Objectives: The aim of the work was the implanting of PCL-PLLA barbed threads on the back of the hands to reduce the skin flap and improve the elasticity of the dermis, with an additional morphological research of the dermis.
Introduction: Rejuvenation of the back of the hands is one of the most difficult issues in aesthetic medicine, and given the aging properties of this area, anatomical, morphological and functional features of the skin, as well as regular damage due to environmental factors and household chemicals, the task still remains relevant. Usually, liquid implants based on hyaluronic acid (HA), polylactic acid (PLA), calcium hydroxyopatite (CaHa), and smooth thread implants such as polycaprolactone and poly-L-lactic acid (PCL-PLLA), polydioxanone ( PDO) compounds are used to correct the changes. All of them are aimed at replenishing the lost volume of adipose tissue on the back of the hand and moisturizing the skin. The purpose of this experiment is to insert PCL-PLLA barbed thread implants into the back of the hands to reduce the skin graft and improve the dermis elasticity, while preserving the natural appearance of the hands, as well as to perform morphological study of the dermis which has not been previously described in literary sources.
Materials / method: The treatment of involutional changes in the skin of the back of the hands was performed on a 50-year-old patient with pronounced excess of atrophic skin of the area accompanied by a significant deficit of fat tissue and moderate visualization of tendons and veins. Thread implants were installed in the manner of the supraaponeurotic cell gap (subcutaneous space) area reinforcement by the fan technique, two punctures were made in the projection of the wrist joint, 2 threads were installed in the internal injection and 3 threads in the external injection of both sides on two hands. In total, 5 thread implants were installed on each hand. The threads partially intersected in the center of the back of the hand, forming a diamond-shaped grid. The threads were installed aseptically, the patient received infiltration anesthesia with a solution of ultracaine and 0.9% NaCl in a ratio of 2:10 before the procedure. The results of the correction were evaluated at 3, 6, and 12 months using visual assessment (photographs), also using the Merz Hand Grading Scale skin quality assessment scales and the Global Aesthetic Improvement and Safety (GAIS) scale. To reliably assess the result, an electronic microscopic examination of punch biopsy specimens taken before the procedure and 3 months after the procedure was carried out.
Results: The treatment of involutional changes in the skin of the back of the hands was performed on a 50-year-old patient with pronounced excess of atrophic skin of the area accompanied by a significant deficit of fat tissue and moderate visualization of tendons and veins. Thread implants were installed in the manner of the supraaponeurotic cell gap (subcutaneous space) area reinforcement by the fan technique, two punctures were made in the projection of the wrist joint, 2 threads were installed in the internal injection and 3 threads in the external injection of both sides on two hands. In total, 5 thread implants were installed on each hand. The threads partially intersected in the center of the back of the hand, forming a diamond-shaped grid. The threads were installed aseptically, the patient received infiltration anesthesia with a solution of ultracaine and 0.9% NaCl in a ratio of 2:10 before the procedure. The results of the correction were evaluated at 3, 6, and 12 months using visual assessment (photographs), also using the Merz Hand Grading Scale skin quality assessment scales and the Global Aesthetic Improvement and Safety (GAIS) scale. To reliably assess the result, an electronic microscopic examination of punch biopsy specimens taken before the procedure and 3 months after the procedure was carried out.
Conclusion: Despite the possibility of bruising in the early stages, the use of PCL-PLLA barbed thread implants, unlike previously used techniques, can significantly reduce the skin flap of the back of the hand and increase the elasticity of the skin while maintaining the natural appearance of the hand. It should be noted that the persisting contouring of the threads on the back of the hands 12 months after the procedure in our case is due to the lack of subcutaneous fat in this area, which further increases the time of the implant hydrolysis prolonging the processes of tissue revitalization.
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