Moris Topaz

Electrical impedance scanning: a new approach to skin cancer diagnosis

Background/aims: Skin cancer diagnosis depends, to a great extent, on visual inspection and histopathological examination of excised tissues. The aim of this study is to evaluate the ability of electrical impedance scanning to differentiate between benign and malignant skin lesions.

Possible Long-Term Complications in Ultrasound-Assisted Lipoplasty Induced by Sonoluminescence, Sonochemistry, and Thermal Effect

Ultrasound-assisted lipoplasty has become a common procedure for the extraction of fat, together with conventional vacuum liposuction. There is a trend to equate ultrasound-assisted lipoplasty with vacuum liposuction, yet it is important to point out that each uses totally different physical modes and techniques to extract fat. Research comparing the efficacy of ultrasound-assisted lipoplasty with vacuum liposuction has been reported and continues to be evaluated. Since its early use by Zocchi1–3 and Maillard et al.,4 much experience and knowledge have been gained regarding side effects and complications. Although short-term side effects such as burns, infection, fibrosis, seroma, and the coagulation of blood vessels and nerves have already been noted and reported, long-term complications are possible. Recent studies have reported the use of ultrasound-assisted lipoplasty on the breast4 and the extraction of high volumes of fat. Emphasis should be placed on the long-term effects of ultrasound-assisted lipoplasty on young patients when sensitive areas such as the head, neck, and breast are treated and when high-intensity ultrasound energy is applied in close proximity to major blood vessels and nerves. The commonly accepted understanding of the physics of the ultrasound energy affecting the surrounding tissue involves the thermal, cavitational, and mechanical effects. A thorough review of the literature regarding the chemistry and physics of ultrasound energy, however, reveals a more detailed and comprehensive mechanism that can contribute to adverse effects of ultrasound energy in biologic systems. This mechanism comprises three major factors that may create long-term complications when associated with ultrasound-assisted lipoplasty: The …

Stress-relaxation and tension relief system for immediate primary closure of large and huge soft tissue defects: an old-new concept: new concept for direct closure of large defects.

AbstractStress–relaxation is a well-established mechanism for laboratory skin stretching, with limited clinical application in conventional suturing techniques due to the inherent, concomitant induction of ischemia, necrosis and subsequent suture failure. Skin defects that cannot be primarily closed are a common difficulty during reconstructive surgery. The TopClosure® tension-relief system (TRS) is a novel device for wound closure closure, providing secured attachment to the skin through a wide area of attachment, in an adjustable manner, enabling primary closure of medium to large skin defects.The aim of this study was to evaluate the efficiency of the TopClosure® TRS as a substitute for skin grafting and flaps for primary closure of large soft tissue defects by stress–relaxation.We present three demonstrative cases requiring resection of large to huge tumors customarily requiring closure by skin graft or flaps. TRS was applied during surgery serving as a tension-relief platform for tension sutures, to enable primary skin-defect closure by cycling of stress–relaxation, and following surgery as skin-secure system until complete wound closure.All skin defects ranging from 7 to 26 cm in width were manipulated by the TRS through stress–relaxation, without undermining of skin, enabling primary skin closure and eliminating the need for skin grafts and flaps. Immediate wound closure ranged 26 to 135 min. TRS was applied for 3 to 4 weeks. Complications were minimal and donor site morbidity was eliminated. Surgical time, hospital stay and costs were reduced and wound aesthetics were improved.In this case series we present a novel technology that enables the utilization of the viscoelastic properties of the skin to an extreme level, extending the limits of primary wound closure by the stress–relaxation principle. This is achieved via a simple device application that may aid immediate primary wound closure and downgrade the complexity of surgical procedures for a wide range of applications on a global scale.

Sonochemistry and Sonoluminescence in Simulated Ultrasound-assisted Lipoplasty Environment

Abstract Background: The issue of safety has arisen with the advent of high-intensity ultrasound energy (HIUE) in ultrasound-assisted lipoplasty (UAL). HIUE has been used in the last 3 decades in a variety of surgical procedures, but scientific data are lacking with regard to biologic interactions. We hypothesize that infiltration of tissue with an aqueous solution and exposure to HIUE as practiced in UAL can induce cavitation with concomitant production of free radicals and oxidizing reactants associated with high-energy chemical reactions and generate sonoluminescence. Objective: The objectives of the research work described in this article serve to verify the above hypotheses. Methods: In a series of experiments continuous-wave HIUE was applied under in vitro conditions that simulate the in vivo extracellular environment of UAL under semiclinical conditions. A sensitive photo-detecting system was used to detect sonoluminescence and sono-chemiluminescence. Results: We are reporting that continuous-wave HIUE applied under conditions that simulate UAL operating in an intercellular environment is above threshold intensities where cavitation is generated with the subsequent creation of free radicals and oxidizing reactants in large quantities and in which sonoluminescence is generated. Conclusions: These findings question the long-term biosafety of UAL in its clinical application.

Improved wound management by regulated negative pressure-assisted wound therapy and regulated, oxygen- enriched negative pressure-assisted wound therapy through basic science research and clinical assessment

Regulated negative pressure-assisted wound therapy (RNPT) should be regarded as a state-of-the-art technology in wound treatment and the most important physical, nonpharmaceutical, platform technology developed and applied for wound healing in the last two decades. RNPT systems maintain the treated wounds environment as a semi-closed, semi-isolated system applying external physical stimulations to the wound, leading to biological and biochemical effects, with the potential to substantially influence wound-host interactions, and when properly applied may enhance wound healing. RNPT is a simple, safe, and affordable tool that can be utilized in a wide range of acute and chronic conditions, with reduced need for complicated surgical procedures, and antibiotic treatment. This technology has been shown to be effective and safe, saving limbs and lives on a global scale. Regulated, oxygen-enriched negative pressure-assisted wound therapy (RO-NPT) is an innovative technology, whereby supplemental oxygen is concurrently administered with RNPT for their synergistic effect on treatment and prophylaxis of anaerobic wound infection and promotion of wound healing. Understanding the basic science, modes of operation and the associated risks of these technologies through their fundamental clinical mechanisms is the main objective of this review.

Early Surgical Management of Large Scalp Infantile Hemangioma Using the TopClosure® Tension-Relief System.

AbstractInfantile hemangiomas (IHs) are the most common benign vascular neoplasms of infancy and childhood. The majority do not need medical intervention. However, large ulcerated scalp IHs may lead to fatal bleeding as well as severe cosmetic disfigurement that indicate early surgical excision, inflicting substantial surgical risks, with short- and long-term morbidity.The TopClosure Tension-Relief System (TRS) is an innovative skin stretching and wound closure-secure system that facilitates primary closure of relatively large skin defects. This system has been shown as a substitute for skin grafts, flaps, or tissue expanders.We describe a case of a giant IH of the scalp usually requiring a complex surgical approach, which was immediately primarily closed applying the TRS.A 3-day-old female infant presented with a giant scalp hemangioma at birth that rapidly grew in the neonatal period with early signs of ulceration. The patient underwent surgical resection of the giant scalp hemangioma with immediate primary closure of the defect using the TRS. Surgical procedure and postoperative period were uneventful.Early surgical resections of IHs at infancy carry substantial surgical risks and morbidity. This is the first reported case of early resection of a scalp hemangioma in the neonatal period, with successful immediate primary closure by application of stress-relaxation technique through the TRS. The application of the TopClosure TRS in this age group has significant advantages. It reduces the complexity and length of surgery, reducing blood loss, eliminating donor site morbidity, improving wound aesthetics, and minimizing the need for future reconstructive procedures.

Injectable volumetric fillers and botulinum toxin in facial rejuvenation

There has been an upsurge in the technology of injectable volumetric filler materials for soft tissue augmentation of the face in the past decade. This is a dynamic field that has provided plastic surgeons and dermatologists who treat the aging face with newer tools and techniques. Injectable volumetric fillers can be applied in a variety of combinations and can be added to the various surgical options in conjunction with surgery or as maintenance following surgery. In practice, there are essentially four classes of materials that may be considered gold standard for minimally invasive rejuvenation and beautification of the face: botulinum toxin A, autologous fat, derivatives of hyaluronic acid, and, to a limited extent, hydroxyapatite. These coincide with the philosophy of applying materials and devices associated with the least amount of risk. Long lasting, or permanent–nondegradable, nonextractable, and nonabsorbable fillers remain an unresolved controversial issue, as the longer lasting the device, the greater also is the likelihood for long-term or even irreversible complications. The current trend for nonsurgical minimally invasive procedures for beautifying the face will most probably continue to surge, in light of their affordability in the growing economies around the globe, the increasing demand for a youthful look, and the need for less downtime for these procedures. There will be a rising demand for more hi-tech (bio- or genetically engineered) safe fillers with higher purity and less immunogenicity that allow a short recuperation time in order to attain a product that will serve as an ideal injectable volumetric filler for soft tissue augmentation.

Position statement of IQUAM 15 July 2006

On 15 July 2006, IQUAM issued its VIIth Position Statement, which reads as follows: IQUAM, the International Committee for Quality Assurance, Medical Technologies and Devices in Plastic Surgery, is a professional medical and scientific organization committed to the surveillance of existing and new medical technologies, devices, and procedures in plastic surgery and is dedicated to their safe use and to the guarantee of patients’ safety. IQUAM reviews and evaluates updated literature and studies, scientific data, and recommends standards of treatment for new devices or technologies. IQUAM proscribes potentially deleterious use of products, devices and technologies, or their unintended application or application for unsuitable indications.

A skin stretch system for the immediately closing of the large skin defects of the anterior chest wall following large keloid excision

Large anterior chest wall skin defects following keloid resection, which are not suitable for primary closure, represent a substantial reconstructive challenge, partly due to the expected high tension closure and the considerable rate of recurrence. The TopClosure® Tension Relief System (TRS) is a novel skin stretching and wound closure-secure system which has been shown as a substitute for skin grafts, tissue expanders, and flaps. A 36-year-old man presented with a large keloid with ulcerations on the anterior chest wall. The patient underwent surgical resection of the keloid with immediate primary closure of the chest wall skin defect using the TRS. The surgical procedure and the postoperative period were uncomplicated. The wound was completely closed with a slightly raised scar after the 15th month follow-up. This is a rare case of immediate primary closure of a skin defect following resection of a large keloid of the anterior chest wall by the application of a skin stretching technique named as TRS. The TopClosure® TRS can help simplify the surgical procedures and shorten the operative time. Furthermore, the appliance can also be used for cosmetic improvements of the scar and minimize the need for future reconstructive procedures as well.Level of Evidence: Level V, therapeutic study

Dynamic computational simulations for evaluating tissue loads applied by regulated negative pressure-assisted wound therapy (RNPT) system for treating large wounds

Regulated negative pressure-assisted wound therapy (RNPT) is one of the most important wound treatment technologies developed and applied over the last two decades. To-date RNPT has been proven to be clinically effective in treating chronic wounds, however, the effects of different specific pressure delivery protocols on the progress and quality of tissue repair are not adequately understood yet. Here, we suggest a viscoelastic, three-dimensional finite element modeling framework of RNPT, with several realistic features such as a non-symmetrically configured multi-layered tissue structure. The effects of the RNPT system on the wound-bed were simulated by applying time varying pressure boundary conditions. Three commonly-used operation modes were simulated: continuous, non-continuous intermittent and dynamic, and each mode was applied at four different pressure levels. Outcome measures of strain and stress magnitudes and distributions were acquired from the dermis and subcutaneous fat. Taken together, the strain and stress data from the different simulated RNPT modes and intensities demonstrated that tissue loads which are actually applied in and around the wound, and at the different tissue components of the wound, can differ substantially from the pressure levels that are set in the device during therapy sessions. This is critical information for understanding the potential effects of RNPT, for setting the device prior to therapy and for designing the next generation of these systems.