Skin Segments Research Articles

The expansion and recoil mechanism of the skin of alligators and its implications for their feeding mechanism

Alligators are said to swallow large food items, but the assumption of an expandable throat skin has not been tested. Alligator skin can expand only through its soft‐cornified interscale skin segments. In the relaxed skin, collagenous skin ligaments in the dermis extend radially to attach to the underside of the rigid, hard‐cornified scales, which are slightly raised above the folded interscale skin. In the stretched skin, the skin ligaments assume a more circumferential orientation, thereby pulling down the scales and allowing the interscale skin to expand, while the Stratum elasticum between the dermis and subcutis is stretched. When the stretched skin is released, the Stratum elasticum returns to its resting length, thereby pushing the scales back to their raised position, allowing the interscale skin to refold, and returning the skin ligaments to their resting configuration. Maximum expansibility of the skin was found in the intermandibular region, which allows the manipulation of large food items in the oral cavity. A lack of circumferential expansibility was found in the cervical region, which limits the size of food items that can pass through the throat before they reach the narrow Isthmus thoracis. Hence, our anatomical analysis, together with observations of feeding alligators, shows that alligators do not swallow food items that are large relative to their neck size. Funding: LSU Foundation to DGHGrant Funding Source : NA

Learning from large dataset: segmentation of capsule endoscopy videos

Reviewing video of capsule endoscopy is a tedious work that takes hours. Hence, efficient and scalable approaches are needed to automate the process of large dataset and be able to refine the model given new examples. This paper presents an incremental SVM to learn from large dataset with dynamic patterns. Our method extends the reduced convex hull concept and defines the approximate skin segments of convex hulls. Experiments were conducted using synthetic data set, real–world data sets, and CE videos. Our results demonstrated highly competitive performance that requires much less resource, which cast new light on learning with limited resource.

Motion-Based-Design of Elastic Material for Passive Assistive Device Using Musculoskeletal Model

We are developing a passive power assist device, “Smart Suit Lite.” Smart Suit Lite is a compact, lightweight power assist device that utilizes the elastomeric force of elastic materials. We have developed a “motion-based assist method” in order to design Smart Suit Lite for particular motions. We have also developed an extended musculoskeletal model which has “Skin segments” that aid in analyzing assistive force. In this paper, we target the movements of caregivers. From three-dimensional motion data and an extended musculoskeletal model, we analyze human muscle forces and assistive forces. We then design the arrangement and properties of the elastic materials, based on the motion-based assist method. Finally, we verify its assistance effect through basic experiments.

Panniculectomy: an alternative approach to the revision of a difficult stoma

We describe a modified abdominoplasty technique as an alternative approach to the revision of a difficult stoma. A patient with a retracted colostomy secondary to change in abdominal wall contour following significant weight loss was treated with this technique. The patient had previous colostomy revision with marlex mesh insertion for combined parastomal and massive ventral hernia repair. A preoperatively marked crescent shaped left upper quadrant segment of skin and subcutaneous fat was excised and the defect was approximated in multiple layers. This shifted the stoma opening cephalad and eliminated the cutaneous crease that originally made it difficult to obtain a proper stoma seal. At one year follow up the patient was extremely satisfied with the results and was able to properly pouch the stoma. Modified abdominoplasty can be used as an alternative, low morbid approach in dealing with selected patients with difficult stoma problems.

Superimposed Segmental Dermatomyositis

I read with great interest the paper by Takahashi et al.1 reporting on a child affected by juvenile dermatomyositis (JDM). The peculiarity of the case was the presence of erythema and violaceous papules following a Blaschko’s line over the posterior aspect of the right thigh. The authors speculate that such lesion is an expression of flagellate erythema. However, flagellate erythema of DM is transient, not infiltrated, typically occurs in multiple streaks on the trunk and does not follow Blaschko’s lines. I rather suggest herein that the reported case actually represents a remarkable example of superimposed segmental dermatomyositis. Two types of skin mosaicism are currently recognized with regard to monogenic skin disorders, i.e. type 1 (segments of heterozygous skin in the setting of nonmutant skin) and type 2 (segments of homozygous skin in the setting of heterozygous skin). Segmental manifestations can also be observed in many acquired polygenic skin disorders. In this case, the terms suggested as equivalents of type 1 and type 2 are “isolated” (segmental lesions as the sole manifestation of a dermatosis) and “superimposed” (segmental lesions coexisting with nonsegmental, otherwise typical manifestations of a dermatosis), respectively.2 Many polygenic skin disorders have been already shown to present, albeit very rarely, with a superimposed segmental manifestation. JDM has been recently included in the list3 after the publication of 3 cases featuring segmental calcinosis.4-6 The case by Takahashi et al. 1 is likely to represent the first reported one in which the segmental manifestation is represented by the pathognomonic findings of DM, i.e. Gottron’s sign and papules.

2A1-E07 筋骨格モデルに基づく介護用スマートスーツ・ライトの開発と実フィールド評価(ウェアラブルロボティクス)

We are developing a passive power assist supporter "Smart Suit Light". The smart suit light is a compact and lightweight power assist device utilizing elastomeric force of elastic materials. We constructed Motion-based-assist method to design the smart suit light for particular motions. Moreover, we developed an extended musculoskeletal model which has skin segments for analyzing assist force. In this paper, we deal with care motions as target movement. From three-dimensional motion data and the extended musculoskeletal model, we analyzed human muscle forces and assist forces. Then we designed arrangement and property of the elastic materials based on Motion-based-assist method. Furthermore, its assist effect was verified by basic experiments.

A novel hybrid module of skin detector using grouping histogram technique for Bayesian method and segment adjacent-nested technique for neural network

Skin detection is a common ancient image processing applications for detecting human images. The applications include video surveillance, naked image filters within unit-spam systems and face detection. Skin color is considered as a useful and discriminating spatial feature for many skin detection related applications, but it is not robust enough to deal with complex image environments. Skin tone ranges from dark (some Africans) to light white (Caucasians and some Europeans). Other factors like light-changing conditions and the presence of objects with skin-like colors could create major difficulties in face pixel-based skin detector when color feature is used. Thus, this paper proposed a novel hybrid module using grouping histogram technique for Bayesian method and back propagation neural network with segment adjacent-nested (SAN) technique based on YCbCr and RGB color space in improving the skin detection performance. The researcher was able to increase the classification reliability in discriminating human skin color and regularizing the skin detection that is exposed to different light conditions. This novel skin detector method depends on three factors. The first part of the method involves the Bayesian part that is applied to a novel grouping histogram technique which uses 600 non-skin images in the processing and then calculates the probability density for each pixel. The second part involves applying the adjacent-nested technique in the preprocessing and calculating the probability density for each pixel in the neural part. Then a combination of the neural part and normalization technique is used to normalize the inputs and targets, so that the target falls in the interval [-1, 1] for each segment, which is created and trained with the training set of the skin and non skin segments. The third part involves a combination of the Bayesian method with the neural network segmentation methods and novel hybrid method. The study, tested on human images, has an upright frontal skin with any background. As such, the results show that the proposed system is able to achieve high detection rates of 98% segmentation and low false positives when compared with the existing methods. Key words: Skin detector, Bayesian method, neural network.

Endaural meatoplasty: the Whipps Cross technique

To describe our technique of endaural meatoplasty for mastoid surgery, and to publish an online video demonstration. After the endaural incision, a skin incision is accurately marked over the anterior conchal bowl, identified by pushing the anti-helix anteriorly. This should meet the line of the endaural incision superiorly and extend inferiorly to the lower anterior edge of the conchal cartilage. After performing the incision, a segment of conchal cartilage is removed. The soft tissue meatoplasty is facilitated by resecting a triangular segment of skin and underlying soft tissue medial to the conchal incision (on which it is based). The free edges are closed with absorbable sutures after the (attico)mastoidectomy. We have used this method on 64 patients over the past two years. Satisfactory functional and cosmetic outcomes were achieved in all. Our technique is simple, easy to learn, quick and effective in helping to achieve our goal of a dry mastoid cavity with an adequate meatoplasty.

Boosting the tumor bed from deep-seated tumors in early-stage breast cancer: A planning study between electron, photon, and proton beams

Purpose To assess the potential dosimetric advantages and drawbacks of photon beams (modulated or not), electron beams (EB), and protons as a boost for the tumor bed in deep-seated early-stage breast cancer. Material and methods Planning CTs of 14 women with deep-seated tumors (i.e., ⩾4 cm depth) were selected. The clinical target volume (CTV) was defined as the area of architectural distortion surrounded by surgical clips. The planning treatment volume (PTV ) was the CTV plus 1 cm margin. A dose of 16 Gy in 2 Gy fractions was prescribed. Organs at risk (OARs) were heart, lungs, breasts, and a 5-mm thick skin segment on the breast surface. Dose–volume metrics were defined to quantify the quality of concurrent treatment plans assessing target coverage and sparing of OAR. The following treatment techniques were assessed: photon beams with either static 3D-conformal, dynamic arc (DCA), static gantry intensity-modulated beams (IMRT), or RapidArc (RA); a single conformal EB; and intensity-modulated proton beams (IMPT). The goal for this planning effort was to cover 100% of the CTV with ⩾95% of the prescribed dose and to minimize the volume inside the CTV receiving >107% of the dose. Results All techniques but DCA and EB achieved the planning objective for the CTV with an inhomogeneity ranging from 2% to 11%. RA showed the best conformity, EB the worst. Contra-lateral breast and lung were spared by all techniques with mean doses <0.5 Gy (zero for protons). The ipsi-lateral lung received a mean dose <10% of that prescribed with photon beams and <2% with IMPT, increasing to 17% with EB. The heart, in left-sided breast tumors, received also the highest dose with EB. The skin was best protected with RA with a mean dose of 5.4 Gy and V 15Gy = 2.4%. Conclusions Boosting the tumor bed in early-stage breast cancer with optimized photon or proton beams may be preferred to EB especially for deep-seated targets. The marked OAR (i.e., ipsi-lateral breast, lung, heart, and skin surface) dose-sparing effect may allow for a potential long-term toxicity risk reduction and better cosmesis. DCA or RA may also be considered alternative treatment options for patients eligible for accelerated partial breast irradiation trials.

Surgical Correction of the Frowning Mouth

The available perioral rejuvenation procedures only partially correct the frowning mouth deformity, which is composed of sagging of the oral commissures and frequently associated with marionette folds. The authors describe their method of surgical correction for this condition and offer a classification for frowning mouth deformity. Twenty-seven patients underwent correction for frowning mouth deformity from 2000 to 2009. The deformities and the corresponding methods of correction were divided into two types. In type I frowning mouth deformity, correction was performed by lentiform excisions at the vermilion border, and in type II deformity, lentiform excisions also included the marionette folds. Correction of frowning mouth deformities, either as an isolated procedure or concurrent with face lift, was satisfactorily achieved in all 27 patients. All patients were followed for a minimum of 3 months, and 88.9 percent were followed for 1 year; 18.8 percent of the patients showed erythema and scar hypertrophy at the sites of marionette fold excision during the early postoperative period. However, all scars improved over time, with high patient satisfaction. Frowning mouth deformities are correctable by excising lentiform segments of skin through incisions placed at the vermilion border that may be extended to include the marionette folds. Proper patient selection and counseling, particularly regarding temporary or possibly permanent noticeable scar formation, is of utmost importance. When such measures are taken, the outcome is good and patient satisfaction is high.

Membranous Aplasia Cutis Congenita

Journal of Ultrasound in MedicineVolume 28, Issue 10 p. 1393-1396 Case Report Membranous Aplasia Cutis Congenita A Recognizable Lesion on Prenatal Sonography Angie C. Jelin MD, Angie C. Jelin MD Division of Perinatal Medicine and Genetics, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California USASearch for more papers by this authorOrit A. Glenn MD, Orit A. Glenn MD Department of Radiology, University of California, San Francisco, California USASearch for more papers by this authorLoretta Strachowski MD, Loretta Strachowski MD Department of Radiology, University of California, San Francisco, California USASearch for more papers by this authorJuan E. Vargas MD, Corresponding Author Juan E. Vargas MD [email protected] Division of Perinatal Medicine and Genetics, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California USAAddress correspondence to Juan E. Vargas, MD, Department of Obstetrics, Gynecology, and Reproductive Sciences, San Francisco General Hospital, 1001 Potrero Ave, Room 6D13, San Francisco, CA 94110 USA.Search for more papers by this author Angie C. Jelin MD, Angie C. Jelin MD Division of Perinatal Medicine and Genetics, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California USASearch for more papers by this authorOrit A. Glenn MD, Orit A. Glenn MD Department of Radiology, University of California, San Francisco, California USASearch for more papers by this authorLoretta Strachowski MD, Loretta Strachowski MD Department of Radiology, University of California, San Francisco, California USASearch for more papers by this authorJuan E. Vargas MD, Corresponding Author Juan E. Vargas MD [email protected] Division of Perinatal Medicine and Genetics, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California USAAddress correspondence to Juan E. Vargas, MD, Department of Obstetrics, Gynecology, and Reproductive Sciences, San Francisco General Hospital, 1001 Potrero Ave, Room 6D13, San Francisco, CA 94110 USA.Search for more papers by this author First published: 01 October 2009 https://doi.org/10.7863/jum.2009.28.10.1393Citations: 6Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume28, Issue10October 2009Pages 1393-1396 RelatedInformation

Abdominoplasty: Same Classification and a New Treatment Concept 20 Years Later

Twenty years after my first paper on abdominoplasty, I find that the classification of abdominoplasty remains the same, but new operative techniques allow for accentuated improvement of the results through more liposuction, less undermining in tunnels, and reduction of skin traction. I use the same classification of diagnoses proposed in 1988, dividing the aesthetic alterations into five groups, and describe my experience during a 6-year period with 502 patients. I used vibroliposuction and performed plicature of the muscular aponeurosis through tunnels (where there are no important muscular perforator vessels), without damaging the vascularization. I propose an appropriate ratio of 1/1.5 between infra- and supraumbilical segments for uses in diagnosis and treatment, and the same ratio between the perimeter of the waist and the hips up to 1/1.618, known as the golden or divine proportion. According to this new treatment concept, vibroliposuction is used in GI. Vibroliposuction and suprapubic fusiform skin resection with an indigenous canoe shape are used in GII. Vibroliposuction, fusiform skin resection, and plicature of the external oblique muscle aponeurosis through two lateral tunnels are used in GIII. Vibroliposuction, fusiform skin resection, plicature of the rectus muscles aponeurosis through a medial tunnel, and detachment of the umbilicus aponeurotic implantation and reattachment in a maximum proportion of 1/1.6 between the infra- and supraumbilical skin segment with a bolster stitch are used in GIV. In GV, all the infraumbilical skin and a subcutaneous segment are removed after vibroliposuction, then a median tunnel from the umbilicus to the xiphoid process and a plicature of the rectus muscle aponeurosis from the pubis to the xiphoid process are made, and then the umbilicus is transposed. When necessary, a plicature of the oblique external muscle aponeurosis through two lateral tunnels is made resulting in three tunnels.

Breast Specimen Orientation

Lumpectomy specimens are commonly divided into six sides: superficial, deep, superior, inferior, medial, and lateral. Orienting stitches are placed on the specimen during surgery to allow reorientation by pathology. Despite those efforts, specimen disorientation may occur. The aim of this study was to assess the correlation in orientation between surgeons and pathologists. Lumpectomy specimens were routinely oriented. An additional Prolene suture was randomly placed by the surgeon on one side to be localized by pathology. The results were recorded and the disorientation rate calculated. Specimen size and presence of skin and/or muscle were also recorded. There were 122 lumpectomy specimens prospectively entered. Average specimen volume was 95.5 cm(3). Twenty-four specimens had segments of skin or muscle. The additional sutures were evenly divided between the six sides. The overall disorientation rate was 31.1% (95% confidence interval, 23.1-40.2).The side-specific disorientation rates were 43%, 40%, 35%, 29%, 28%, and 14% for the deep, superficial, lateral, medial, superior, and inferior surfaces, respectively (no statistical difference). Presence of skin or muscle on the specimen did not contribute to better orientation. Specimen volumes, however, were highly associated with orientation. Specimens of <20 cm(3) had a disorientation rate of 78%, while larger specimen had a disorientation rate of 20% (p < .001). Specimen orientation with stitches placed on two surfaces is associated with a high disorientation rate. Better orientation techniques are necessary to minimize the specimen disorientation.

Robot-assisted vaginal construction using ileum in a case of Mayer-Rokitansky-Küster-Hauser syndrome.

Congenital absence of the vagina is a rare condition commonly associated with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, Morris Syndrome, and XY sex reversal. Secondarily this condition may be caused by exenteration of various pelvic tumors. Surgical options for treating this devastating condition include external vaginal dilation, internal dilation using traction devices, and vaginal construction using flaps of skin, bladder, or various bowel segments. We describe our innovative surgical technique employing robotic assistance in the creation of a neo-vagina for a young woman with MRKH syndrome. To the best of our knowledge this is the first report of this surgical technique.

Tissue Engineering a Complete Vaginal Replacement From a Small Biopsy of Autologous Tissue

In women, a healthy, patent vagina is important for the maintenance of a good quality of life. Apart from congenital abnormalities, such as cloacal exstrophy, intersex disorders, and an absence of the posterior two thirds of the organ, individuals may also suffer from cancer, trauma, infection, inflammation, or iatrogenic injuries leading to tissue damage and loss -- all of which require vaginal repair or replacement. Of necessity, reconstruction is often performed with nonvaginal tissue substitutes, such as segments of large intestine or skin, which are not anatomically or functionally ideal (Hendren and Atala, J Urol 1994; 152: 752; Hendren and Atala, J Pediatr Surg 1995; 30: 91). Whenever such tissue is used additional complications often ensue, such as strictures, infection, hair growth, graft shrinkage, diverticuli, and even malignancy (Filipas et al., BJU Int 2000; 85: 715; Lai and Chang, Changgeng Yi Xue Za Zhi 1999; 22: 253; Parsons et al., J Pediatr Surg 2002; 37: 629; Seccia et al., Ann Plast Surg 2002; 49: 379; Filipas, Curr Opin Urol 2001; 11: 267). Using a rabbit model, we report here the construction of a functional vagina using autologous cells expanded from a small vaginal biopsy. RESULTS.: Six months after total vaginal replacement, radiographic analysis of rabbits implanted with the neovagina demonstrated wide, patent vaginal calibers without strictures. Histologic analysis revealed well-organized epithelial and muscle cell layers. Physiologic studies showed normal-range responses to electrical stimulation or to an adrenergic agonist. These data indicate that a tissue engineering approach to clinical vaginal reconstruction in women is now a realistic possibility.

Decreasing Intracellular Superoxide Corrects Defective Ischemia-induced New Vessel Formation in Diabetic Mice

Tissue ischemia promotes vasculogenesis through chemokine-induced recruitment of bone marrow-derived endothelial progenitor cells (EPCs). Diabetes significantly impairs this process. Because hyperglycemia increases reactive oxygen species in a number of cell types, and because many of the defects responsible for impaired vasculogenesis involve HIF1-regulated genes, we hypothesized that HIF1 function is impaired in diabetes because of reactive oxygen species-induced modification of HIF1alpha by the glyoxalase 1 (GLO1) substrate methylglyoxal. Decreasing superoxide in diabetic mice by either transgenic expression of manganese superoxide dismutase or by administration of an superoxide dismutase mimetic corrected post-ischemic defects in neovascularization, oxygen delivery, and chemokine expression, and normalized tissue survival. In hypoxic fibroblasts cultured in high glucose, overexpression of GLO1 prevented reduced expression of both the EPC mobilizing chemokine stromal cell-derived factor-1 (SDF-1) and of vascular epidermal growth factor, which modulates growth and differentiation of recruited EPCs. In hypoxic EPCs cultured in high glucose, overexpression of GLO1 prevented reduced expression of both the SDF-1 receptor CXCR4, and endothelial nitric-oxide synthase, an enzyme essential for EPC mobilization. HIF1alpha modification by methylglyoxal reduced heterodimer formation and HIF1alpha binding to all relevant promoters. These results provide a basis for the rational design of new therapeutics to normalize impaired ischemia-induced vasculogenesis in patients with diabetes.

Investigation and comparative characteristic of factors determining human skin elasticity

The results of examining the variation in skin elasticity at its expansion are presented for different skin thickness, different content of collagen and intercellular and intracellular fluids, different venous pressure, and for tension and relaxation of the smooth muscle of skin vessels (vasomotion). Elasticity was determined using the acoustic method by the velocity of the surface shear acoustic wave, the self-resonance method by the frequency of mechanic skin resonance, and the vacuum method by the volume of the skin segment pulled into the aperture of a thin tube by air rarefaction. It is shown that the main factors determining the skin elasticity are its stretching, thickness, and collagen and fluid content. The influence of venous pressure and contractile activity of the vasculature on elasticity is insignificant. This gives grounds for using skin elasticity factors as indicators of systemic and local lesion of connective tissue.

Dynamic interaction of fingertip skin and pin of tactile device

The present paper deals with investigations performed with the aim to study transmitting tactile information into the area of mechanoreceptors of the fingertip skin segment and to estimate the dynamic properties and behavior of the skin by performing numerical analysis. A computational finite element model consisting of four main layers of skin was used for transient analysis of contact dynamic interaction when loading the skin by a moving pin, as well as for modal analysis of skin and analysis of skin stress–strain state under harmonic loading (a plane strain case was studied). Material properties of the skin were assumed as linear elastic because of a very small excitation signal level. The efficiency of the regime of the skin dynamic loading in terms of the tactile signal level was defined on the basis of the strain level in the dermis zone where mechanoreceptors are placed. The possibilities of using vibratory control signal were analyzed.

Cicatrização conduzida e enxerto de pele parcial no tratamento de feridas

The present study compared the treatment of skin wounds by means of conducted healing (an innovative method for treatment of secondary healing) and autogenous skin graft. Seventeen rabbits were submitted to removal of two skin segments, one on each side of the dorsum. The graft donor area was left as a wound for conducted healing (A) and was submitted only to debridement, local care and dressings. The skin removed from the above mentioned side was implanted as a graft (B) to cover the wound on the other side. Thus, each animal received the two types of treatment on its dorsum (A and B). Rabbits were divided into two groups according to size of the wounds: Group 1--A and B (4 cm2) and Group 2--A and B (25 cm2). Healing time was of 19 days for Group 1 and of 35 days for Group 2. The final macro- and microscopic aspects of healing were comparatively analyzed in the four subgroups. Presence of inflammatory cells, of epidermal cysts and of giant cells was assessed by histology. Data were statistically analyzed by the nonparametric Fisher, Kruskal-Wallis and Wilcoxon tests. No macro- or microscopic difference was observed between conducted healing and skin graft, although conducted healing led to a more rapid wound healing. Conducted healing seems to be a good therapeutic option for skin wounds in rabbits.

Improving the Lateral Fullness of the Upper Eyelid

The lateral fullness of the upper eyelid is its convex surface area from the eyebrow to the eyelid crease. Rejuvenation of upper eyelids can be achieved by accenting their fullness. An S-shaped fusiform skin segment is removed from the upper eyelid, with care taken to spare the orbicularis occuli muscle. Approximately 1 ml of fat tissue is excised from the medial compartment by transmuscular incision. The fat is placed in the crease, and the orbicularis occuli muscle is stitched together over the transplanted fat tissue. Imbrication of the orbicularis occuli muscle and insertion of 1 ml of fat tissue into the muscle layers increase the lateral fullness and significantly emphasizes the aesthetic result of upper eyelid blepharoplasty.