Aesthetic Dermatology

BOSTON — Infrared light energy delivered through an intelligent pulsed light handpiece can safely and effectively induce tissue tightening in lax skin of the face, neck, arms, abdomen, and buttocks, suggesting that infrared light technology is a useful tool for nonablative tissue tightening, Dr. Matthew E. Halpern said at the annual meeting of the American Society for Laser Medicine and Surgery.

In a clinical trial designed to evaluate the tissue-tightening capability of the Solera Titan, which achieves dermal heating using infrared light at wavelengths of 1100–1800 nm and provides continuous epidermal cooling, Dr. Halpern and his colleagues at St. Luke's-Roosevelt Hospital, New York, enrolled 42 patients with primary tissue laxity or tissue laxity resulting from a liposuction procedure.

Of the initial 42 patients who underwent the nonablative tissue-tightening treatment of multiple anatomic areas, 32 completed one treatment and follow-up; 14 of the 32 completed additional treatment and follow-up.

The light energy delivery parameters for the project included four passes over each area, for a total of 100–500 pulses depending on the area, and fluences ranging from 35 to 50 J/cm

The observers scored baseline tissue laxity as none, mild, moderate, severe, or extreme. They scored degree of improvement as none if there was less than 10% visible improvement, mild for 10%–25% improvement, moderate for 25%–50% improvement, and significant for 50%–75% improvement.

"After one treatment, 94% of patients had better than 10% improvement and 34% had better than 25% improvement," he reported. "All of the patients who underwent two treatments had better than 10% improvement following the second treatment, approximately 75% of them had better than 25% improvement, and about a third of them had better than 50% improvement."

To determine the characteristics of patients who had the most vigorous response to the infrared treatment, the investigators first looked at patient response by age and then by baseline tissue laxity.

"We found that patients between ages 40 and 50 years tended to have higher improvement scores than older patients after both one and two treatments," Dr. Halpern said. Although these numbers didn't reach statistical significance, the trend toward lower improvement scores among older patients suggests that "perhaps there's something inherent about older fibroblasts, that they respond less well to bulk dermal heating," he said.

In evaluating patient response by baseline tissue laxity, "patients with severe and extreme tissue laxity had higher mean improvement scores after both one and two treatments than patients with mild to moderate tissue laxity," Dr. Halpern noted. "These numbers also did not reach statistical significance, but that is probably a function of the small study size."

Most of the patients had mild erythema and edema that lasted 24–48 hours; three patients developed local blistering, which resolved, with transient hyperpigmentation. "There was no scarring or lipoatrophy in our patients," he said.

The study results suggest that infrared light therapy "is a safe and effective way to induce tissue tightening when used in appropriate settings," said Dr. Halpern, who reported receiving consulting fees and honoraria from Cutera, manufacturer of the Titan product line. "Future studies are needed to confirm whether patient age and baseline tissue laxity are accurate predictors of therapeutic response."

BOSTON — Infrared light energy delivered through an intelligent pulsed light handpiece can safely and effectively induce tissue tightening in lax skin of the face, neck, arms, abdomen, and buttocks, suggesting that infrared light technology is a useful tool for nonablative tissue tightening, Dr. Matthew E. Halpern said at the annual meeting of the American Society for Laser Medicine and Surgery.

In a clinical trial designed to evaluate the tissue-tightening capability of the Solera Titan, which achieves dermal heating using infrared light at wavelengths of 1100–1800 nm and provides continuous epidermal cooling, Dr. Halpern and his colleagues at St. Luke's-Roosevelt Hospital, New York, enrolled 42 patients with primary tissue laxity or tissue laxity resulting from a liposuction procedure.

Of the initial 42 patients who underwent the nonablative tissue-tightening treatment of multiple anatomic areas, 32 completed one treatment and follow-up; 14 of the 32 completed additional treatment and follow-up.

The light energy delivery parameters for the project included four passes over each area, for a total of 100–500 pulses depending on the area, and fluences ranging from 35 to 50 J/cm

The observers scored baseline tissue laxity as none, mild, moderate, severe, or extreme. They scored degree of improvement as none if there was less than 10% visible improvement, mild for 10%–25% improvement, moderate for 25%–50% improvement, and significant for 50%–75% improvement.

"After one treatment, 94% of patients had better than 10% improvement and 34% had better than 25% improvement," he reported. "All of the patients who underwent two treatments had better than 10% improvement following the second treatment, approximately 75% of them had better than 25% improvement, and about a third of them had better than 50% improvement."

To determine the characteristics of patients who had the most vigorous response to the infrared treatment, the investigators first looked at patient response by age and then by baseline tissue laxity.

"We found that patients between ages 40 and 50 years tended to have higher improvement scores than older patients after both one and two treatments," Dr. Halpern said. Although these numbers didn't reach statistical significance, the trend toward lower improvement scores among older patients suggests that "perhaps there's something inherent about older fibroblasts, that they respond less well to bulk dermal heating," he said.

In evaluating patient response by baseline tissue laxity, "patients with severe and extreme tissue laxity had higher mean improvement scores after both one and two treatments than patients with mild to moderate tissue laxity," Dr. Halpern noted. "These numbers also did not reach statistical significance, but that is probably a function of the small study size."

Most of the patients had mild erythema and edema that lasted 24–48 hours; three patients developed local blistering, which resolved, with transient hyperpigmentation. "There was no scarring or lipoatrophy in our patients," he said.

The study results suggest that infrared light therapy "is a safe and effective way to induce tissue tightening when used in appropriate settings," said Dr. Halpern, who reported receiving consulting fees and honoraria from Cutera, manufacturer of the Titan product line. "Future studies are needed to confirm whether patient age and baseline tissue laxity are accurate predictors of therapeutic response."

BOSTON — Infrared light energy delivered through an intelligent pulsed light handpiece can safely and effectively induce tissue tightening in lax skin of the face, neck, arms, abdomen, and buttocks, suggesting that infrared light technology is a useful tool for nonablative tissue tightening, Dr. Matthew E. Halpern said at the annual meeting of the American Society for Laser Medicine and Surgery.

In a clinical trial designed to evaluate the tissue-tightening capability of the Solera Titan, which achieves dermal heating using infrared light at wavelengths of 1100–1800 nm and provides continuous epidermal cooling, Dr. Halpern and his colleagues at St. Luke's-Roosevelt Hospital, New York, enrolled 42 patients with primary tissue laxity or tissue laxity resulting from a liposuction procedure.

Of the initial 42 patients who underwent the nonablative tissue-tightening treatment of multiple anatomic areas, 32 completed one treatment and follow-up; 14 of the 32 completed additional treatment and follow-up.

The light energy delivery parameters for the project included four passes over each area, for a total of 100–500 pulses depending on the area, and fluences ranging from 35 to 50 J/cm

The observers scored baseline tissue laxity as none, mild, moderate, severe, or extreme. They scored degree of improvement as none if there was less than 10% visible improvement, mild for 10%–25% improvement, moderate for 25%–50% improvement, and significant for 50%–75% improvement.

"After one treatment, 94% of patients had better than 10% improvement and 34% had better than 25% improvement," he reported. "All of the patients who underwent two treatments had better than 10% improvement following the second treatment, approximately 75% of them had better than 25% improvement, and about a third of them had better than 50% improvement."

To determine the characteristics of patients who had the most vigorous response to the infrared treatment, the investigators first looked at patient response by age and then by baseline tissue laxity.

"We found that patients between ages 40 and 50 years tended to have higher improvement scores than older patients after both one and two treatments," Dr. Halpern said. Although these numbers didn't reach statistical significance, the trend toward lower improvement scores among older patients suggests that "perhaps there's something inherent about older fibroblasts, that they respond less well to bulk dermal heating," he said.

In evaluating patient response by baseline tissue laxity, "patients with severe and extreme tissue laxity had higher mean improvement scores after both one and two treatments than patients with mild to moderate tissue laxity," Dr. Halpern noted. "These numbers also did not reach statistical significance, but that is probably a function of the small study size."

Most of the patients had mild erythema and edema that lasted 24–48 hours; three patients developed local blistering, which resolved, with transient hyperpigmentation. "There was no scarring or lipoatrophy in our patients," he said.

The study results suggest that infrared light therapy "is a safe and effective way to induce tissue tightening when used in appropriate settings," said Dr. Halpern, who reported receiving consulting fees and honoraria from Cutera, manufacturer of the Titan product line. "Future studies are needed to confirm whether patient age and baseline tissue laxity are accurate predictors of therapeutic response."

SCOTTSDALE, ARIZ. — When a complex lower-extremity wound is unresponsive to conventional treatments and amputation looms as the only option, an acellular regenerative tissue matrix can be effective, Brock A. Liden, D.P.M., said at the annual meeting of the Wound Healing Society.

"Bioengineered skin grafts have become a promising alternative for the treatment of chronic, nonhealing, full-thickness lower-extremity wounds," said Dr. Liden, whose retrospective study evaluated the Graftjacket (Wright Medical Technology Inc.) human acellular dermal matrix.

"The matrix maintains a moist wound environment during the incorporation phase of wound healing and provides a barrier to the outside to reduce the chance of infection, and granulation tissue forms within 5–7 days, reducing the depth of wounds," explained Dr. Liden, a podiatrist in Circleville, Ohio.

The double-layered membrane, which prompts revascularization of the reticular layer and wound closure, can be applied over tendon and bone.

The regenerative tissue matrix was applied to 23 wounds on 13 patients under a standard protocol, and wounds were assessed using the University of Texas diabetic wound classifications. Dr. Liden said that 12 of the wounds were classified as III-D (infected to the bone) and had poor blood supply.

The cohort's average age was 62 years, with women outnumbering men 3:2. Nearly all patients had cardiac disease, while 78% were diabetic, 69% had infection on initial presentation, 65% had osteomyelitis initially, and 91% had peripheral vascular disease. The average age of treated wounds was 17 weeks.

"This was not front-line defense," explained Dr. Liden. "Everything else had failed for these patients." The defense held, with all but two of the patients achieving complete healing.

One exception was a woman who had stepped on a nail, developed an abscess, and required amputation.

The other was a noncompliant man who was successfully treated on a second attempt.

"The average time to graft incorporation, which is what I consider to be the most important part of the treatment, was about 1 week, and we averaged about 12 weeks to complete healing. The quickest we healed was 3 weeks and the slowest was 30 weeks," Dr. Liden explained. "This acellular tissue matrix is safe and efficacious for complex lower-extremity wounds and is universally applicable."

Graftjacket has several advantages over conventional wound coverings. "It has extremely high tensile strength, retains its vascular channels, and incorporates and converts in the host tissue. The collagen in this product is utilized rather than replaced. Also, its acellular structure eliminates worry about inflammation and rejection," he said, adding that growth factors FGF2 and VEGF are present in the product upon application.

When the graft is used on a full-thickness wound, he explained, it's important to remove as much necrotic tissue as possible and try to get down to the bleeding wound bed.

"Make sure the graft doesn't 'tent,' which occurs when you don't make maximum contact with the wound. And watch for bleeding, which can lift the graft away from the wound bed," Dr. Liden said. He added that the matrix has to be anchored down like a skin graft to eliminate motion.

"The more motion that occurs, the higher the chance of failure," he said, advising against the use of Steri-Strips. "You can lay this over necrotic tissue, bone, or tendon—all of which I've done without problems."

Dr. Liden acknowledged receiving a retainer, contribution to research funds, and contribution to travel funds from Wright Medical.

SCOTTSDALE, ARIZ. — When a complex lower-extremity wound is unresponsive to conventional treatments and amputation looms as the only option, an acellular regenerative tissue matrix can be effective, Brock A. Liden, D.P.M., said at the annual meeting of the Wound Healing Society.

"Bioengineered skin grafts have become a promising alternative for the treatment of chronic, nonhealing, full-thickness lower-extremity wounds," said Dr. Liden, whose retrospective study evaluated the Graftjacket (Wright Medical Technology Inc.) human acellular dermal matrix.

"The matrix maintains a moist wound environment during the incorporation phase of wound healing and provides a barrier to the outside to reduce the chance of infection, and granulation tissue forms within 5–7 days, reducing the depth of wounds," explained Dr. Liden, a podiatrist in Circleville, Ohio.

The double-layered membrane, which prompts revascularization of the reticular layer and wound closure, can be applied over tendon and bone.

The regenerative tissue matrix was applied to 23 wounds on 13 patients under a standard protocol, and wounds were assessed using the University of Texas diabetic wound classifications. Dr. Liden said that 12 of the wounds were classified as III-D (infected to the bone) and had poor blood supply.

The cohort's average age was 62 years, with women outnumbering men 3:2. Nearly all patients had cardiac disease, while 78% were diabetic, 69% had infection on initial presentation, 65% had osteomyelitis initially, and 91% had peripheral vascular disease. The average age of treated wounds was 17 weeks.

"This was not front-line defense," explained Dr. Liden. "Everything else had failed for these patients." The defense held, with all but two of the patients achieving complete healing.

One exception was a woman who had stepped on a nail, developed an abscess, and required amputation.

The other was a noncompliant man who was successfully treated on a second attempt.

"The average time to graft incorporation, which is what I consider to be the most important part of the treatment, was about 1 week, and we averaged about 12 weeks to complete healing. The quickest we healed was 3 weeks and the slowest was 30 weeks," Dr. Liden explained. "This acellular tissue matrix is safe and efficacious for complex lower-extremity wounds and is universally applicable."

Graftjacket has several advantages over conventional wound coverings. "It has extremely high tensile strength, retains its vascular channels, and incorporates and converts in the host tissue. The collagen in this product is utilized rather than replaced. Also, its acellular structure eliminates worry about inflammation and rejection," he said, adding that growth factors FGF2 and VEGF are present in the product upon application.

When the graft is used on a full-thickness wound, he explained, it's important to remove as much necrotic tissue as possible and try to get down to the bleeding wound bed.

"Make sure the graft doesn't 'tent,' which occurs when you don't make maximum contact with the wound. And watch for bleeding, which can lift the graft away from the wound bed," Dr. Liden said. He added that the matrix has to be anchored down like a skin graft to eliminate motion.

"The more motion that occurs, the higher the chance of failure," he said, advising against the use of Steri-Strips. "You can lay this over necrotic tissue, bone, or tendon—all of which I've done without problems."

Dr. Liden acknowledged receiving a retainer, contribution to research funds, and contribution to travel funds from Wright Medical.

SCOTTSDALE, ARIZ. — When a complex lower-extremity wound is unresponsive to conventional treatments and amputation looms as the only option, an acellular regenerative tissue matrix can be effective, Brock A. Liden, D.P.M., said at the annual meeting of the Wound Healing Society.

"Bioengineered skin grafts have become a promising alternative for the treatment of chronic, nonhealing, full-thickness lower-extremity wounds," said Dr. Liden, whose retrospective study evaluated the Graftjacket (Wright Medical Technology Inc.) human acellular dermal matrix.

"The matrix maintains a moist wound environment during the incorporation phase of wound healing and provides a barrier to the outside to reduce the chance of infection, and granulation tissue forms within 5–7 days, reducing the depth of wounds," explained Dr. Liden, a podiatrist in Circleville, Ohio.

The double-layered membrane, which prompts revascularization of the reticular layer and wound closure, can be applied over tendon and bone.

The regenerative tissue matrix was applied to 23 wounds on 13 patients under a standard protocol, and wounds were assessed using the University of Texas diabetic wound classifications. Dr. Liden said that 12 of the wounds were classified as III-D (infected to the bone) and had poor blood supply.

The cohort's average age was 62 years, with women outnumbering men 3:2. Nearly all patients had cardiac disease, while 78% were diabetic, 69% had infection on initial presentation, 65% had osteomyelitis initially, and 91% had peripheral vascular disease. The average age of treated wounds was 17 weeks.

"This was not front-line defense," explained Dr. Liden. "Everything else had failed for these patients." The defense held, with all but two of the patients achieving complete healing.

One exception was a woman who had stepped on a nail, developed an abscess, and required amputation.

The other was a noncompliant man who was successfully treated on a second attempt.

"The average time to graft incorporation, which is what I consider to be the most important part of the treatment, was about 1 week, and we averaged about 12 weeks to complete healing. The quickest we healed was 3 weeks and the slowest was 30 weeks," Dr. Liden explained. "This acellular tissue matrix is safe and efficacious for complex lower-extremity wounds and is universally applicable."

Graftjacket has several advantages over conventional wound coverings. "It has extremely high tensile strength, retains its vascular channels, and incorporates and converts in the host tissue. The collagen in this product is utilized rather than replaced. Also, its acellular structure eliminates worry about inflammation and rejection," he said, adding that growth factors FGF2 and VEGF are present in the product upon application.

When the graft is used on a full-thickness wound, he explained, it's important to remove as much necrotic tissue as possible and try to get down to the bleeding wound bed.

"Make sure the graft doesn't 'tent,' which occurs when you don't make maximum contact with the wound. And watch for bleeding, which can lift the graft away from the wound bed," Dr. Liden said. He added that the matrix has to be anchored down like a skin graft to eliminate motion.

"The more motion that occurs, the higher the chance of failure," he said, advising against the use of Steri-Strips. "You can lay this over necrotic tissue, bone, or tendon—all of which I've done without problems."

Dr. Liden acknowledged receiving a retainer, contribution to research funds, and contribution to travel funds from Wright Medical.

SCOTTSDALE, ARIZ. — The use of topical autologous human platelets was safe and effective for treating dermal wounds in two preliminary studies presented at the annual meeting of the Wound Healing Society.

"Our pilot study provides preliminary evidence that topical autologous platelet gel may hasten wound closure in full-thickness dermal wounds in healthy individuals," said Dr. David B. Hom of the University of Minnesota Hospital and Clinic in Minneapolis.

Animal studies have shown autologous platelet gel's (APG's) ability to increase wound granulation and organize collagen bundles, but its performance in treating animal wounds has been mixed. Clinical studies, however, have been promising.

To compare APG with conventional wound treatment, Dr. Hom and his associates created 80 full-thickness skin-punch wounds, each 6 mm in diameter, on the thighs of four men and four women. With each person serving as his or her own control, APG was applied topically to five sites per leg, while the opposite thigh had an antibiotic ointment and/or a semiocclusive dressing applied as the control, also on five punch sites per leg.

Biopsies showed that wound closure occurred significantly faster in the APG-treated sites. On day 17, the APG sites were, on average, 81% closed, vs. 57% for controls.

The biopsy findings correlated with digital planimetry photographic measurements taken over a 42-day period, and the APG wounds closed significantly faster than the controls within 14 days of wounding. "At 28 and 31 days, half of APG-treated wounds reached full closure vs. 15% of controls, though the controls did catch up by day 42," Dr. Hom explained.

Experimental and control sites over time were histologically similar. "APG should not be used in its present state in patients allergic to bovine products," he cautioned.

In another presentation at the meeting, New Jersey researchers reported that a thrombin-free autologous platelet-rich fibrin matrix (PRFM) "appears to show significant potential for accelerating complete closure of chronic venous leg ulcers and maintains an extended-release source of growth factors, obviating the potential harmful potential of bovine thrombin," which is used in other dressings, including APG. Bovine thrombin can trigger a harmful immune response.

The ongoing prospective study, led by Sean M. O'Connell, Ph.D., involved 11 patients with venous leg ulcers and 6 with nonvenous leg ulcers, all of which had been unresponsive to a variety of standard treatments for at least 4 months. Each PRFM-treated patient received up to three applications of a 50-mm fenestrated membrane. PRFM was prepared at bedside from 36 mL of whole blood from which platelet-rich plasma was isolated and processed to produce a 100-μm-thick membrane with 50–100 times the platelet-fibrin concentration of whole blood.

By 8 weeks, closure was complete in 7 of the 11 patients with venous leg ulcers. In the nonvenous ulcer group, 50% closure was achieved, said Dr. O'Connell of Englewood (N.J.) Hospital and Medical Center and Mount Sinai School of Medicine in New York. "We see a sustained and consistent release of growth factors over the first 7 days," he said in an interview.

Dr. Hom acknowledges contract payments for research performed and ad hoc consulting fees. His study was funded by Medtronic Inc. Dr. O'Connell acknowledges contract payments for research performed and ad hoc consulting fees. His study was funded by Cascade Medical Enterprises LLC.

ELSEVIER GLOBAL MEDICAL NEWS

SCOTTSDALE, ARIZ. — The use of topical autologous human platelets was safe and effective for treating dermal wounds in two preliminary studies presented at the annual meeting of the Wound Healing Society.

"Our pilot study provides preliminary evidence that topical autologous platelet gel may hasten wound closure in full-thickness dermal wounds in healthy individuals," said Dr. David B. Hom of the University of Minnesota Hospital and Clinic in Minneapolis.

Animal studies have shown autologous platelet gel's (APG's) ability to increase wound granulation and organize collagen bundles, but its performance in treating animal wounds has been mixed. Clinical studies, however, have been promising.

To compare APG with conventional wound treatment, Dr. Hom and his associates created 80 full-thickness skin-punch wounds, each 6 mm in diameter, on the thighs of four men and four women. With each person serving as his or her own control, APG was applied topically to five sites per leg, while the opposite thigh had an antibiotic ointment and/or a semiocclusive dressing applied as the control, also on five punch sites per leg.

Biopsies showed that wound closure occurred significantly faster in the APG-treated sites. On day 17, the APG sites were, on average, 81% closed, vs. 57% for controls.

The biopsy findings correlated with digital planimetry photographic measurements taken over a 42-day period, and the APG wounds closed significantly faster than the controls within 14 days of wounding. "At 28 and 31 days, half of APG-treated wounds reached full closure vs. 15% of controls, though the controls did catch up by day 42," Dr. Hom explained.

Experimental and control sites over time were histologically similar. "APG should not be used in its present state in patients allergic to bovine products," he cautioned.

In another presentation at the meeting, New Jersey researchers reported that a thrombin-free autologous platelet-rich fibrin matrix (PRFM) "appears to show significant potential for accelerating complete closure of chronic venous leg ulcers and maintains an extended-release source of growth factors, obviating the potential harmful potential of bovine thrombin," which is used in other dressings, including APG. Bovine thrombin can trigger a harmful immune response.

The ongoing prospective study, led by Sean M. O'Connell, Ph.D., involved 11 patients with venous leg ulcers and 6 with nonvenous leg ulcers, all of which had been unresponsive to a variety of standard treatments for at least 4 months. Each PRFM-treated patient received up to three applications of a 50-mm fenestrated membrane. PRFM was prepared at bedside from 36 mL of whole blood from which platelet-rich plasma was isolated and processed to produce a 100-μm-thick membrane with 50–100 times the platelet-fibrin concentration of whole blood.

By 8 weeks, closure was complete in 7 of the 11 patients with venous leg ulcers. In the nonvenous ulcer group, 50% closure was achieved, said Dr. O'Connell of Englewood (N.J.) Hospital and Medical Center and Mount Sinai School of Medicine in New York. "We see a sustained and consistent release of growth factors over the first 7 days," he said in an interview.

Dr. Hom acknowledges contract payments for research performed and ad hoc consulting fees. His study was funded by Medtronic Inc. Dr. O'Connell acknowledges contract payments for research performed and ad hoc consulting fees. His study was funded by Cascade Medical Enterprises LLC.

ELSEVIER GLOBAL MEDICAL NEWS

SCOTTSDALE, ARIZ. — The use of topical autologous human platelets was safe and effective for treating dermal wounds in two preliminary studies presented at the annual meeting of the Wound Healing Society.

"Our pilot study provides preliminary evidence that topical autologous platelet gel may hasten wound closure in full-thickness dermal wounds in healthy individuals," said Dr. David B. Hom of the University of Minnesota Hospital and Clinic in Minneapolis.

Animal studies have shown autologous platelet gel's (APG's) ability to increase wound granulation and organize collagen bundles, but its performance in treating animal wounds has been mixed. Clinical studies, however, have been promising.

To compare APG with conventional wound treatment, Dr. Hom and his associates created 80 full-thickness skin-punch wounds, each 6 mm in diameter, on the thighs of four men and four women. With each person serving as his or her own control, APG was applied topically to five sites per leg, while the opposite thigh had an antibiotic ointment and/or a semiocclusive dressing applied as the control, also on five punch sites per leg.

Biopsies showed that wound closure occurred significantly faster in the APG-treated sites. On day 17, the APG sites were, on average, 81% closed, vs. 57% for controls.

The biopsy findings correlated with digital planimetry photographic measurements taken over a 42-day period, and the APG wounds closed significantly faster than the controls within 14 days of wounding. "At 28 and 31 days, half of APG-treated wounds reached full closure vs. 15% of controls, though the controls did catch up by day 42," Dr. Hom explained.

Experimental and control sites over time were histologically similar. "APG should not be used in its present state in patients allergic to bovine products," he cautioned.

In another presentation at the meeting, New Jersey researchers reported that a thrombin-free autologous platelet-rich fibrin matrix (PRFM) "appears to show significant potential for accelerating complete closure of chronic venous leg ulcers and maintains an extended-release source of growth factors, obviating the potential harmful potential of bovine thrombin," which is used in other dressings, including APG. Bovine thrombin can trigger a harmful immune response.

The ongoing prospective study, led by Sean M. O'Connell, Ph.D., involved 11 patients with venous leg ulcers and 6 with nonvenous leg ulcers, all of which had been unresponsive to a variety of standard treatments for at least 4 months. Each PRFM-treated patient received up to three applications of a 50-mm fenestrated membrane. PRFM was prepared at bedside from 36 mL of whole blood from which platelet-rich plasma was isolated and processed to produce a 100-μm-thick membrane with 50–100 times the platelet-fibrin concentration of whole blood.

By 8 weeks, closure was complete in 7 of the 11 patients with venous leg ulcers. In the nonvenous ulcer group, 50% closure was achieved, said Dr. O'Connell of Englewood (N.J.) Hospital and Medical Center and Mount Sinai School of Medicine in New York. "We see a sustained and consistent release of growth factors over the first 7 days," he said in an interview.

Dr. Hom acknowledges contract payments for research performed and ad hoc consulting fees. His study was funded by Medtronic Inc. Dr. O'Connell acknowledges contract payments for research performed and ad hoc consulting fees. His study was funded by Cascade Medical Enterprises LLC.

ELSEVIER GLOBAL MEDICAL NEWS

LAS VEGAS — A simple survey can provide physicians with a sense of patient satisfaction after cosmetic procedures, Dr. Jarl Bunæs said at an international symposium sponsored by the American Academy of Facial Plastic and Reconstructive Surgery.

As the operator of the oldest facial plastic surgery clinic in Norway (Klinikk Bunæs in Sandvika), each year he performs approximately 1,500 surgical procedures. He sent a questionnaire that he designed to 100 consecutive patients who had undergone cosmetic procedures at least 1 year earlier. Of the 84 patients who responded, 62 (74%) were women; the mean age was 42 years (ranging from 18 to 68), said Dr. Bunæs.

Asked to rate their satisfaction with the procedure's results on a visual analog scale of 1–10 (with 10 being the best), patients reported a mean score of 8. They also rated their overall quality of life after the procedure as 8.

Seventy-one patients (84%) said the cosmetic problem that was treated had lowered their self-esteem before the procedure, and 71 patients said their self-esteem improved after treatment.

LAS VEGAS — A simple survey can provide physicians with a sense of patient satisfaction after cosmetic procedures, Dr. Jarl Bunæs said at an international symposium sponsored by the American Academy of Facial Plastic and Reconstructive Surgery.

As the operator of the oldest facial plastic surgery clinic in Norway (Klinikk Bunæs in Sandvika), each year he performs approximately 1,500 surgical procedures. He sent a questionnaire that he designed to 100 consecutive patients who had undergone cosmetic procedures at least 1 year earlier. Of the 84 patients who responded, 62 (74%) were women; the mean age was 42 years (ranging from 18 to 68), said Dr. Bunæs.

Asked to rate their satisfaction with the procedure's results on a visual analog scale of 1–10 (with 10 being the best), patients reported a mean score of 8. They also rated their overall quality of life after the procedure as 8.

Seventy-one patients (84%) said the cosmetic problem that was treated had lowered their self-esteem before the procedure, and 71 patients said their self-esteem improved after treatment.

LAS VEGAS — A simple survey can provide physicians with a sense of patient satisfaction after cosmetic procedures, Dr. Jarl Bunæs said at an international symposium sponsored by the American Academy of Facial Plastic and Reconstructive Surgery.

As the operator of the oldest facial plastic surgery clinic in Norway (Klinikk Bunæs in Sandvika), each year he performs approximately 1,500 surgical procedures. He sent a questionnaire that he designed to 100 consecutive patients who had undergone cosmetic procedures at least 1 year earlier. Of the 84 patients who responded, 62 (74%) were women; the mean age was 42 years (ranging from 18 to 68), said Dr. Bunæs.

Asked to rate their satisfaction with the procedure's results on a visual analog scale of 1–10 (with 10 being the best), patients reported a mean score of 8. They also rated their overall quality of life after the procedure as 8.

Seventy-one patients (84%) said the cosmetic problem that was treated had lowered their self-esteem before the procedure, and 71 patients said their self-esteem improved after treatment.

BOCA RATON, FLA. — A new light-emitting diode device awaiting approval and an expected expanded indication for a laser are poised to expand the dermatologic device armamentarium, Dr. Vic Narurkar said at the annual meeting of the Florida Society of Dermatology and Dermatologic Surgery.

"One of the most exciting technologies to come out this year is a dermal spectrophotometer, because it will be a way of determining the skin's erythema and melanin content," said Dr. Narurkar, a dermatologist in private practice in San Francisco.

This advance is needed because the Fitzgerald skin type classification is outdated, he explained. "Darker skin often gets lumped into the Fitzpatrick IV, V, and VI, when there are many variations within all of those skin types," he said.

A far better method is to have some type of computer model determine the pigmentation and redness, as well as the background pigmentation and redness.

Another reason for improving the current classification system is that coloring on the face and body may not match.

This LED device, manufactured by Palomar Medical Technologies Inc., is pending approval. The hope is that it will be released by summer's end, he said.

Photopneumatic laser therapy, another new device, manufactured by Aesthera Corp., has been cleared by the FDA for hair removal and skin rejuvenation. However, it is being used off label to treat acne and is in clinical trials for that indication.

The theory behind this device is very intriguing, in that is uses suction and lower wavelengths of light, explained Dr. Narurkar. "When we treat acne with lasers, we either try to destroy the Propionibacterium acnes bacteria with devices that are in the blue light wavelength, or we try to modify the sebaceous glands with devices that are in the red light wavelength," he said. A suction-based device can be brought closer to the skin and simultaneously is able to address both the P. acnes bacteria and the sebaceous glands. The photopneumatic laser uses a lower band of light, which allows for better absorption.

"In our clinical study, we saw an immediate improvement in the inflammatory component of acne, and then more of a delayed effect in the reduction of new acne lesions," Dr. Narurkar explained. "The device is in clinical trials right now."

Dr. Narurkar is a member of the medical advisory board of Aesthera, and he performs clinical studies for Palomar Medical Technologies.

BOCA RATON, FLA. — A new light-emitting diode device awaiting approval and an expected expanded indication for a laser are poised to expand the dermatologic device armamentarium, Dr. Vic Narurkar said at the annual meeting of the Florida Society of Dermatology and Dermatologic Surgery.

"One of the most exciting technologies to come out this year is a dermal spectrophotometer, because it will be a way of determining the skin's erythema and melanin content," said Dr. Narurkar, a dermatologist in private practice in San Francisco.

This advance is needed because the Fitzgerald skin type classification is outdated, he explained. "Darker skin often gets lumped into the Fitzpatrick IV, V, and VI, when there are many variations within all of those skin types," he said.

A far better method is to have some type of computer model determine the pigmentation and redness, as well as the background pigmentation and redness.

Another reason for improving the current classification system is that coloring on the face and body may not match.

This LED device, manufactured by Palomar Medical Technologies Inc., is pending approval. The hope is that it will be released by summer's end, he said.

Photopneumatic laser therapy, another new device, manufactured by Aesthera Corp., has been cleared by the FDA for hair removal and skin rejuvenation. However, it is being used off label to treat acne and is in clinical trials for that indication.

The theory behind this device is very intriguing, in that is uses suction and lower wavelengths of light, explained Dr. Narurkar. "When we treat acne with lasers, we either try to destroy the Propionibacterium acnes bacteria with devices that are in the blue light wavelength, or we try to modify the sebaceous glands with devices that are in the red light wavelength," he said. A suction-based device can be brought closer to the skin and simultaneously is able to address both the P. acnes bacteria and the sebaceous glands. The photopneumatic laser uses a lower band of light, which allows for better absorption.

"In our clinical study, we saw an immediate improvement in the inflammatory component of acne, and then more of a delayed effect in the reduction of new acne lesions," Dr. Narurkar explained. "The device is in clinical trials right now."

Dr. Narurkar is a member of the medical advisory board of Aesthera, and he performs clinical studies for Palomar Medical Technologies.

BOCA RATON, FLA. — A new light-emitting diode device awaiting approval and an expected expanded indication for a laser are poised to expand the dermatologic device armamentarium, Dr. Vic Narurkar said at the annual meeting of the Florida Society of Dermatology and Dermatologic Surgery.

"One of the most exciting technologies to come out this year is a dermal spectrophotometer, because it will be a way of determining the skin's erythema and melanin content," said Dr. Narurkar, a dermatologist in private practice in San Francisco.

This advance is needed because the Fitzgerald skin type classification is outdated, he explained. "Darker skin often gets lumped into the Fitzpatrick IV, V, and VI, when there are many variations within all of those skin types," he said.

A far better method is to have some type of computer model determine the pigmentation and redness, as well as the background pigmentation and redness.

Another reason for improving the current classification system is that coloring on the face and body may not match.

This LED device, manufactured by Palomar Medical Technologies Inc., is pending approval. The hope is that it will be released by summer's end, he said.

Photopneumatic laser therapy, another new device, manufactured by Aesthera Corp., has been cleared by the FDA for hair removal and skin rejuvenation. However, it is being used off label to treat acne and is in clinical trials for that indication.

The theory behind this device is very intriguing, in that is uses suction and lower wavelengths of light, explained Dr. Narurkar. "When we treat acne with lasers, we either try to destroy the Propionibacterium acnes bacteria with devices that are in the blue light wavelength, or we try to modify the sebaceous glands with devices that are in the red light wavelength," he said. A suction-based device can be brought closer to the skin and simultaneously is able to address both the P. acnes bacteria and the sebaceous glands. The photopneumatic laser uses a lower band of light, which allows for better absorption.

"In our clinical study, we saw an immediate improvement in the inflammatory component of acne, and then more of a delayed effect in the reduction of new acne lesions," Dr. Narurkar explained. "The device is in clinical trials right now."

Dr. Narurkar is a member of the medical advisory board of Aesthera, and he performs clinical studies for Palomar Medical Technologies.

OUR LUCAYA, BAHAMAS — Performing Mohs surgery or other close, long-duration procedures may cause repetitive strain injuries, Dr. Henry W. Randle said at the annual meeting of the American Society for Mohs Surgery.

Mohs surgeons are at particular risk for injuries resulting from prolonged work that involves repetitive movements and awkward body positions. "Even young surgeons are at risk. Early intervention is important," said Dr. Randle of the Mayo Clinic, Jacksonville, Fla., whose interest in the topic stemmed from his own experience with neck pain after years of performing Mohs surgery.

A survey of 17 Mohs surgeons from three Mayo Clinic sites (Florida, Minnesota, and Arizona) revealed surprising results: 16 reported symptoms of repetitive strain injuries. Of those, 12 said the symptoms started while they were performing Mohs surgery, while 4 reported preexisting conditions that worsened during the procedure. "This was really quite striking. I thought we'd find three or four," he said.

The group comprised 12 men and 5 women, with a mean age of 39.5 years. They had an average of 7 years' experience with Mohs surgery, spending approximately 24 hours per week performing the procedure. The majority (14) operated primarily while standing.

Among the 12 who reported symptoms that began while practicing Mohs, the average age of onset was 35.4 years after a mean of just 2.5 years in practice. "This was much earlier than I thought … It happens very early in your career," he said.

Neck pain was the most common complaint, affecting 10 of the 17 respondents. Shoulder pain was reported by 9, low back pain by 7, eye fatigue/burning by 5, headaches, by 4, and leg edema by 3. Low back pain was more common among the surgeons who typically worked while standing, while neck pain was more common among those who were usually seated while doing Mohs.

But on the bright side, there are ways of minimizing these problems. After analyzing videotapes of six study participants, an expert in occupational medicine and ergonomics made the following recommendations to alleviate the various symptoms:

▸ Neck pain. Often a result of too much distance between the surgeon and the patient, neck pain can be exacerbated by bulky operating tables that require the surgeon to bend over too far. Less bulky operating tables, such as dental chairs, can allow for closer access to the patient. Odd angles of the neck can also lead to pain. Repositioning yourself in front of the patient and taking frequent breaks to stretch can provide relief.

▸ Shoulder pain. Reaching over the patient is a common cause. Sometimes with older patients who can't move themselves very easily, surgeons will tend to adjust themselves around the patient. But it's better to move the patient (or have the nurse do it) than to strain. A chair that provides sternal support allows the surgeon to rest his or her elbows while leaning forward over the patient, thereby easing tension in the neck, Dr. Randle explained.

▸ Low back pain. Surgeons with low back pain who stand for Mohs surgery might try sitting. Chairs with sternal support can also help alleviate low back pain. For those who still want to stand, "sit stands" allow the surgeon to take short breaks and lean back during the procedure.

▸ Eye fatigue and headaches. Bright lights and glare contribute to both problems. Lowering the lighting in the room and using black instruments may help.

▸ Leg edema. Inactive posture is the culprit here, but the problem can be alleviated by moving around and taking frequent breaks. Sitting, foot rests/rails, and compression stockings may also help. Floor mats with surface variations have been installed in the operating rooms at Mayo to help alleviate foot pressure. Gel-containing shoe inserts available over the counter at drugstores can accomplish the same thing.

During the question and answer period, audience member and fellow conference speaker Dr. Daniel Buchen, who is in private practice in New Jersey and Staten Island, N.Y., told the audience that he is a loyal follower of—but has no financial ties to—a program called PowerPosture (www.powerposture.com

OUR LUCAYA, BAHAMAS — Performing Mohs surgery or other close, long-duration procedures may cause repetitive strain injuries, Dr. Henry W. Randle said at the annual meeting of the American Society for Mohs Surgery.

Mohs surgeons are at particular risk for injuries resulting from prolonged work that involves repetitive movements and awkward body positions. "Even young surgeons are at risk. Early intervention is important," said Dr. Randle of the Mayo Clinic, Jacksonville, Fla., whose interest in the topic stemmed from his own experience with neck pain after years of performing Mohs surgery.

A survey of 17 Mohs surgeons from three Mayo Clinic sites (Florida, Minnesota, and Arizona) revealed surprising results: 16 reported symptoms of repetitive strain injuries. Of those, 12 said the symptoms started while they were performing Mohs surgery, while 4 reported preexisting conditions that worsened during the procedure. "This was really quite striking. I thought we'd find three or four," he said.

The group comprised 12 men and 5 women, with a mean age of 39.5 years. They had an average of 7 years' experience with Mohs surgery, spending approximately 24 hours per week performing the procedure. The majority (14) operated primarily while standing.

Among the 12 who reported symptoms that began while practicing Mohs, the average age of onset was 35.4 years after a mean of just 2.5 years in practice. "This was much earlier than I thought … It happens very early in your career," he said.

Neck pain was the most common complaint, affecting 10 of the 17 respondents. Shoulder pain was reported by 9, low back pain by 7, eye fatigue/burning by 5, headaches, by 4, and leg edema by 3. Low back pain was more common among the surgeons who typically worked while standing, while neck pain was more common among those who were usually seated while doing Mohs.

But on the bright side, there are ways of minimizing these problems. After analyzing videotapes of six study participants, an expert in occupational medicine and ergonomics made the following recommendations to alleviate the various symptoms:

▸ Neck pain. Often a result of too much distance between the surgeon and the patient, neck pain can be exacerbated by bulky operating tables that require the surgeon to bend over too far. Less bulky operating tables, such as dental chairs, can allow for closer access to the patient. Odd angles of the neck can also lead to pain. Repositioning yourself in front of the patient and taking frequent breaks to stretch can provide relief.

▸ Shoulder pain. Reaching over the patient is a common cause. Sometimes with older patients who can't move themselves very easily, surgeons will tend to adjust themselves around the patient. But it's better to move the patient (or have the nurse do it) than to strain. A chair that provides sternal support allows the surgeon to rest his or her elbows while leaning forward over the patient, thereby easing tension in the neck, Dr. Randle explained.

▸ Low back pain. Surgeons with low back pain who stand for Mohs surgery might try sitting. Chairs with sternal support can also help alleviate low back pain. For those who still want to stand, "sit stands" allow the surgeon to take short breaks and lean back during the procedure.

▸ Eye fatigue and headaches. Bright lights and glare contribute to both problems. Lowering the lighting in the room and using black instruments may help.

▸ Leg edema. Inactive posture is the culprit here, but the problem can be alleviated by moving around and taking frequent breaks. Sitting, foot rests/rails, and compression stockings may also help. Floor mats with surface variations have been installed in the operating rooms at Mayo to help alleviate foot pressure. Gel-containing shoe inserts available over the counter at drugstores can accomplish the same thing.

During the question and answer period, audience member and fellow conference speaker Dr. Daniel Buchen, who is in private practice in New Jersey and Staten Island, N.Y., told the audience that he is a loyal follower of—but has no financial ties to—a program called PowerPosture (www.powerposture.com

OUR LUCAYA, BAHAMAS — Performing Mohs surgery or other close, long-duration procedures may cause repetitive strain injuries, Dr. Henry W. Randle said at the annual meeting of the American Society for Mohs Surgery.

Mohs surgeons are at particular risk for injuries resulting from prolonged work that involves repetitive movements and awkward body positions. "Even young surgeons are at risk. Early intervention is important," said Dr. Randle of the Mayo Clinic, Jacksonville, Fla., whose interest in the topic stemmed from his own experience with neck pain after years of performing Mohs surgery.

A survey of 17 Mohs surgeons from three Mayo Clinic sites (Florida, Minnesota, and Arizona) revealed surprising results: 16 reported symptoms of repetitive strain injuries. Of those, 12 said the symptoms started while they were performing Mohs surgery, while 4 reported preexisting conditions that worsened during the procedure. "This was really quite striking. I thought we'd find three or four," he said.

The group comprised 12 men and 5 women, with a mean age of 39.5 years. They had an average of 7 years' experience with Mohs surgery, spending approximately 24 hours per week performing the procedure. The majority (14) operated primarily while standing.

Among the 12 who reported symptoms that began while practicing Mohs, the average age of onset was 35.4 years after a mean of just 2.5 years in practice. "This was much earlier than I thought … It happens very early in your career," he said.

Neck pain was the most common complaint, affecting 10 of the 17 respondents. Shoulder pain was reported by 9, low back pain by 7, eye fatigue/burning by 5, headaches, by 4, and leg edema by 3. Low back pain was more common among the surgeons who typically worked while standing, while neck pain was more common among those who were usually seated while doing Mohs.

But on the bright side, there are ways of minimizing these problems. After analyzing videotapes of six study participants, an expert in occupational medicine and ergonomics made the following recommendations to alleviate the various symptoms:

▸ Neck pain. Often a result of too much distance between the surgeon and the patient, neck pain can be exacerbated by bulky operating tables that require the surgeon to bend over too far. Less bulky operating tables, such as dental chairs, can allow for closer access to the patient. Odd angles of the neck can also lead to pain. Repositioning yourself in front of the patient and taking frequent breaks to stretch can provide relief.

▸ Shoulder pain. Reaching over the patient is a common cause. Sometimes with older patients who can't move themselves very easily, surgeons will tend to adjust themselves around the patient. But it's better to move the patient (or have the nurse do it) than to strain. A chair that provides sternal support allows the surgeon to rest his or her elbows while leaning forward over the patient, thereby easing tension in the neck, Dr. Randle explained.

▸ Low back pain. Surgeons with low back pain who stand for Mohs surgery might try sitting. Chairs with sternal support can also help alleviate low back pain. For those who still want to stand, "sit stands" allow the surgeon to take short breaks and lean back during the procedure.

▸ Eye fatigue and headaches. Bright lights and glare contribute to both problems. Lowering the lighting in the room and using black instruments may help.

▸ Leg edema. Inactive posture is the culprit here, but the problem can be alleviated by moving around and taking frequent breaks. Sitting, foot rests/rails, and compression stockings may also help. Floor mats with surface variations have been installed in the operating rooms at Mayo to help alleviate foot pressure. Gel-containing shoe inserts available over the counter at drugstores can accomplish the same thing.

During the question and answer period, audience member and fellow conference speaker Dr. Daniel Buchen, who is in private practice in New Jersey and Staten Island, N.Y., told the audience that he is a loyal follower of—but has no financial ties to—a program called PowerPosture (www.powerposture.com