An Analysis of the Factors Influencing Forehead Soft-Tissue Thickness: An Ultrasound Study

BackgroundIn human subcutaneous adipose tissue, the superficial fascia distinguishes superficial and deep microenvironments showing extensions called retinacula cutis. The superficial subcutaneous adipose tissue has been described as hyperplastic and the deep subcutaneous adipose tissue as inflammatory. However, few studies have described stromal-vascular fraction (SVF) content and adipose-derived stromal/stem cells (ASCs) behavior derived from superficial and deep subcutaneous adipose tissue. In this study, we analyzed a third conjunctive microenvironment: the retinacula cutis superficialis derived from superficial subcutaneous adipose tissue.MethodsThe samples of abdominal human subcutaneous adipose tissue were obtained during plastic aesthetic surgery in France (Declaration DC-2008-162) and Brazil (Protocol 145/09).ResultsThe SVF content was characterized in situ by immunofluorescence and ex vivo by flow cytometry revealing a high content of pre-adipocytes rather in superficial subcutaneous adipose tissue microenvironment. Adipogenic assays revealed higher percentage of lipid accumulation area in ASCs from superficial subcutaneous adipose tissue compared with retinacula cutis superficialis (p < 0.0001) and deep subcutaneous adipose tissue (p < 0.0001). The high adipogenic potential of superficial subcutaneous adipose tissue was corroborated by an up-regulation of adipocyte fatty acid-binding protein (FABP4) compared with retinacula cutis superficialis (p < 0.0001) and deep subcutaneous adipose tissue (p < 0.0001) and of C/EBPα (CCAAT/enhancer-binding protein alpha) compared with retinacula cutis superficialis (p < 0.0001) and deep subcutaneous adipose tissue (p < 0.0001) microenvironments. Curiously, ASCs from retinacula cutis superficialis showed a higher level of adiponectin receptor gene compared with superficial subcutaneous adipose tissue (p = 0.0409), widely known as an anti-inflammatory hormone. Non-induced ASCs from retinacula cutis superficialis showed higher secretion of human vascular endothelial growth factor (VEGF), compared with superficial (p = 0.0485) and deep (p = 0.0112) subcutaneous adipose tissue and with adipogenic-induced ASCs from superficial (p = 0.0175) and deep (p = 0.0328) subcutaneous adipose tissue. Furthermore, ASCs from retinacula cutis superficialis showed higher secretion of Chemokine (C–C motif) ligand 5 (CCL5) compared with non-induced (p = 0.0029) and induced (p = 0.0089) superficial subcutaneous adipose tissue.ConclusionsThis study highlights the contribution to ASCs from retinacula cutis superficialis in their angiogenic property previously described for the whole superficial subcutaneous adipose tissue besides supporting its adipogenic potential for superficial subcutaneous adipose tissue.

A profound understanding of the various frontal tissues' morphology and their relationship with forehead lines can efficiently guide clinical treatment. The authors explored the relationship between frontal anatomy and frontal lines. We measured the thickness and shape of tissues in different regions of the forehead of 241 Asians. Then, we analyzed the relationship between the types of frontalis muscle and frontal lines, as well as the relationship between the frontal anatomical structures and the production of frontal lines. We classified the types of frontalis muscle into 3 categories comprising 10 subtypes. The skin (0.78 mm vs 0.90 mm, P < .05), superficial subcutaneous tissue (0.66 mm vs 0.75 mm, P < .05), and frontalis muscle thickness (0.29 mm vs 0.37 mm, P < .05) of people with obvious dynamic forehead lines were significantly thicker than those of people without significant dynamic forehead lines. However, no significant difference in the deep subcutaneous tissue thickness was found between people with and without static forehead lines (1.36 mm vs 1.34 mm, P < .05). This study shows the relationship between the frontal structure and frontal lines. Therefore, these results can provide references for treating frontal lines, to a certain extent.

Introduction: The prevalence of non-alcoholic fatty liver disease (NAFLD) has increased dramatically during the past decades, affecting 50-75 % of the obese subjects. Visceral adipose tissue (VAT) is regarded to be an important factor in the pathogenesis of NAFLD. Subcutaneous adipose tissue (SAT) is separated by the fascia superficialis into the deep SAT (dSAT) and superficial SAT (sSAT). It has been suggested that dSAT is related to an increased risk for obesity related complications, whereas sSAT has a more favorable profile. The aim of this study was to investigate the association of superficial and deep subcutaneous adipose tissue with hepatic steatosis. Methods: We recruited a subcohort of the Nijmegen Biomedical Study, a large population based cohort, including 133 subjects, BMI &gt; 27 kg/m 2 , aged 55-81 years. Abdominal magnetic resonance imaging was performed at level L4-L5 to measure VAT, dSAT and sSAT volumes. The amount of liver fat was quantified by MR spectroscopy. Results: Men had significantly higher volumes of VAT and lower volumes of sSAT compared with women. No differences in volumes of dSAT were observed. In univariate analysis, the VAT volume was found to be correlated with hepatic steasosis (r = 0.339; p &lt;0.001), while no significant correlation was found between total SAT, sSAT or dSAT with hepatic steatosis. After adjustment for age, alcohol use and sex, VAT was still positively correlated with hepatic steatosis with a standardized β of 0,276 (p=0.007), and sSAT, but not total SAT or dSAT, was negatively correlated with hepatic steatosis with a standardized β of -0,363 (p=0.033). Conclusions: VAT as measured by MRI is positively correlated with hepatic steatosis, in contrast to sSAT which is negatively correlated after adjustment for age, alcohol use and sex. We found no significant correlation between total SAT or dSAT and hepatic steatosis.

To develop an automatic segmentation algorithm to classify abdominal adipose tissues into visceral fat (VAT), deep (DSAT), and superficial (SSAT) subcutaneous fat compartments and evaluate its performance against manual segmentation. Data were acquired from 44 normal (BMI 18.0-22.9 kg/m(2) ) and 38 overweight (BMI 23.0-29.9 kg/m(2) ) subjects at 3T using a two-point Dixon sequence. A fully automatic segmentation algorithm was developed to segment the fat depots. The first part of the segmentation used graph cuts to separate the subcutaneous and visceral adipose tissues and the second step employed a modified level sets approach to classify deep and superficial subcutaneous tissues. The algorithmic results of segmentation were validated against the ground truth generated by manual segmentation. The proposed algorithm showed good performance with Dice similarity indices of VAT/DSAT/SSAT: 0.92/0.82/0.88 against the ground truth. The study of the fat distribution showed that there is a steady increase in the proportion of DSAT and a decrease in the proportion of SSAT with increasing obesity. The presented technique provides an accurate approach for the segmentation and quantification of abdominal fat depots.

A thin skin flap is often required for optimal resurfacing of particular areas of the body such as oral lining, hands, and feet. Using wide and thin flaps provides a higher level of esthetic and functional results in reconstructive surgery. Recently, the authors also applied the thinning procedure for free SCIA/SIEA flaps. From 2003 to 2006, 11 patients underwent soft tissue reconstruction using thin free SCIA/SIEA flaps. In this procedure, deep subcutaneous fat tissue was removed totally while superficial subcutaneous tissue was thinned and a fat tissue layer was left under the skin to protect the subdermal network. All procedures were performed without using an operating microscope. The flap ranged 10 to 60 cm in length and from 6 to 55 cm in width. Ten flaps survived completely, while 1 occurrence of distal superficial necrosis was observed. No secondary flap defatting or revision was necessary. The free SCIA/SIEA flap may be prepared safely using a simple surgical procedure such as wide and thin flap in reconstructive surgery.

Hidradenitis suppurativa is a chronic and often refractory skin disease that can require radical excision of the full layer of fatty tissue under the lesion. Closure using a split-thickness skin graft often results in depression deformity and lack of tissue flexibility. We have developed a two-stage procedure to preserve fatty tissue during radical excision and apply an artificial dermis graft, and we have performed this procedure in 18 patients (33 lesions). To describe our two-stage procedure and report results of the procedure in our patient series. In the first step, all diseased skin including the superficial subcutaneous fatty tissue is excised; normal deep subcutaneous fatty tissue is preserved. Artificial dermis is then grafted to the preserved fatty tissue. Two weeks later, split-thickness skin grafts are applied to the skin defects. We evaluated graft success, any recurrence, and postoperative appearance in our patients, who were followed up for 8 to 36months. All 32 skin grafts were successful. There was only one recurrence, which was treated using reoperation, and postoperative appearances were good. Our new procedure incorporating artificial dermis appears to be a good treatment option for advanced hidradenitis suppurativa.

Research Problem / Aim: The ventrogluteal injection area is one of the areas most frequently used by nurses in intramuscular injection applications. The thicknesses of the subcutaneous tissue and the muscle tissue in this area are important for a safe injection. The aim of this study is the determination of the subcutaneous and muscle tissue thicknesses on the ventrogluteal injection area and the anthropometric data about it. Method: The study has designed a cross-sectional study. 150 individuals who applied to the ultrasound unit of the hospital and accepted to participate in the study were included in the study. The ventrogluteal injection area was determined with the ‘’V’’ method by the researcher. The subcutaneous and muscle tissue thicknesses from the areas on the injection area and the areas 2 and 4 cm around the injection area were determined using the ultrasound device. Moreover, the relation between the anthropometric measurements of the individuals (height, weight, waist, hip and crista iliaca circumferences, distance between the large trochanter and crista iliaca and crista iliaca anterior) and the tissue thicknesses on the injection area were evaluated. The data of the research were evaluated with definitive statistics, ANOVA test and posthoc Tukey test, t test and correlation analysis. The p&lt;0.05 value was accepted as statistically significant for all results. Findings: The average subcutaneous tissue thickness in the injection area was determined as 15.44±8.01 mm and the average tissue thickness there was determined as 31.75±11.86 mm. The subcutaneous tissue thickness in women was found more than the subcutaneous tissue thickness in men. When the tissue thicknesses 2 and 4 cm around the injection area were analyzed, it was found that the area where the total tissue thickness was the least was over 2 cm (41.67±14.83) and over 4 cm (35.79±15.55) of the injection area. It was determined that the average total thickness 4 cm around the injection area was less than 38 mm in underwight individuals. Conclusions: According to the results obtained from the study, the weight and body mass index of the individual should be considered in the choice of the injection area and the length of the needle to be used when the ventrogluteal injection area was used in intramuscular injections. Especially in obese individuals, longer needles can be preferred. Besides, it must be thought that there may be the risk of bone injury 4 cm around the injection area in asthenic individuals and individuals with normal weight. Moreover, since the individuals’ having a large waist and hip circumference is related to their subcutaneous tissue thickness, it is recommended that long needles should be chosen in these individuals.

Comparison between handheld ultrasound and regional and whole-body dual energy x-ray absorptiometry (DXA) for body fat assessment.

Muscle, subcutaneous tissue and total tissue thicknesses are important factors in successful intramuscular injection. Muscle mass decreases and subcutaneous tissue increases with age. This may negatively affect the safety and effectiveness of intramuscular injection in older adults by increasing the risk of bone contact and subcutaneous drug administration. Intramuscular injection sites should be evaluated in this respect, but no previous study has evaluated the most appropriate sites for safe and effective intramuscular injection in older adults. This study aimed to examine the safety of dorsogluteal and ventrogluteal injection sites in older adults. This cross-sectional study included 171 older adults who presented to the radiology clinic of a hospital between November 2022 and February 2023. We collected the study data using a descriptive characteristics form and an ultrasonographic measurement form. To complete the descriptive characteristics form, we interviewed the participants and measured their waist circumference, hip circumference, weight and height. Muscle, subcutaneous tissue and total tissue thicknesses at the ventrogluteal and dorsogluteal sites were determined by ultrasonography. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline. At the ventrogluteal and dorsogluteal sites, respectively, total tissue thicknesses were 59.43 ± 11.21 and 48.78 ± 9.68 mm, subcutaneous tissue thicknesses were 20.07 ± 6.64 and 22.97 ± 7.40 mm and muscle thicknesses were 40.13 ± 5.59 and 25.61 ± 4.30 mm. Tissue thicknesses at both sites differed according to sex, weight, hip circumference and waist circumference (p < 0.05). Although both sites were acceptable according to the tissue thickness thresholds for intramuscular injection given in the literature (subcutaneous tissue < 25 mm, total tissue > 35 mm), the ventrogluteal site was more advantageous in terms of greater muscle thickness and lower subcutaneous tissue thickness. The results of this study indicated that both the ventrogluteal and dorsogluteal sites are safe for intramuscular injections in older adults in terms of tissue thickness. However, the ventrogluteal site may be safer for older adults because of the lower risk of bone contact and subcutaneous injection. Further studies are needed on this subject. This study is important in terms of determining the safe and effective gluteal site for IM injection in older people aged 65 and over, preventing complications that may arise from site selection, and developing nursing policies that consider older people as a special group in the selection of IM injection sites.

Giriş ve Amaç: Adipokinler ve disfonksiyonel yağ dokusu arasındaki ilişkide subkutan yağ dokusundan ziyade viseral yağ dokusundaki değişikliklerin rolüne dikkat çekilmiştir. Özellikle cilt altı yağ dokusunun etkilendiği lipödemde adipokinler hakkında bilgi yetersizdir. Bu çalışmada lipödemli hastalarda adiponektin, ghrelin, resistin ve visfatin düzeylerinin ve bunların yağ doku kalınlığı ile ilişkisinin araştırılması amaçlandı. Bu amaçla cilt altı yağ dokusu kalınlığı ultrasonografi ile objektif olarak değerlendirildi. Gereç ve Yöntemler: Lipödem tanısı almış toplam 19 kadın hasta ve yaş farkı olmayan 15 sağlıklı kadın çalışmaya dahil edildi. Deri ve deri altı yağ dokusu kalınlıkları ultrasonografik olarak ölçüldü. Tüm deneklerin serum adiponektin, ghrein, resistin ve visfatin seviyeleri sandviç ELISA protokolü kullanılarak ölçüldü. Bulgular: Lipödemli hastalarda, uyluk ve baldırda subkutan subkutan doku kalınlığı ve toplam deri-subkutan kalınlığı kontrollere kıyasla, uyluktaki deri kalınlığı dışında önemli ölçüde arttı (P0.05). Lipödemli hastalarda ve kontrollerde ultrason ile adiponektin, ghrelin, resistin ve visfatin ile deri, deri altı ve toplam kalınlık ölçümleri arasında anlamlı bir ilişki bulunmadı (P&gt;0.05). İstatistiksel olarak anlamlı olmasa da detaylı incelendiğinde adipokinler ve ultrason ölçümleri arasındaki ilişkide gruplar arasında pozitif veya negatif korelasyonlar gözlendi. Sonuç: Bulgularımıza göre, serum adipokin düzeyleri ile deri altı yağ dokusu kalınlığı arasında anlamlı bir ilişki bulunmamakla birlikte, tamamen ilgisiz oldukları tartışmalıdır. Daha geniş serilerde yapılacak çalışmalar adipokinlerin cilt altı doku kalınlığı ile ilişkisine ve ultrasonografinin önemine ışık tutacaktır.

To develop and evaluate an automated segmentation method for accurate quantification of abdominal adipose tissue (AAT) depots (superficial subcutaneous adipose tissue [SSAT], deep subcutaneous adipose tissue [DSAT], and visceral adipose tissue [VAT]) in neonates and young children. This was a secondary analysis of prospectively collected data, which used abdominal MRI data from Growing Up in Singapore Towards healthy Outcomes, or GUSTO, a longitudinal mother-offspring cohort, to train and evaluate a convolutional neural network for volumetric AAT segmentation. The data comprised imaging volumes of 333 neonates obtained at early infancy (age ≤2 weeks, 180 male neonates) and 755 children aged either 4.5 years (n = 316, 150 male children) or 6 years (n = 439, 219 male children). The network was trained on images of 761 randomly selected volumes (neonates and children combined) and evaluated on 100 neonatal volumes and 227 child volumes by using 10-fold validation. Automated segmentations were compared with expert-generated manual segmentation. Segmentation performance was assessed using Dice scores. When the model was tested on the test datasets across the 10 folds, the model had strong agreement with the ground truth for all testing sets, with mean Dice similarity scores for SSAT, DSAT, and VAT, respectively, of 0.960, 0.909, and 0.872 in neonates and 0.944, 0.851, and 0.960 in children. The model generalized well to different body sizes and ages and to all abdominal levels. The proposed segmentation approach provided accurate automated volumetric assessment of AAT compartments on MR images of neonates and children.Keywords Pediatrics, Deep Learning, Convolutional Neural Networks, Water-Fat MRI, Image Segmentation, Deep and Superficial Subcutaneous Adipose Tissue, Visceral Adipose TissueClinical trial registration no. NCT01174875 Supplemental material is available for this article. © RSNA, 2021.

Background Chronic Low Back Pain (CLBP) is the most prevalent muskuloskeletal condition in Europe (27%) and generates a high cost about 100€ per subject during 1 year. The CLBP origin remains unclear. Nevertheless, stated the relationship between muscular contractibility and CLBP. Consequently, the Council of the European Union (2010) recommended new assessment devices to evaluate the muscular tissue. The Tensomiography (TMG) is a tool which asses the contractibility characteristics of the superficial musculature. The Rehabilitative Ultrasound Imaging (RUSI) technique may be used to determine the thickness of the low back tissues. The aim of this study was to correlate the contractibility characteristics of the superficial musculature (TMG) with the thickness of the skin,subcutaneous and connective tissue in the low back region. Methods A sample of 50 subjects (32 men/18 women), between 25 and 53 years old, were recruited. All evaluations were carried out in prone position. Maximum radial displacement (Dm), contraction time (Tc), delay time (Td), sustained contraction time (Ts), and relaxation time (Tr) were recorded in the maximum lordosis point of the paravertebral muscles at 100 mA by TMG (TMG-BMC Ltd, Ljubljana, Slovenia), according to Rodriguez-Matoso et al. (2010). A diagnostic ultrasound system (Mindray Z6; Shenzhen Mindray Bio-Medical Electronics, Nansham, 518057, China) with a 5-to 10.0-MHz range linear transducer (7L4P type; 38 mm footprint), a frequency of 10.0-MHz, a total depth imaging of 4 cm and the focus located with a depth of 1.5 cm were used to assess resting B-mode ultrasound imaging at the end of expiration. A single rater used 3 repeated measurements, coinciding with the same point of TMG, to stablish the mean of the skin, subcutaneous tissue and superficial connective tissue thickness. The Spearman correlations test were carried out with a 95% confidence interval. Results The subcutaneous tissue thickness showed a negative moderate correlation (P Conclusions The connective tissue and skin thickness by RUSI needs to be stablished in the Dm and Tr assessments of TMG evaluation in the paravertebral musculature of the low back region, especially during interexaminer asessments.

The present study examined cross-sectional and longitudinal relationships between total and segmental subcutaneous tissue thicknesses from ultrasonography (US) and total and segmental fat mass (FM) estimates from dual-energy X-ray absorptiometry (DXA). Traditional US FM estimates were also examined. Twenty resistance-trained males (mean±SD; age: 22.0±2.6years; body mass: 74.8±11.5kg; DXA fat: 17.5±4.5%) completed a 6-week supervised resistance training programme while consuming a hypercaloric diet. Pre- and post-intervention body composition was assessed by DXA and B-mode US. Data were analysed using Pearson's correlation (r), Lin's correlation coefficient (CCC), paired t-tests, Wilcoxon signed-rank tests and Bland-Altman analysis, as appropriate. Cross-sectionally, correlations were observed between total DXA FM and total subcutaneous tissue thickness (r=0.88). Longitudinally, a correlation was observed between total DXA FM changes and total subcutaneous tissue changes (r=0.49, CCC=0.38). Correlations of similar magnitudes were observed for the upper body and trunk estimates, but DXA FM changes were unrelated to subcutaneous tissue changes for the lower body and arms. Cross-sectionally, US 2-compartment FM and DXA FM were correlated (r=0.91, CCC=0.83). Longitudinally, a weaker correlation was observed (r=0.47, CCC=0.33). In summary, longitudinal associations between US and DXA are weaker than cross-sectional relationships; additionally, correlations between US subcutaneous tissue and whole-body DXA FM appear to be driven by the trunk region rather than appendages. Reporting raw skinfold thicknesses rather than FM estimates alone may improve the utility of techniques based on subcutaneous tissue thickness, such as US and skinfolds.

Erysipelas and cellulitis are a group of acute bacterial infectious skin diseases involving the deep layers of the cutaneous and subcutaneous tissues. The typical skin lesions of erysipelas are edematous erythema with clear boundaries, mainly involving the dermis and superficial subcutaneous tissue. However, cellulitis is an infiltrating erythema with an unclear boundary, which has a tendency to purify and can involve deep subcutaneous tissues and muscles. Adequate and effective antibiotic treatment can relieve systemic symptoms, control the spread of inflammation and prevent recurrence. Here we reported a case of erysipelas with facial erythema with a butterfly distribution and review the literature of acute skin infectious diseases briefly.KeywordsFacial erythemaErysipelasCellulitisBacterial infectionSkin and soft tissue infection

Fat distribution is an important variable explaining metabolic heterogeneity of obesity. Abdominal subcutaneous adipose tissue (SAT) is divided by the Scarpa's fascia into a deep subcutaneous adipose tissue (dSAT) and a superficial subcutaneous adipose tissue (sSAT) layer. This study sought to characterize functional differences between the two SAT layers to explore their relative contribution to metabolic traits and cardiovascular risk (CVR) profile. We recruited 371 Caucasians consecutively from a local random, population-based screening project in Oxford and 25 Asian Indians from the local community. The depth of the SAT layers was determined by ultrasound (US), and adipose tissue (AT) biopsies were performed under US guidance in a subgroup of 43 Caucasians. Visceral adipose tissue (VAT) mass was quantified by dual-energy X-ray absorptiometry scan. Male adiposity in both ethnic groups was characterized by a disproportionate expansion of dSAT, which was strongly correlated with VAT mass. dSAT depth was a strong predictor of global insulin resistance (IR; homeostatic model assessment of IR), liver-specific IR (insulin-like growth factor binding protein-1), and Framingham risk score independently of other measures of adiposity in men. Moreover, dSAT had higher expression of proinflammatory, lipogenic, and lipolytic genes and contained higher proportions of saturated fatty acids. There was increased proportion of small adipocytes in dSAT. SAT is heterogeneous; dSAT expands disproportionally more than sSAT with increasing obesity in Caucasian males (confirmed also in Asian Indians). Its expansion is related to increased CVR independent of other adiposity measures, and it has biological properties suggestive of higher metabolic activity contributing to global IR.