BackgroundFacial lines and wrinkles are strongly influenced by individual differences in anatomy and muscle activity and no single injection protocol will suit all patients. However, there is only limited information in the published literature on how to develop a tailored approach to botulinum toxin treatment.MethodsAn expert panel of physicians was convened to establish a consensus on developing an individualized approach to treatment of the forehead with incobotulinumtoxinA. Separate treatment protocols were developed for men and women and subdivided by background level of muscle activity: kinetic, hyperkinetic, and hypertonic. Each muscle tone category was then further subdivided to take account of individual characteristics that can influence treatment.ResultsConsensus members describe how to perform a dynamic assessment to optimize the dose and injection technique for each patient. A tailored treatment protocol is described for men and women with a wide range of forehead presentations. For each presentation, units of toxin as well as the precise location of injection points were defined by creating a 12-zone map of the forehead.ConclusionThese recommendations depart from traditional consensus documents by providing detailed incobotulinumtoxinA injection protocols for the forehead based on the major parameters that differ between patients, including muscular anatomy, size, and tone. It is expected that the use of this document will lead to more satisfactory, natural, and individualized aesthetic outcomes for patients.
The peer tutoring is a teaching strategy where generally more advanced semesters students, accompanying their peers from lower semesters in reinforcing learning processes within a subject area. In Universidad Industrial de Santander this mode is implemented through "Programa de Asesoría para el Mejoramiento del Rendimiento Académico", seeking to reduce the dropout rate in all academic programs. The objetive of this paper is to reflect on the importance of peer tutoring and describe the methodology provided by the program in the section histology of general morphophysiology land subject from the medicine program. Because peer tutoring has benefits for both the tutor and the beneficiary, it is important to implement this strategy in the transition from primary school to college and that is why the program recruitment, training and assessment tutors. Tutorials are conducted in small groups in the laboratory with visualization of histological slides and using media to the description of the different microscopic structures.
Tissue expansion allows reconstruction of large cutaneous defects with adjacent skin, similar in appearance and type, without using skin grafts or multiple, regional, distant, or microsurgical flaps. Conventional expansion produces a greater increase in surface and length than intraoperative expansion, but it has several disadvantages and should be reserved for closing problematic defects. There is considerable controversy about the relative effects of intraoperative expansion and undermining on the tensions of closing wounds, although immediate expansion is commonly used particularly in head and neck reconstruction. New multiple external devices have recently been described to expand skin externally, but there are few options as internal expanders. We have chosen multiple Foley catheter balloons, because of their availability and low cost, to repair 11 limb defects after excision of large naevi. The wounds are easy to close, primarily, and postoperative results are good. Dark pigmentation scars are the most common possible complications.
Papillary endothelial hyperplasia first described by Masson as vegetant intravascular hemangioendothelioma, is a reactive endothelial proliferation that, in many respects, mimics an angiosarcoma. Such lesions are most commonly located within veins of the head, neck and fingers, and must be included in differential diagnosis of vascular lesions. The clinicopathologic features of an unusual hand case are reported because of the origin of such a lesion from the first common volar digital artery. Surgical excision was followed by end-to-end vascular reconstruction, adequate blood flow was confirmed by a second angiographic study three months later.
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