage. Laryngoscope 2014; 124:E405-10. [PMID: 24687330 DOI: 10.1002/lary.24696] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 03/12/2014] [Accepted: 03/26/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Electromechanical reshaping (EMR) involves reshaping cartilage by mechanical deformation and delivering electric current to the area around the bend axis, causing local stress relaxation and permanent shape change. The mechanism of EMR is currently unclear, although preliminary studies suggest that voltage and application time are directly related to the concentration and diffusion of acid-base products within the treated tissue with little heat generation. This study aims to characterize local tissue pH changes following EMR and to demonstrate that local tissue pH changes are correlated with tissue damage and shape change. STUDY DESIGN Ex vivo animal study involving EMR of rabbit nasal septal cartilage and biochemical estimation of tissue pH changes. METHODS The magnitude and diffusion of acid-base chemical products in control (0V, 2 minutes), shape change (4V, 4 minutes; 6V, 1, 2, 4 minutes; 8V, 1, 2 minutes), and tissue damage (8V, 4, 5 minutes; 10V, 4, 5 minutes) parameters following EMR are approximated by analyzing local pH changes after pH indicator application. RESULTS There is a direct relationship between total charge transfer and extent of acid-base product diffusion (P <0.05). A "pH transition zone" is seen surrounding the bend apex above 8V, 2 minutes. Colorimetric analysis suggests that small local pH changes (10(-8) hydrogen ions) are at least partly implicated in clinically efficacious EMR. CONCLUSIONS These results provide additional insight into the translational applications of EMR, particularly the relationship among pH changes, shape change, and tissue injury, and are integral in optimizing this promising technology for clinical use.
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Affiliation(s)
- Edward C Kuan
- Department of Head and Neck Surgery, University of California-Los Angeles, Los Angeles; Beckman Laser Institute and Medical Clinic, University of California-Irvine, Irvine, California, U.S.A
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