Tapan K. Bhattacharyya

Vascular Anatomy of the Nose and the External Rhinoplasty Approach

OBJECTIVE To characterize the venous, lymphatic, and arterial blood supply of the nose and determine the effect of the external rhinoplasty approach on this vasculature. We hypothesized that dissection in the areolar tissue plane below the musculoaponeurotic layer of the nose will preserve the nasal vasculature and minimize postoperative nasal tip edema. DESIGN The study included preoperative and postoperative clinical evaluation, cadaver dissection, and histologic examination. In the clinical section, lymphoscintigraphy was performed before and after rhinoplasty using the endonasal (transnostril) or external (open) approach. Additionally, nasal tip edema was subjectively quantified at specified interval after surgery. In the cadaver dissection section, 15 fresh cadavers were dissected to identify the venous and arterial vasculature. In the histology section, fresh nasal tissue was examined by light microscopy to verify the anatomy of arteries, veins, and lymphatic vessels. SETTING Subjects for the clinical section of the study were volunteers undergoing primary rhinoplasty surgery at the University of Illinois College of Medicine at Chicago. PATIENTS Lymphoscintigraphy was performed on nine patients who underwent rhinoplasty surgery. Seven of these patients underwent postoperative lymphoscintigraphy. INTERVENTIONS The rhinoplasty procedures included three different methods of exposure of the nasal structures. Two patients underwent an endonasal (transnostril) nondelivery approach using a transcartilaginous incision. Five patients underwent the external approach with three receiving dissection in the areolar tissue plane below the musculoaponeurotic layer (preserving major nasal vasculature) and two undergoing dissection above the musculoaponeurotic layer (disrupting nasal vasculature). MAIN OUTCOME MEASURES In the clinical section of the study, the outcome measures were tracer flow as seen on lymphoscintigraphy and tip edema scores subjectively quantitated on a scale from 1 (none) to 4 (maximal). RESULTS Clinical Section: Lymphoscintigraphy revealed flow of tracer along the lateral aspect of the nose (cephalic to lateral crura) to the preparotid lymph nodes. Postoperative scans revealed preservation of flow of tracer with the endonasal (transnostril) approach and the external approach with submusculoaponeurotic areolar tissue plane dissection. There was loss of normal flow of tracer with the external approach using dissection that disrupted the musculoaponeurotic layer with supratip debulking. The nasal tip edema scores for the transnostril and external approach using areolar plane dissection were significantly lower than the external approach with disruption of the musculoaponeurotic layer. Cadaver Dissection Section: Other than the lateral nasal veins, the major arteries, veins, and lymphatic vessels ran superficial to the musculoaponeurotic layer of the nose. The lateral and dorsal nasal and the columellar arteries comprise an alar arcade that provides the major blood supply to the flap elevated in the external rhinoplasty approach. Histologic Section: Light microscopy of plastic resin sections verified the lymphoscintigraphic and cadaver dissection findings. The lymphatic vessels were located primarily in the reticular dermis above the muscle layer. CONCLUSIONS The major arterial, venous, and lymphatic vasculature courses in or above the musculoaponeurotic layer of the nose. In the external rhinoplasty approach, dissection in the areolar tissue plane below the musculoaponeurotic layer will minimize tip edema and protect against skin necrosis by preserving the major vascular supply to the nasal tip.

An evaluation of fibrin tissue adhesive concentration and application thickness on skin graft survival

Objectives To e‐amine the effects of fibrinogen concentration and application thickness of fibrin tissue adhesive on skin graft survival.

Peripheral nerve regeneration: Comparison of laminin and acidic fibroblast growth factor

PURPOSE In an effort to show the differences between neurotrophic factors, laminin and acidic fibroblast growth factor (aFGF) were compared in terms of their abilities to regenerate axons in vivo over an extended distance. MATERIALS AND METHODS The sciatic nerve was transected in 15 Sprague-Dawley rats. A 15-mm Silastic tube (Dow Corning, Midland, MI) was placed between the ends of the cut nerve and filled with either laminin, aFGF, or buffer applied to collagen sponges. RESULTS Ten weeks postimplantation, mean axon counts showed that both laminin (2432) and aFGF (1612) produced significantly higher numbers of axons than controls (1009) (P < .05) and that laminin showed significantly more nerve regeneration than aFGF (P < .05). CONCLUSION These results indicate that laminin and aFGF enhance peripheral nerve regeneration across a large gap, presumably through their neurotrophic effects and mitogenic properties on supporting cells. Furthermore, it is concluded that the transient nature of aFGFs effect on the regenerative environment limits its effectiveness at regenerating axons over a prolonged period of time.

A Histologic Analysis of Three-Dimensional Versus Two-Dimensional Tissue Expansion in the Porcine Model†

Objective Recently, a two‐dimensional Silastic Dacron stretching skin device has been developed for scalp reduction surgery. Attached subgaleally, this device stretches skin over time, while avoiding the visible volumetric distention that is typical of three‐dimensional tissue expanders. Unlike three‐dimensional expanders, the histological changes observed with a two‐dimensional stretching device have not been described in the literature. The present study compares the histological effects of two‐dimensional and three‐dimensional skin tissue expansion in the porcine model.

Effects of Topicals on the Aging Skin Process

This article summarizes the antiaging properties of retinoids, glycolic acid, ascorbic acid, and peptide topicals. The supporting evidence is taken from the literature and the primary authors research, consisting of previously published data and new results from ongoing projects.

Profilometric and Morphometric Response of Murine Skin to Cosmeceutical Agents

OBJECTIVE To investigate whether topical antiaging compounds can reduce wrinkle depth as noted at replica profilometry with comparable changes in histologic findings in hairless mice. METHODS Commercial retinoic acid cream, a peptide lotion, and a soy cream were applied to the dorsal skin for 4 weeks. Silicone-negative replicas of treated and untreated skin surface were photographed and evaluated for traditional features of surface roughness. Skin samples were processed using histomorphometry and immunohistochemistry of proliferating cell nuclear antigen. Quantitative light microscopic data were acquired for estimating replication of epidermal keratinocytes, epidermal thickness, and depth of dermal collagen bundles. RESULTS Data were analyzed by comparing means with 1-way analysis of variance, and significant changes in all measurements were noted. Augmented keratinocyte proliferation and thickening of viable epidermis were observed with all 3 compounds, although a greater effect was found in the retinoic acid and peptide treatment groups. A similar trend was noted with respect to widening of the collagen layer. Epidermal surface roughness manifested maximum smoothing after treatment with the peptide compound. CONCLUSION The pronounced effects noted with all 3 compounds indicate that topical agents other than retinoic acid may have comparative stimulating effects on the skin in nonirradiated mice.

Cosmeceutical Effect on Skin Surface Profiles and Epidermis in UV-B–Irradiated Mice

IMPORTANCE These data may be useful for developing guidelines for clinicians and the general population related to the reversal of photoaging effects on the aging face damaged by solar radiation. OBJECTIVE To investigate antiaging effects of 4 commercially available topical agents on the dorsal skin in photoaged hairless mice. DESIGN AND SETTING Animal study at an academic medical center. Animals comprised 56 female Skh-1 hairless mice (6-8 weeks old). Skin samples were collected from nonirradiated intact mice (control), mice irradiated with UV-B for 8 weeks, mice irradiated with UV-B and then exposed to a topical cosmeceutical applied for 5 weeks, and UV-B-irradiated mice not exposed to cosmeceuticals and retained for 5 weeks until the end of the experiment. INTERVENTION The mice were exposed to UV-B light 3 times a week for 2 months, followed by topical application of a peptide, antioxidant, estrogen, and retinoic acid agent for 5 weeks. MAIN OUTCOMES AND MEASURES Surface features such as wrinkling were analyzed from replicas along with histomorphometric determination of epidermal thickness, sebocyte counts, and immunohistochemical study of proliferating cell nuclear antigen (PCNA). RESULTS Exposure to UV-B induced significant wrinkle formation after 13 weeks, which was attenuated with treatments with a peptide cream, antioxidant mixture, and estrogen cream (mean [SD] Rz values: control [C], 60.7 [19.0]; irradiated [RAD], 51.8 [15.9] [P < .001]; irradiated-long [RAD-long], 86.0 [28.3] [P = .01]; antioxidant [AO], 45.2 [13.2]; peptide, 63.4 [18.8], estrogen, 64.6 [21.2]; retinoic acid [RA], 73.9 [28.5]; RAD-long vs C [P = .01], vs RAD [P < .001], vs estrogen [P = .04], vs peptide [P = .02], vs AO [P<.001], vs RA [P = .25]. There was a trend of reversal of irradiation-induced augmentation of epidermal thickness in animals treated with the peptide and AO (mean [SD] epidermal width: C, 21.0 [2.2] μm; RAD, 41.3 [7.0] μm [P < .001]; RAD-long, 39.1 [11.0] μm [P = .006]; AO, 37.3 [14] μm [P < .001]; peptide, 33.9 [3.8] μm [P = .01]; estrogen, 59.2 [9.2] μm [P = .003]; RA, 52.4 [8.7] μm [P < .001]). Retinoic acid augmented epidermal width and sebocyte counts (mean [SD] sebocyte data [number per gland]: C, 9.4 [2.0]; RAD, 11.69 [1.5] [P < .001]; RAD-long, 6.5 [1.3] [P = .73]; peptide, 7.2 [1.7] [P = .03]; estrogen, 4.1 [0.9] [P < .001]; AO, 7.2 [1.7] [P = .06]; RA, 11.0 [1.4] [P = .01]). Estrogen cream was effective in restoring surface features but enhanced thickness of epidermis in irradiated specimens. All groups had a higher PCNA index score except for peptide treatment, which brought it down to the control level (mean [SD] PCNA index values: C, 17.3 [1.5]; RAD, 32.4 [6.8] [P < .001]; RAD-long, 34.0 [6.1] [P < .001]; AO, 62.1 [3.5] [P = .01]; peptide, 20.1 [6.3] [P < .001]; estrogen, 56.8 [10.0] [P < .001]; RA, 35.2 [10.2] [P < .001]). CONCLUSIONS AND RELEVANCE Of the 4 cosmeceuticals tested within this experimental period, peptide cream and antioxidant mixture were the most effective overall in reversing photoaging effects; retinoic acid was the least effective of these topical agents. LEVEL OF EVIDENCE NA.

Comparison of Epidermal Morphologic Response to Commercial Antiwrinkle Agents in the Hairless Mouse

BACKGROUND A large number of commercial antiwrinkle and antiaging compounds are available to consumers for rejuvenation of facial skin ravaged by age or solar radiation. Experimental data on the histological effects of these commercial products in laboratory models are sparse. OBJECTIVES To compare the efficacy of topical application of five commercially available antiaging compounds (retinoic acid, glycolic acid, vitamin C, estrogen, and soy) on the dorsal skin. METHODS AND MATERIALS The effects were examined using light microscopic analysis of the epidermis in the normal nonirradiated hairless mouse. The agents were applied daily to dorsal tattooed areas for 2 weeks before histological assessment; neighboring untreated surface areas were used as control. Morphometric measurements of total epidermal width, nuclear volume of keratinocytes in three layers, and index of proliferating cell nuclear antigen according to immunohistochemistry were obtained and statistically analyzed. RESULTS Significant histomorphometric effects were noticed with all five agents, but more pronounced changes were obtained with glycolic acid, estrogen, and retinoic acid product. CONCLUSIONS These baseline data will be useful for future studies on the effect of ultraviolet radiation to cause photoaging and reparative effects of similar agents in this animal. The information contained in the report may provide guidelines to consumers and clinicians. The authors have indicated no significant interest with commercial supporters.

Epidermal cell proliferation in calorie-restricted aging rats

Calorie restriction (CR) has been known to produce many beneficial health effects, and lowered cell proliferation from CR has been shown to produce anti-cancer effects in some tissues. In this study the rate of epidermal cell proliferation in aging Fischer 344 rats from ad libitum fed (AL) and CR colonies was assessed in relation to changes in epidermal thickness with age. Proliferating cell nuclear antigen (PCNA) was detected using immunohistochemical method on paraffin sections in the epidermis of dorsal skin and footpad in these animals obtained from the National Institute on Aging. The proliferating cell index was compared with morphometric measurement of epidermis in young, young adult and old animals (six per group). Data were analyzed by Excel and SPSS 14.0 softwares for statistical evaluation. Two-way analysis of variance (ANOVA) was applied to data to test the effects of age, diet, and age-diet interaction. The following significant effects were noted: (I) age and age-diet effects in dorsal skin epidermal width, and PCNA; (II) age, and diet effect on footpad epidermal thickness, and PCNA index. There was a trend of increasing epidermal thickness in the dorsal skin in normally feeding aging rats which was depressed with CR in the two younger groups. PCNA index showed a trend of attrition from young to old. The thickness of epidermis in foot pad showed a curvilinear trend in both AL and CR groups with lowest mean values in the old group, and more predominant effect in CR-exposed animals. The proliferation index in the foot pad demonstrated a trend of reduction in old specimens with lower mean values in each corresponding CR age group. This report agrees with CR-inhibited cell proliferation reported in many organs by other investigators, and the observed results might have been caused by physiological or endocrine mechanisms affecting the epithelium in these calorie-restricted animals.

Staining behavior and distribution of elastic fibers in the pig skin dermis

Abstract For histological demonstration of elastic fibers in the skin, different investigators use a variety of staining procedures. However, some of these popular methods have produced equivocal results for staining sections of mammalian and human skin. The current study concerned the elastic fiber distribution in the skin of the domestic pig from specimens fixed in four different histological fixatives and subjected to paraffin microtomy at various thickness levels and staining by three commonly used procedures, i.e., aldehyde fuchsin, orcein, and Verhoeff elastic stain. An interconnected elastic fiber network was demonstrated in thick paraffin sections (25–60 μm), whereas thin sections (5–7 μm) presented a disrupted or discontinuous fiber profile. All the staining procedures produced satisfactory results on thin sections. For thicker sections, the most satisfactory results were obtained with aldehyde fuchsin procedure after preoxidation. Preliminary manual morphometric measurement of elastic fiber density with an eyepiece reticle revealed a significantly greater quantity in thicker sections. The distribution pattern of elastic fibers in this animal model seems to simulate that reported for human skin. For future experimental procedures with pigskin to explore skin expansion, or dermabrasion, thick paraffin sections stained with aldehyde fuchsin method will reveal more meaningful information on elastic fiber distribution and better quantitative estimation