JP2019515750A - Pixel array medical system, device and method - Google Patents

Abstract

Systems, devices, methods and compositions are described which include removing a portion of the epidermis within a subject's donor site and incorporating a dermal plug within the donor site. The injectable filler is formed by incising the dermal plug. The injectable filler is configured for injection into the target recipient site. [Selected figure] Fig. 146

Description

RELATED APPLICATIONS This application claims the benefit of priority from US Patent Application No. 62 / 331,076, filed May 3, 2016.
This application claims the benefit of priority from US Patent Application No. 62 / 456,775, filed Feb. 9, 2017.
This application claims the benefit of priority from US Patent Application No. 62 / 481,391, filed April 4, 2017.
This application is a continuation-in-part of US patent application Ser. No. 15 / 431,247, filed Feb. 13, 2017.
This application is a continuation-in-part of US patent application Ser. No. 15 / 431,230, filed Feb. 13, 2017.
This application is a continuation-in-part of US patent application Ser. No. 15 / 017,007, filed Feb. 5, 2016.
This application is a continuation-in-part of US patent application Ser. No. 15 / 016,954 filed Feb. 5, 2016.
This application is a continuation-in-part of US patent application Ser. No. 14 / 840,307, filed Aug. 31, 2015.
This application is a continuation-in-part of US Patent Application No. 14 / 840,290, filed August 31, 2015.
This application is a continuation-in-part of US patent application Ser. No. 14 / 840,267, filed Aug. 31, 2015.
This application is a continuation-in-part of US patent application Ser. No. 14 / 840,284 filed Aug. 31, 2015.
This application is a continuation-in-part of US patent application Ser. No. 14 / 840,274 filed Aug. 31, 2015.
This application is a continuation-in-part of US patent application Ser. No. 14 / 505,183, filed Oct. 2, 2014.
This application is a continuation-in-part of US patent application Ser. No. 14 / 505,090 filed Oct. 2, 2014.
This application is a continuation-in-part of US patent application Ser. No. 14 / 099,380, filed Dec. 6, 2013.
This application is a continuation-in-part of US patent application Ser. No. 14 / 556,648, filed Dec. 1, 2014. U.S. Patent Application No. 14 / 556,648 is a continuation of U.S. Patent Application No. 12 / 972,013, filed December 17, 2010 (now U.S. Patent No. 8,900,181).

TECHNICAL FIELD Embodiments herein relate to medical systems, devices or devices, and methods, and more particularly to medical devices and methods applied to surgical management of burns, skin defects, and hair transplantation.

  The aging process is most visually represented by the progression of dependent skin relaxation. This lifelong process can be seen as early as the thirties, and then gradually worsens over the decades. Previous studies have shown that some of the causes of skin-dependent elongation and age-related relaxation are progressive dermal atrophy, which is associated with reduced skin tension. Combined with the downward force of gravity, aging-related dermal atrophy will cause a two-dimensional stretch of the skin envelope. The clinical manifestation of this physical-organizational process is excessive skin relaxation. The areas most affected are the head, neck, upper arm, thigh, chest, lower abdomen and knee. The most visible of all these areas are the head and neck. In this area there is a pronounced "turkey gobbler" relaxation in the neck and a "jowls" in the lower part of the face, the cause of which is the dependence on the appearance of the skin in these areas.

  A plastic surgical procedure has been developed to remove excess loose skin. These procedures must use long incisions. In many cases, long incisions are hidden around anatomical boundaries. Such a boundary is, for example, between the ear and the scalp if the face is wrinkled and the lower part of the breast if it is a chest uplift (breast fixation). However, in some areas of skin relaxation, there is a trade-off between improved appearance due to firmer skin and visibility of the surgical incision. For this reason, excess skin on the upper arm, patella, thighs and buttocks is generally not removed because of the visibility of the surgical scar.

  Due to the frequency of this aesthetic distortion and the negative social impact, development of "face lift" surgery has been promoted. Other relevant plastic surgery procedures in different areas are abdominal surgery (abdomen), mastostatic (chest), and upper arm sagging (upper arm). The inherent adverse effects of these procedures are the risk of post-operative pain and scarring and surgical complications. Even though the aesthetic improvement of these techniques is an acceptable trade-off for the significant surgical incisions required, considerable permanent scarring is always part of these techniques. For this reason, plastic surgeons design these techniques to hide significant scars around anatomical boundaries such as hairline (face lift) and lower breast (mammary fixation) and inguinal sulcus (abdominoplasty) . However, many of these incisions are hidden away from the area of skin relaxation, thus limiting their effectiveness. Other skin relaxation areas, such as on the patella (upper front), are not correctable with plastic surgical resection due to poor tradeoff with more visible surgical scarring.

  Recently, electromagnetic medical devices that generate reverse thermal gradients (ie, Thermage) have attempted to tighten the skin without surgery, with or without success. At present, these electromagnetic devices are best used for patients with moderate skin relaxation. Because of the limitations of electromagnetic devices and the potential side effects of surgery, minimally invasive techniques are required to avoid surgical variability of medically relevant scars and electromagnetic heating of the skin. For many patients with aging-related skin relaxation (neck and face, arms, armpits, axilla, thigh, knee, buttocks, braline, chest pituitary), partial excision of excess skin is a significant part of conventional plastic surgery It can strengthen the segment.

  Even more prominent than cosmetic changes in the skin envelope are the surgical management of burns and other trauma-related skin defects. Severe burns are classified by the amount of burnt body surface and the depth of thermal destruction. First and second degree burns are generally managed in a non-surgical manner with topical cream application and burn dressings. Deeper third degree burns include thermal destruction of the entire thickness of the skin. Surgical management of these serious injuries involves the removal of burn scabs and the application of split skin grafts.

  Skin defects of full thickness are often generated by burns and resection of trauma and skin cancer and can be closed with flap transfer or skin tissue transplantation using current commercial equipment. Both surgical approaches require uptake from the donor site. The use of flaps is further limited by the need to include a stemmed blood supply and in most cases by the need to directly close the donor site.

  The split-skin approach requires the incorporation of transplanted tissue from its own skin, ie from the same patient, due to immunological limitations.

  Typically, the burn patient's donor site is selected from the unburned area, and a partial thickness sheet of skin is taken from the area. It is the generation of a partial thickness skin defect at the donor site that goes around this approach. This loss of donor site is itself similar to a deep second degree burn. Healing by re-epithelialisation at this site is often painful and can take days. In addition, a visible deterioration of the donor site is generated that appears to be permanently thinner and bleached than the surrounding skin. For patients with significant surface area burns, skin graft uptake may be limited by the availability of non-burn areas.

  For these reasons, there is a need for equipment and procedures for cosmetic surgical skin tightening in the rapidly expanding aesthetic market. There is a need for a system, device, device or method that can repeatedly introduce skin grafts from the same donor site while removing degeneration of the donor site.

Incorporation by Reference Each patent, each patent application, and / or each publication referred to herein is incorporated herein by reference in its entirety. The extent is as much as if each individual patent, patent application and / or publication is specifically and individually indicated to be incorporated by reference.

FIG. 6 shows a PAD kit placed at a target site under the embodiment. In an embodiment, it is a cross section of a skull pet punch or device including a skull pet array. In an embodiment, it is a partial cross-section of a sculpt punch or device including a sculpt array. In the embodiment, an adhesive film with a backing (adhesive substrate) included in a PAD kit is shown. FIG. 7 shows an adhesive film (adhesive substrate) when used with a PAD kit frame and blade assembly under an embodiment. In the context of the embodiment, removal of skin pixels is shown. FIG. 10 is a side view showing the blade crossing and removing the cut skin pixel by the PAD kit under the embodiment; FIG. 16 is an isometric view showing blade / pixel interactions between approaches using a PAD kit, under an embodiment. FIG. 17 is another view of the procedure in which the PAD kit (with the exception of the blade for clarity) under the embodiment, resected and acquired skin pixels or plugs and unablated prior to ablation FIG. 6 shows both skin pixels or plugs. FIG. 6 is a side view of a portion of a pixel array, under an embodiment, showing a scalpet held on an infesting plate; FIG. 8A is a side view of a portion of a pixel array, showing an alternative embodiment, showing a sculpt held on an integrating plate. FIG. 2 is a top view of a skull pet plate according to the embodiment. FIG. 6 is an enlarged view of a part of the skull pet plate according to the embodiment. In the embodiment, an example of a rotating pixel drum is shown. In the embodiment, an example of a rotating pixel drum assembled to a handle is shown. In an embodiment, a drum dermatome is shown for use with a skull pet plate. Fig. 2 shows a drum dermatome arranged on a skull pet plate under an embodiment. FIG. 7 is another view of a drum dermatome disposed on a skull pet plate under an embodiment. FIG. 10 is an isometric view of the application of a drum dermatome (eg, Paget dermatome) to a sculpt plate under an embodiment, wherein the adhesive film is that drum of the dermatome prior to rolling the drum on the ingesting plate. Applies to FIG. 10 is a side view of a portion of a drum dermatome, under an embodiment, showing the position of the blade relative to the sculpt plate. FIG. 10 is a side view of a portion of a drum dermatome, under an embodiment, showing different positions of the blade relative to the scalpet plate. FIG. 7 is a side view of a drum dermatome with an alternative position of the blade relative to the sculpt plate under an embodiment; FIG. 10 is a side view of a drum dermatome with a transversal blade clip, under an embodiment, showing transversal of skin pixels by the blade clip. FIG. 6 is a bottom view of the drum dermatome along the skull pet plate, under an embodiment. FIG. 6 is a front view of the drum dermatome along the skull pet plate, under an embodiment. FIG. 6 is a rear view of the drum dermatome along the skull pet plate, under an embodiment. FIG. 1 shows an assembly view of a dermatome with pixel-on-lay sleeve (POS) under an embodiment. FIG. 7 shows an exploded view of a dermatome with pixel-on-lay sleeve (POS) under an embodiment. In an embodiment, a portion of a dermatome with a pixel on lay sleeve (POS) is shown. The slip-on PAD which slides on a paget drum dermatome is shown under an embodiment. FIG. 2 shows an assembly drawing of a slip-on PAD installed on a paget drum dermatome, under an embodiment. Fig. 7 shows a slip-on PAD installed on a paget drum dermatome and used with a perforated template or guide plate under an embodiment. Fig. 7 shows the skin pixel uptake by the paget drum dermatome and the installed slip-on PAD under an embodiment. An example of the pixel drum dermatome currently applied to the target site of the skin surface under an embodiment is shown. FIG. 10 shows another view of a portion of a pixel drum dermatome being applied to a target site on a skin surface, under an embodiment. In an embodiment, a side perspective view of the PAD assembly is shown. FIG. 10 shows a top perspective view of a scalpet device for use with a PAD assembly, under an embodiment. FIG. 10 shows a bottom perspective view of a scalpet device used with a PAD assembly, under an embodiment. In an embodiment, a side view of a punch impact device including a vacuum component is shown. In accordance with an embodiment, a top view of a vibrating flat skull pet array and blade device is shown. FIG. 7 shows a bottom view of a vibrating flat skull pet array and blade device under an embodiment. FIG. 6 is an enlarged view of a flat array when the scalpet array, the blade, the adhesive film, and the adhesive backer are assembled under the embodiment. FIG. 7 is an enlarged view of a flat array of scalpets with feeder components, under an embodiment. In an embodiment, a cylindrically cut cadaver dermal matrix is shown, resembling a size-incorporated skin pixel graft. In an embodiment, a drum array drug delivery device. FIG. 7 is a side view of a needle array drug delivery device, under an embodiment. FIG. 10A is a top isometric view of a needle array drug delivery device, under an embodiment. FIG. 7A is a bottom isometric view of a needle array drug delivery device, under an embodiment. Indicates the composition of human skin. Shown is the physiological cycle of hair growth. In the embodiment, uptake of donor hair follicle is shown. Under the embodiment, preparation of a recipient site is shown. Under the embodiment, the arrangement of the incorporated hair plug in the recipient site is shown. In the embodiment, the arrangement of the porous plate at the donor site of the occipital scalp is shown. In the embodiment, the depth of penetration of the scalpet into the skin is shown when the scalpet is configured to penetrate the subcutaneous fat layer to obtain a hair follicle. In an embodiment, hair plug uptake using a porous plate at the donor site at the back of the head is shown. Under the embodiment, the generation of visible hairline is shown. Under the embodiment, preparation of donor sites for producing identical skin defects in recipient sites using patterned porous plates and spring loaded pixelated devices is shown. Under the embodiment, implantation of the incorporated plug by inserting the incorporated plug into the corresponding skin defect generated at the recipient site is shown. In the context of an embodiment, a clinical endpoint using pixel dermatome devices and techniques is shown. In an embodiment, it is an image of the skin in which the engraving was performed at the corner and the middle point of the area to be ablated. In the embodiment, it is an image of a postoperative skin resection field. FIG. 10 is an image after 11 days of surgery under the embodiment, showing an image showing that the resection has been primarily cured together with the measured margin. In an embodiment, it is an image of 29 days after the operation, which is an image showing the primary healing of the resection and the measured primary maturation of the resected field along with the margin. In an embodiment, it is an image of 29 days after the operation, which is an image showing along with the lateral dimension measured that the excision is primary healing and primary maturation of the excision field is continued. In the embodiment, it is an image 90 days after the operation, which is an image showing along with a lateral dimension measured that the excision is primary healing and primary maturation of the excision field is continued. According to an embodiment, it is a scalpet that exhibits an applied rotational and / or impact force. In an embodiment, an array including a gear skull pet and a gear skull pet is shown. FIG. 7 is a bottom perspective view of the ablation device including a sculpt assembly with a gear sculpt array, under an embodiment. FIG. 7 is a bottom perspective view of a sculpt assembly (housing not shown) with a gear sculpt array in accordance with an embodiment. FIG. 2 is a detailed view of a gear skull pet array according to the embodiment. In an embodiment, an array is shown that includes a sculpt in a friction drive configuration. In an embodiment, an array is shown comprising a spiral sculpt (outwardly) and a spiral sculpt (outwardly). Under the embodiment, a side perspective view (left) of a sculpt assembly including a spiral sculpt array and a side perspective view (right) of a cutting device including a sculpt assembly with a spiral sculpt array (right) Housing shown). FIG. 7 is a side view of an ablation device (with the housing depicted as transparent for clarity of the description) including a sculpt assembly with a helical sculpt array assembly under an embodiment. FIG. 16 is a bottom perspective view of the ablation device (with the housing depicted as transparent for clarity of the description) including a sculpt assembly with a helical sculpt array assembly under an embodiment. FIG. 16 is a top perspective view of the ablation device (with the housing depicted as transparent for clarity of the description) including a sculpt assembly with a helical sculpt array assembly under an embodiment. In an embodiment, it is a push plate of a spiral sculpt array. In an embodiment, a spiral sculpt array with a push plate is shown. In accordance with an embodiment, an array including an inner spiral sculpt and an inner spiral sculpt is shown. In an embodiment, a spiral sculpt array with a drive plate is shown. In accordance with an embodiment, an array including a slotted scalpel and a slotted scalpet is shown. In an embodiment, a portion of a slotted sculpt array (eg, four (4) sculpts) with drive rods is shown. In an embodiment, an exemplary slotted scarpet array (e.g., 25 sculpts) with a drive rod is shown. In an embodiment, a vibratory pin drive assembly with a scalpel is shown. In an embodiment, variable skull pet exposure control with a skull pet guide plate is shown. 7 depicts a sculpt assembly including a sculpt array (eg, helical) configured to be manually driven by an operator, under an embodiment. The force exerted on the scalpet via application to the skin is shown. In the embodiment, a steady axial compression using a scalpel is shown. In the embodiment, the compression plus motion impact force by a constant single axial force using a scalpet is represented. In the embodiment, it indicates that the skull pet is moved at a certain speed and applied to the skin and penetrated. In the embodiment, the tip of a plurality of needles is shown. In accordance with an embodiment, a toothless square sculpt (left) and a square sculpt with multiple teeth (right) are shown. FIG. 10 shows a side view, front view (or rear view) and side perspective view of a round scalpet with beveled tip, under an embodiment. In accordance with an embodiment, a round sculpt with a serrated edge is shown. FIG. 10 shows a side view of the ablation device (the housing is depicted as being transparent for clarity), including an embodiment of a sculpt array and a sculpt assembly with a push pin. FIG. 7 shows a top perspective cross-sectional view of the ablation device (the housing is depicted as being transparent for clarity), including an embodiment of a sculpt array and a sculpt assembly with a push pin. In an embodiment, a side view and a top perspective view of a sculpt assembly including a sculpt array and a push pin are shown. FIG. 10A is a side view of an ablation device including a sculpt assembly with a sculpt array assembly connected to a vibration source, under an embodiment. In an embodiment, a scalpel array driven by an electrodynamic source or scalpet array generator is shown. FIG. 2 is an illustration of an ablation device including a vacuum system, under an embodiment. FIG. 10 shows an example vacuum manifold applied to a target skin surface to remove / incorporate cut-out skin / hair plugs under an embodiment. FIG. 10 shows an vacuum manifold with an integrated wire mesh applied to a target skin surface to remove / incorporate cut-out skin / hair plugs under an embodiment. FIG. 10 shows an example vacuum manifold with integrated wire mesh configured to vacuum remove subcutaneous fat. FIG. In an embodiment, the collapsible docking station and the skin pixel to be inserted are represented. The docking station is formed of an elastic material, but is not limited thereto. FIG. 2 is a top view of the extended configuration (left) and the non-extended configuration (right) of the (e.g., resilient) docking station under the embodiment, under the embodiment; FIG. Under the embodiment, it is shown to remove the loose surplus skin without obvious wounds. Under the embodiment, we show the tightening of the skin without apparent wounding. In an embodiment, a three-dimensional contouring of the skin envelope is shown. In accordance with an embodiment, variable partial ablation densities in the treatment area are shown. Under the embodiment, a partial ablation of fat is shown. Indicates crocking of the skin surface. Under the embodiment, a deeper level topographic mapping of partial fat resection is shown. In the embodiment, a plurality of treatment contours are shown. Under the embodiment, a curvilinear treatment pattern is shown. FIG. 10 shows a digital image of a patient with a drawn digital wire mesh program, under an embodiment. In an embodiment, directional occlusion of a partial ablation field is shown. Under the embodiment, directed partial ablation of the skin is shown. In the context of an embodiment, the shortening of the incision through the continuous partial procedure is shown. FIG. 7 is an exemplary illustration of a “dog ear” skin surplus in chest reduction and abdominal surgery. In an embodiment, it is an sPAD that includes a single sharpened scalpet with depth control. Under the embodiment, it is sPAD including a standard single sculpt. In an embodiment, it is a sPAD that includes a pen-style gear reduction handpiece. In the embodiment, it is an sPAD including a 3 × 3 centerless array. In an embodiment, it is an sPAD that includes a large array cordless surgical drill. In an embodiment, it is a sPAD including a drill mounted 5 × 5 centerless array. In an embodiment, it is a sPAD including a vacuum assisted pneumatic cut spADD. In an embodiment, it is a VAPR sPAD that engages the drill via a DAC. In the embodiment, VAPR sPAD in the prepared state (left) and that in the extended treatment state (right) are shown. Under the embodiment, the SAVR sPAD is shown in the prepared state (left) and in the retracted state (right). FIG. 5 is a side cross-sectional view of a negative pressure aspirator configured to engage or attach in series with a vacuum manifold and a scalpel array, under an embodiment. FIG. 6 is an isometric cross-sectional view of a negative pressure aspirator configured to engage or attach in series with a vacuum manifold and a scalpel array, under an embodiment. FIG. 7 is a side view of an embodiment of a negative pressure suction device configured to engage or attach in series with the vacuum manifold and the scalpet array; FIG. 2 is a side cross-sectional view of a sculpt array used with a negative pressure aspirator, under an embodiment. FIG. 5 is an isometric cross-sectional view of a scalpet array for use with a negative pressure aspirator, under an embodiment. FIG. 2 is a perspective side view of a scalpet array for use with a negative pressure aspirator, under an embodiment. FIG. 1 is a side cross-sectional view of a vacuum manifold configured to engage or connect to a negative pressure aspirator, under an embodiment. FIG. 7 is an isometric cross-sectional view of a vacuum manifold configured to engage with or connect to a negative pressure aspirator, under an embodiment. FIG. 1 is a perspective side view of a vacuum manifold configured to engage or be connected to a negative pressure aspirator, under an embodiment. FIG. 6A is a perspective side view of a device with a vacuum component configured for manual control through an aperture, under an embodiment. FIG. 7 is an isometric view of a hand piece configured to include or incorporate a vacuum, under an embodiment. FIG. 7 is an isometric cutaway view of a handpiece configured to contain or incorporate a vacuum, under an embodiment. FIG. 7A is a side cross-sectional view of a single sculpt device applied to a target tissue site, under an embodiment. FIG. 7 is an isometric cross-sectional view of a single sculpt device applied to a target tissue site, under an embodiment. FIG. 7 is a side cross-sectional view of a multi-scarpet device applied to a target tissue site, under an embodiment. FIG. 6 is an isometric cross-sectional view of a multi-scarpet device applied to a target tissue site, under an embodiment. Under the embodiment, it is an exemplary slot sculpt. In an embodiment, it is an exemplary slotted blunt microtip cannula. In an embodiment, an exemplary ink stencil marking system. In the embodiment, an adhesive translucent porous plastic film is shown. FIG. 6 is a side view of an ASPPMP in use as a depth guide with a single sculpt device under an embodiment. FIG. 15 is a top isometric view of an ASPPMP in use as a depth guide with a single sculpt device under an embodiment. Under the example, partial excision of the skin and partial subdermal / subcutaneous lipectomy are shown. FIG. 16 shows a side view of a guy as a target area of partial skin excision and partial subdermal / subcutaneous lipectomy under the embodiment. FIG. 16 shows a bottom view (looking up) of a partially excised field guy as a target area for partially resected skin and partially subdermal / subcutaneous lipectomy under an embodiment. In an embodiment, a horizontal alignment treatment area on the guy and the side of the neck is shown for intense skin relaxation. Under an embodiment, it shows a wider partial lipectomy in mental health against severe lipodystrophy. 3 illustrates an example directional occlusion face and neck vector, under an embodiment. The Langer line of occlusion is shown. In accordance with an embodiment, a marked target area of the neck and a partial cut of the below-the-muscular fatter is shown. In an embodiment, an exemplary stencil is shown. In an embodiment, an exemplary directional occlusion vector is shown for the guy and fore neck. Show Z and W plastic scar repair. Under the embodiment, an example of a partial decontouring technique of scar removal is shown. Under the embodiment, an example of partial scarring of a wide hypotrophic scar is shown. In the embodiment, an example including shortening of a lower breast incision when applied to chest reduction and / or chest relocation is shown. 6 shows an exemplary flap closure. Under the embodiment, an example including partial skin grafting to be applied to the donor site is shown. Under the embodiment, an example including angiogenesis of partial skin transplantation at the recipient site is shown. In an embodiment, an illustrative docking station is shown that includes a docking tray and an adjustable slide. For example, a face having a target tissue that includes wrinkles and sags is shown. In accordance with an embodiment, a partially incised field (containing a skin plug) is shown. FIG. 7 is a detailed view of partial skin ablation defect incorporation, under an embodiment. In the embodiment, an example is shown with a skin plug taken in using a membrane applied directly to the drum dermatome. FIG. 7 shows the removal of epidermal components by crossing the dermatome-generated skin plug with a dermatome outrigger blade, under an embodiment. Under the embodiment, it is shown that skin plugs are individually taken on the membrane and then the membrane is applied to the dermatome (eg, drum). In accordance with an embodiment, there is shown a non-compressive mosherizer configured to mechanically cut the dermal plug into a viscous liquid. Under the embodiment, injection of LADMIX filler at the target tissue site is shown. In the embodiment, an example of a scalpet device including a multifunctional chamber is shown. In an embodiment, an exemplary vacuum flow path through the scalpet device is shown. In an embodiment, an exemplary scalpet device is shown following collection of pixels into a collection chamber. In an embodiment, the reverse handpiece is shown with the pixels in the collection chamber. FIG. 12 shows an inverted handpiece with an alternative end cap and fitting plug attached to an embodiment. Fig. 6 shows a handpiece with a sculpted blade mounted and positioned in a collection chamber with pixel solution under an embodiment. The bottom of an embodiment shows a LADMIX filler drawn into a syringe. 7 shows the syringe and attached needle ready for injection of LADMIX filler into the target tissue site under an embodiment. Under the embodiment, the skin blisters formed in the whole partial field are shown. FIG. 10 shows a partial field after removal of the overburdened tissue overlapping the entire partial field, under an embodiment. In accordance with an embodiment, the formation of a plurality of skin blisters is shown. In accordance with an embodiment, a plurality of partial fields are shown after removal of the overlying tissue that overlaps the partial fields. Under an embodiment, a single sculpt system or multiple sculpt arrays are used to illustrate incorporating dermal plugs within a blistered area. In an embodiment, a collection vessel or canister is shown including an incorporated dermal plug. In an embodiment, there is shown an squeeze container or canister containing an incorporated dermal plug. In accordance with an embodiment, a manual engraver is shown that includes a blade device configured to move up and down and / or rotate. In accordance with an embodiment, there is shown a motorized engraver including a blade or cutting device configured to rotate under power. In an embodiment, it is an exemplary marking system template. In accordance with an embodiment, the generation of a recipient pocket for injection is shown. In an embodiment, it is a recipient pocket with an injected filler. Under the embodiment, LADMIX infusion is used to treat female urinary incontinence.

  Systems, devices, methods and compositions are described which include removing a portion of the epidermis within a subject's donor site and incorporating a dermal plug within the donor site. The injectable filler is formed by incising the dermal plug. The injectable filler is configured for injection into the target recipient site.

  Systems, apparatus and methods are described that include a housing configured to include a sculpt device including a sculpt assembly. The skull pet assembly includes a skull pet array and one or more guide plates. The skull pet array includes a collection of skull pets, and in one aspect, the collection of skull pets includes a plurality of skull pets. The guide plate maintains the configuration of the skull pet assembly. The collection of sculpts is configured to exit the housing and into the housing and is configured to generate an open skin pixel at the target site upon exit. Incised skin pixels are taken.

  The scalpet devices described herein satisfy the rapidly expanding aesthetic market for devices and procedures for cosmetic surgical skin tightening. In addition, the embodiments allow for repeated incorporation of skin grafts from the same donor site while removing degeneration of the donor site. The embodiments described herein are configured to ablate excess relaxed skin without leaving a visible scar. In this case, all areas of excess skin relaxation can be ablated by the pixel array dermatome, and techniques can be performed in areas that were previously prohibited for visibility of the surgical incision. The technical effects achieved through the embodiments described herein include smooth and firm skin without visible scars and long scars along anatomical boundaries.

  The embodiments described in detail herein include pixel skin tissue grafting devices and methods configured to provide the ability to repeatedly take up a split-skin graft without leaving visible scars at the donor site. Be done. During the procedure, pixel array dermatome (PAD) is used to capture skin grafts from selected donor sites. During the uptake operation, the pixelated skin graft is placed on a quasi-porous flexible adhesive film. The incorporated skin graft / membrane hybrid is then applied directly to the skin defect site of the recipient. Partially excised donor sites are closed by the application of an adhesive sheet or bandage (eg, Flexzan® sheeting, etc.) which functions as a large butterfly type bandage for a predetermined period of time (eg, one week, etc.) . The primary healing process is promoted by closing the intradermal skin defect generated by PAD. In the process, the normal epidermal-dermal architecture is reorganized in an anatomical manner to minimize scarring. As occurs after surgery, the adhesive film desquaesates with the stratum corneum of the transplanted tissue. The membrane can then be removed from the recipient bed without disturbing the transplanted tissue.

  The many effects achieved by the pixel skin tissue grafting approach are worthy of explanation. Because skin grafts are pixelated, they provide drainage gaps between skin plug components, which can increase the percentage of "takes" as compared to sheet skin grafts. In the first week after surgery, skin grafts "take" at the recipient site by the process of angiogenesis. There, new blood vessels from the skin defect recipient bed grow in the new skin graft. The semi-porous membrane directs the exudate to the bandage.

  The flexible membrane is configured to have elastic recoil characteristics. The properties promote juxtaposition of component skin plugs within the graft / membrane mix, promote primary adjacent healing of the skin graft plug, and convert the skin appearance of the skin graft into a more uniform sheet form Be done. In addition, the membrane aligns the micro-architectural component skin plug so that the dermis is aligned with the dermis and the epidermis is aligned with the epidermis, which can promote a primary healing process that reduces scarring.

  There are many major clinical applications for the dermatome detailed herein. Partial skin removal for skin tightening, partial hair transplantation for alopecia, and partial skin uptake for skin transplantation. Partial skin ablation of embodiments involves incorporating the skin plug with an adhesive film, but a partially incised skin plug may be removed without incorporation. The incision, removal, and closure paradigm best describes the clinical application of skin tightening. The embodiments described herein are configured to facilitate dissection and removal. Embodiments also include novel means for dissecting the skin surface to provide a larger sculpt array comprising a large number of sculpts.

  Pixel array medical systems, devices or devices, and methods for skin grafting, skin resection and hair grafting are described. In the following description, numerous specific details are set forth in order to provide a thorough understanding of the embodiments of the present specification and a description for enabling the same. However, one skilled in the art will recognize that these embodiments can be practiced without one or more of the specific details, or with other components, systems, etc. Also, well-known structures or operations are not shown or described in detail to avoid obscuring aspects of the disclosed embodiments.

  The following terms, as they are used herein, are intended to have the following general meanings. However, the terms are not limited to the meanings mentioned herein. The meaning of any term is to be understood as it may include other meanings as understood and applied by the person skilled in the art.

  As used herein, "first degree burn" includes superficial burns without destruction of the dermis from the epidermis. The first burn is seen as erythema (redness) of the skin.

  As used herein, "second degree burn" includes relatively deep burns in which there is disruption of the dermis from the epidermis and degeneration of the epidermis of variable thickness. Most second-degree burns involve the formation of blisters. Deep second-degree burns can usually turn into third-degree burns of total thickness, usually by oxidation or infection.

  As used herein, "third degree burn" includes burns with thermal destruction throughout the thickness of the skin, including the dermis and epidermis. Third-degree burns may involve thermal destruction of the deeper underlying tissues (subcutaneous and muscle layers).

  As used herein, "ablation" includes the removal of tissue by the destruction of tissue, such as, for example, the heat removal of a skin lesion by a laser.

  As used herein, "autograft" includes transplants taken from the same patient.

  As used herein, a "backed adherent membrane" includes an elastic adhesive membrane that obtains a transversal skin plug. The supported adhesive film of the embodiment is supported on the outer surface to maintain the alignment of the skin plug during uptake. After uptake of the skin plug, the backing is removed from the adhesive film with the incorporated skin plug. The membranes of the embodiments have porosity to allow drainage when placed at the recipient site. The membrane of the embodiment has elastic recoil characteristics. Thus, when the backing is removed, it brings the sides of the skin plug closer together and promotes healing as a sheet graft at the recipient site.

  As used herein "burn scar contraction" includes the tightening of scar tissue that occurs during the wound healing process. This process is likely to occur with a third degree burn that has not been treated.

  As used herein, "burn scar contracture" includes a band of scar tissue that limits the range of motion of the joint or distorts the patient's appearance, i.e., a facial burn scar contracture.

  As used herein, "dermomatome" includes a device that "cuts the skin" or takes a sheet-like split-skin graft. Examples of drum dermatomes include Padgett and Reese dermatome. The electric dermatome is one electrical version of the Zimmer dermatome and the Paget dermatome.

  As used herein, "dermis" comprises the deep layers of the skin that are the main structural support, mainly comprising non-cellular collagen fibers. Fibroblasts are cells in the dermis that produce collagen protein fibers.

  As used herein, "donor site" includes an anatomic site from which skin graft tissue is taken up.

  As used herein, "Epidermis" comprises the outer layer of skin comprising viable epidermal cells and a non-viable stratum corneum that acts as a biological barrier.

  "Excise" as used herein includes surgical removal of tissue.

  As used herein, "Excisional Skin Defect" refers to a partial thickness defect or more typically a full thickness defect caused by surgical removal (ablation / dissection) of the skin (lesion) Including.

  As used herein, "FTSG" includes full-thickness skin grafts where the full thickness of the skin is incorporated. With the exception of instruments as described herein, the donor site is closed as a surgical incision. This limits the FTSG to the surface area that can be incorporated.

  As used herein, "granulation tissue" includes highly angiogenic tissues that grow in response to lack of skin in a full thickness skin defect. Granule tissue is an ideal base at skin graft recipient sites.

  As used herein, "Healing by primary intention" involves a wound healing process in which the normal anatomical configuration is reorganized with minimal scar tissue formation. Morphologically, scarring is less likely to be visible.

  As used herein, "Healing by secondary intention" is a more cohesive, less congenial arrangement of the anatomical structure and results in healing with more scar collagen produced. Not including wound healing process. Morphologically, scarring tends to be visible.

  As used herein, "homograft" includes transplanted tissue taken from different persons and applied as a temporary bio-bandage to a patient's recipient site. Many allogeneic transplants are taken as cadaver skin. While the temporary "take" of allotransplantation is partially achievable by immunosuppression, allotransplantation is eventually replaced by autologous transplantation if the patient survives.

  As used herein, "incise" includes making a surgical incision without removing tissue.

  As used herein, "Mesh Split Thickness Skin Graft" is a split-skinned skin whose surface has been expanded by repeatedly incising a skin graft taken in with a device called "Messher". including. Mesh-partitioned grafts have a higher "take" percentage than sheet-like grafts. Mesh separation grafts allow drainage through the graft and are better matched to the irregularity of the recipient site contour. However, it produces a scaly reticulated graft appearance at the recipient site.

  As used herein, "PAD" includes the pixel array dermatome, which is a class of equipment for partial skin ablation.

  A "PAD kit" as used herein comprises a disposable single use procedure kit comprising a porous guide plate, a scalpet stamper, a guide plate frame, a supported adhesive film, and a crosscutting blade. .

  As used herein, a "perforated guide plate" includes a perforated plate that includes the entire implant capture area, where the holes in the guide plate are aligned with the stamper with handle or the slipper on a slip-on-PAD. The plate also acts as a guard to prevent unintentional tearing of the skin next to it. The plurality of holes in the guide plate may be of different shapes, such as, but not limited to, circles, ovals, squares, rectangles and / or triangles.

  As used herein, “pixelated full-thickness skin graft” is a full-thickness skin graft taken up by the device described herein and does not involve reduced well-visible scarring at the donor site Including full thickness skin grafting. The transplanted tissue has an improved appearance at the recipient site as sheet-like FTSG, but will better fit at the recipient site and have a higher percentage of "takes" due to the drainage gap between the skin plugs. Another significant advantage of pixelated FTSG as compared to sheet-like FTSG is the ability to implant wider surfaces that would otherwise require STSG. This advantage results from the ability to reduce and introduce scarring visible from multiple donor sites.

  As used herein, "Pixilated Graft Harvest" includes skin grafting taken from a donor site by the devices detailed herein.

  As used herein, "pixelated split-layer skin" includes partial-layer skin taken up by the SRG instrument. Skin grafting shares the benefits of meshed skin grafts without ugly donor sites or ugly recipient sites.

  As used herein, "recipient site" includes skin defect sites to which skin graft tissue is applied.

  As used herein, "resect" includes excision.

  As used herein, "scarpet" includes a single-edged knife that dissects skin and soft tissue.

  As used herein, "scarpet" includes terms that describe a small geometry (e.g., circular, oval, rectangular, square, etc.) scalpet that dissects a skin plug.

  As used herein, “sculpet array” includes an array or array of a plurality of sculpts held on a substrate (eg, a base plate, stamper, stamper with handle, end, disposable end, etc.).

  As used herein, "sculpet stamper" includes the handle and sculpt array instrument component of a PAD kit that dissects a skin plug through a perforated guide plate.

  As used herein, “scar” includes visually noticeable morphological malformations from irregular collagen tissue deposition following wounds or irregular collagen tissue deposition following wounds.

  As used herein, "sheet-like full-thickness skin grafting" includes applying FTSG to recipient sites as a continuous sheet. The appearance of FTSG is superior to that of STSG, so it is mainly used for skin grafting in visually noticeable areas such as the face.

  As used herein, "sheet-like split-skin grafting" is a continuous sheet and includes partial-layer grafting with typical donor site malformation.

  As used herein, "skin defect" includes the absence of the entire layer of skin which may include deeper layers such as a subcutaneous fat layer and muscle. Skin defects can occur for a variety of reasons: surgical removal of burns, trauma or cancer and correction of congenital deformities.

  As used herein, a "skin pixel" includes a piece of skin comprising an epidermis and a divided or full thickness dermis cut out by a sculpt. Skin pixels may include skin appendages such as hair follicles with or without subcutaneous fat cuffs. Also includes skin plugs.

  As used herein, a "skin plug" is a circular (or other geometric shape) skin piece comprising an epidermis and a stratified or full thickness dermis, including a skin piece cut out by a sculpt, which is transverse Crossed by a cutting blade and obtained by an adhesive backing membrane.

  As used herein, "STSG" includes partial layer skin grafts in which part of the dermis and epidermis are taken up by transplantation.

  As used herein, "subcutaneous fat layer" includes a layer consisting of fat cells directly under the skin and mainly referred to as lipid cells. This layer acts as the main isolation layer from the environment.

  As used herein, a "cross-cutting blade", as detailed herein, is a horizontally disposed single-edged blade which is slotted in the frame of the perforated plate or attached to the outrigger arm of the drum dermatome. Including. The transversal blade traverses the base of the cut skin plug.

  As used herein, “wound healing” includes the essential biological processes that result from any type of wound, whether thermal, kinematic or surgical.

  As used herein, "xenograft" includes transplanted tissue taken from different species and applied as a temporary biological bandage to a recipient site of a patient.

  Several embodiments of pixel array medical systems, devices or devices, and methods used are detailed herein. The systems, devices or devices described herein, and methods for skin grafting, allow for skin that is not covered by visible scarring through devices used in various surgeries such as plastic surgery. Includes minimally invasive surgical approaches for firming skin excision, and additionally for hair transplantation. In one embodiment, the device is a disposable device. Embodiments herein avoid clinical variability of surgical-related scarring and electromagnetic heating of the skin and perform small scale multi-pixelated ablation of the skin as a minimally invasive alternative to large scale plastic surgical removal of the skin . The embodiments herein may be used for hair transplantation and may also be used on body parts that are plastically prohibited for visibility of surgical scars. In addition, the approach can perform a skin grafting operation while reducing scarring on the patient's donor site by taking a lateral incision in the skin from the donor's tissue site and placing it on the recipient's skin defect site.

  Minimally invasive pixels herein for many patients with aging-related skin relaxation (as non-limiting examples, neck and face, arms, axilla, thighs, knees, buttocks, braline, chest pituitary, etc.) Array medical devices and methods perform pixelated transection / cutting of excess skin, replacing scarred plastic surgery. In general, the techniques described herein are performed in an office setting, under local anesthesia, to minimize perioperative discomfort, but are not limited thereto. Only a short recovery period is required, as compared to the long healing phase from plastic surgery. Preferably, the bandage and support garment wrapped around the treatment area are applied for a pre-specified period of time (eg, 5 days, 7 days, etc.). There is no or minimal pain associated with this procedure.

  The relatively small (e.g., in the range of about 0.5 mm to 4.0 mm) skin defects produced by the devices described herein apply a tacky sheet (e.g., Flexan (R)) Closed with Adhesive sheets (e.g., Flexan (R)) function as large butterfly bandages and may be pulled in a direction ("vector") that maximizes aesthetic contouring of the treatment area. A compressible elastic garment may be applied over the bandage to further aid in aesthetic contouring. After completion of the initial healing phase, a large number of small linear scars in the treatment area will have reduced visibility as compared to a larger plastic surgical incision in the same area. Due to the delayed wound healing response, it is likely that additional skin tightening will occur over several months. Other potential applications of the embodiments described herein are hair transplantation, treatment of alopecia, treatment of snoring / sleep apnea, orthopedics / physical therapy, vaginal tightening, Treatment of female urinary incontinence and tightening of the gastrointestinal sphincter.

  Severe burns are classified by the amount of burnt body surface and the depth of thermal destruction. The method used to manage these burns relies heavily on this classification. First and second degree burns are usually managed in a non-surgical manner with topical cream application and burn dressings. Deeper third degree burns include full-thickness thermal destruction of the skin and produce full-thickness skin defects. Surgical management of this serious wound usually involves scab scum removal of the burn and application of a split peel.

  Skin defects of full thickness are most often generated by burns and resection of trauma and skin cancer and can be closed with flap transfer or skin tissue transplantation using conventional commercial equipment. Both surgical approaches require uptake from the donor site. The use of flaps is further limited by the need to include a stemmed blood supply and in most cases by the need to directly close the donor site.

  The split-skin approach requires the incorporation of autologous skin grafts from the same patient due to immunological limitations. Typically, the burn patient's donor site is selected from the unburned area, and a partial thickness sheet of skin is taken from the area. It is the generation of a partial thickness skin defect at the donor site that goes around this approach. This loss of donor site is itself similar to a deep second degree burn. Healing by re-epithelialisation at this site is often painful and can take days. In addition, a visible deterioration of the donor site, which appears to be permanently thinner and bleached than the surrounding skin, is often produced. For patients with significant surface area burns, skin graft uptake may be limited by the availability of non-burn areas.

  Both conventional surgical approaches to closing skin defects (flap transfer and skin grafting) not only involve significant scarring of skin defect recipient sites, but also donor sites where graft tissue is taken. In contrast to conventional approaches, the embodiments described herein include pixel skin grafting approaches, also referred to as pixel array approaches. It removes this donor site deformation and provides a method to recapture skin grafts from any existing donor site including either sheet-like or pixelated donor sites. This ability to recapture skin grafts from existing donor sites reduces the surface area requirements for the donor site skin and also provides additional skin in severe burn patients with limited burn donor skin surface area. Provide portability.

  The pixel skin graft technique of the embodiment is used as a full thickness skin graft. Many clinical applications such as facial skin grafts, hand surgery and treatment of congenital deformities are best performed with full-thickness skin grafts. The texture, color and overall morphology of full-thickness skin grafts are closer to the skin next to the defect than split skin grafts. For this reason, full-thickness skin grafts in visually noticeable areas are visually superior to split skin grafts. The main drawback of full-thickness skin grafting under conventional procedures is the long linear scar created from surgical sutures of full-thickness donor site defects. This scarring limits the size and availability of full thickness skin grafts.

  In comparison, the full thickness skin grafts of the pixel skin graft procedure described herein have a lower degree of restriction on their size and availability as linear scars at the donor site are removed. Thus, many skin defects that are usually covered by split skin grafts will instead be treated using pixelated full thickness skin grafts.

  The pixel skin graft approach provides the ability to introduce split skin grafts and full thickness skin grafts while minimizing visible scars at the donor site. During the procedure, a pixel array dermatome (PAD) device is used to capture skin grafts from selected donor sites. During the uptake operation, the pixelated skin graft is placed on the adhesive film. Although the adhesive film of embodiment contains a quasi-porous flexible adhesive film, it is not limited to this. The incorporated skin graft / membrane hybrid is then applied directly to the skin defect site of the recipient. The partially excised donor site is closed for a week by the application of an adhesive sheet (eg, Flexzan®) that functions as a large butterfly-type bandage. Closing the relatively small (eg, 1.5 mm) intradermal circular skin defect promotes the primary healing process. In the process, the normal epidermal-dermal architecture is reorganized in an anatomical manner to minimize scarring. The adhesive film, along with the stratum corneum of the transplanted tissue, exfoliates (falls off) as occurring about one week after the operation. The membrane can then be removed from the recipient bed without disturbing the transplanted tissue. Thus, healing of the donor site occurs rapidly, with minimal discomfort and scarring.

  Because the skin graft at the recipient defect site using the pixel skin graft technique is pixelated, it provides a drainage gap between skin pixel components, thereby "takes" compared to the sheet skin graft. ) Can be increased. In the first week after surgery (approximately), skin grafts "take" at the recipient site by the process of angiogenesis. There, new blood vessels from the skin defect recipient bed grow in the new skin graft. The semi-porous membrane directs the exudate (fluid) to the bandage. In addition, flexible membranes are designed with elastic recoil characteristics. The properties facilitate juxtaposition of component skin pixels within the graft / membrane complex, promote primary adjacent healing of skin graft pixels, and convert the pixelated appearance of skin graft into a uniform sheet form. Ru. In addition, the membrane aligns the micro-architectural component skin pixels so that the dermis is aligned to the dermis and the epidermis is aligned to the epidermis, which can facilitate a primary healing process that reduces scarring. In addition, pixelated skin grafts are more easily adapted to irregular recipient sites.

  The embodiments described herein include pixel skin ablation techniques, also referred to as pixel techniques. For many patients with aging-related skin relaxations (neck and face, arms, armpits, axilla, thigh, knee, buttocks, braline, chest pituitary, etc.), partial excision of excess skin is a plastic surgery with scarring Replace a significant segment of. In general, the pixel approach is performed under local anesthesia in an office setting. The post-operative recovery period includes wearing the support clothes for the days (for example, 5 days, 7 days, etc.) days (for example, 5, 7 etc.) designated in advance in the treatment area. It is expected that there will be no or relatively minor pain associated with the procedure. Small (e.g., 1.5 mm) circular skin defects are closed by applying an adhesive sheet (e.g., Flexan (R)). The adhesive sheet acts as a large butterfly bandage and is pulled in a direction ("vector") that maximizes aesthetic contouring of the treatment area. A compressible elastic garment may be applied over the bandage to further aid in aesthetic contouring. After completion of the initial healing phase, many small linear scars in the treatment area will not be visually noticeable. Furthermore, additional skin tightening will continue to occur over several months due to the delayed wound healing response. Thus, the pixel approach is the least invasive alternative to large scars in plastic surgery.

  The pixel array medical device of the embodiment includes a PAD kit. FIG. 1 shows a PAD kit placed at a target site under the embodiment. The PAD kit consists of a flat porous guide plate (guide plate), a scalpel punch or device containing a skull pet array (Figure 1-3), a supported adhesive film or substrate (Figure 4), a skin pixel crossing It comprises, but is not limited to, a blade and (FIG. 5). The skull pet punch according to the embodiment is a hand-held device, but is not limited thereto. In alternative embodiments, the guide plate is optional. This is detailed herein.

  FIG. 2 is a cross-sectional view of a PAD kit sculpt punch including a sculpt array according to the embodiment. A skull pet array contains one or more skull pets. FIG. 3 is a partial cross-sectional view of a PAD kit sculpt punch including a sculpt array according to the embodiment. Although the partial cross section shows that the total length of the scalpet of the skull pet array is determined by the thickness of the porous guide plate and the incision depth to the skin, the embodiment is not limited thereto.

  FIG. 4 shows an adhesive film with a backing (adhesive substrate) included in the PAD kit under the embodiment. The lower surface of the adhesive film is applied to the cut skin of the target site.

  FIG. 5 shows an adhesive film (adhesive substrate) when used with a PAD kit frame and blade assembly under an embodiment. The top surface of the adhesive film is oriented with the adhesive side down in the frame and pressed onto the porous plate to obtain the extruded skin pixel (also referred to herein as a plug or a skin plug) .

  Referring to FIG. 1, in the procedure using a PAD kit, a porous guide plate is applied to the skin excision / donor site. The scalpet punch is applied through at least the collection of holes in the perforated guide plate to incise the skin pixels. If the punch sculpt array contains fewer sculpts than the total number of holes in the guide plate, the sculpt punch is applied multiple times to the plurality of sets of holes. After one or more successive applications of the scalpet punch, the cut skin pixel or plug is captured on the adhesive substrate. The adhesive substrate is applied to capture the skin pixel or plug from which the adhesive was extruded. For example, the top surface of the adhesive substrate of the embodiment is oriented with the adhesive side down in the frame (if a frame is used) and pressed onto the porous plate to capture the extruded skin pixels or plugs Be As the membrane is pulled up, the captured skin pixels are crossed at its base by a crossing blade.

  FIG. 6 shows the removal of skin pixels under an embodiment. The adhesive substrate is lifted from the target site and pulled back (released). This action floats or pulls the cut skin pixel or plug. While the adhesive substrate is being lifted, a cutting blade is used to cross the base of the cut skin pixel. FIG. 7 is a side view showing, in accordance with an embodiment, the use of a PAD kit to cross cut and remove cut skin pixels. Crossing the skin pixel or plug base completes the pixel capture. FIG. 8 is an isometric view showing blade / pixel interactions during an approach using a PAD kit, under an embodiment. FIG. 9 is another view of an embodiment using a PAD kit (with the exception of the blade for clarity), wherein the resected and acquired skin pixel or plug and the resected is shown in FIG. FIG. 10 shows both a front unablated skin pixel or a plug. At the donor site, the pixelated skin excision site is closed by applying Flexan® sheeting.

  Guide plates and sculpt devices are also used to generate skin defects at the recipient site. The skin defect is configured to receive skin pixels that have been taken or captured at the donor site. The guide plate used at the recipient site may be the same as the guide plate used at the donor site or may be different with a different pattern or configuration of holes.

  The skin pixels or plugs placed on the adhesive substrate during the crossing are then transported to the skin defect site (recipient site). They are applied as pixelated skin grafts at the recipient skin defect site. The adhesive substrate has elastic recoil properties, which allow for closer alignment of skin pixels or plugs within the skin graft. Incised skin pixels can be applied directly from the adhesive substrate to the skin defect of the recipient site. Application of the incised skin pixel at the recipient site includes aligning the incised skin pixel with the skin defect and inserting the incised skin pixel into the corresponding skin defect of the recipient site.

  The pixel array medical device of the embodiment includes a pixel array dermatome (PAD). The PAD comprises a flat array of relatively small circular skullpets held on a substrate (e.g., an integrating plate). The sculpt combined with the substrate is referred to herein as a sculpt array, pixel array or sculpt plate. FIG. 10A is a side view of a portion of a pixel array, under an embodiment, showing a sculpt held on an integrating plate. FIG. 10B is a side view of a portion of the pixel array, showing an alternative embodiment, with the sculpt held on the inverting plate. FIG. 10C is a top view of the scalpet plate according to the embodiment.

  FIG. 10D is an enlarged view of a portion of the scalpet plate according to the embodiment. The skull pet plate is applied directly to the skin surface. One or more sculpts of the sculpt array include one or more of a sharp surface, a needle, and a needle including a plurality of tips.

  Embodiments of pixel array medical devices and methods include using an intake pattern instead of a guide plate. The uptake patterns include, but are not limited to, indicators or markers on the skin surface of at least one of the donor site and the recipient site. Markers include any compound that can be applied directly to the skin to mark the area of the skin. The uptake pattern is placed at the donor site and the scarpet array of the device is aligned or positioned with the uptake pattern of the donor site. As described herein, skin pixels are dissected at the donor site with a scalpel array. The recipient site is prepared by placing the uptake pattern at the recipient site. The uptake pattern used at the recipient site may be the same as the uptake pattern used at the donor site or may be different with different patterns or marker configurations. A skin defect is generated and an incision skin pixel is applied to the recipient site as described herein. Alternatively, the guide plate of the embodiment is used when applying the intake pattern, but is not limited thereto.

  The array of the embodiment may be used in conjunction with or as a modification to a drum dermatome, such as, for example, Paget Dermatome or Reids Dermatome, in order to leverage the existing surgical instruments, but is not limited thereto. The Paget Drum Dermatome, referred to herein, was originally developed by Dr. Earl Padget in the 1930's and continues to be widely used for skin transplantation by plastic surgeons around the world. Later, a modified version of the Paget Dermatome was developed to better calibrate the thickness of the incorporated skin graft. Although the drum dermatome of the embodiment is disposable (every operation), it is not limited thereto.

  In general, FIG. 11A shows an example of a rotating pixel drum 100 under an embodiment. FIG. 11B shows an example of a rotating pixel drum 100 assembled to the handle, under an embodiment. More specifically, FIG. 11C shows a drum dermatome for use with a scalpel plate, under an embodiment.

  In general, as with all pixel devices described herein, the pixel drum 100 can have various shapes without limitation, such as, for example, circular, semicircular, oval, square, flat, rectangular, etc. . In one embodiment, the pixel drum 100 is supported by an accelerator / handle assembly 102 and rotates about a drum rotation component 104 that is moved by, for example, an electric motor. In one embodiment, the pixel drum 100 may be placed on a stand (not shown) when not in use. The stand may function as a charger for the motorized rotary component of the drum or the motorized component of the syringe plunger. In one embodiment, a vacuum (not shown) may be applied to the skin surface of the pixel drum 100, and an outrigger (not shown) may be provided for tracking and stability of the pixel drum 100.

  In one embodiment, the pixel drum 100 incorporates a scalpel array 106 on the surface of the drum 100, whereby a plurality of small (e.g., 0.5-1.. 5 mm) Generate a circular incision. In one embodiment, the sculpt boundary shape may be designed to reduce pinking ("trap door") while creating a skin plug. The circumference of each skin plug can be extended by the skull pet to a skin plug of semicircular, oval or square shape in a non-limiting example instead of a circular skin plug. In one embodiment, the length of the scalpet 106 may vary depending on the thickness of the skin area selected by the surgeon for skin implantation purposes, ie, split or full layer.

  When the drum 100 is applied to the skin surface, the blades 108 provided inside the drum 100 traverse the base of each skin plug generated by the scalpet array. The inner blade 108 is connected to the central drum accelerator / handle assembly 102 and / or to an outrigger attached to the central accelerator assembly 102. In an alternative embodiment, the internal blade 108 is not connected to the drum accelerator assembly 102, and the base of the skin incision is traversed. In one embodiment, the internal blade 108 of the pixel drum 100 is either manually oscillated or moved by an electric motor. Depending on the density of the circular sculpts on the drum, within the area of excess skin relaxation, variable proportions of the skin (e.g. 20%, 30%, 40%, etc.) are crossed.

  In one embodiment, the additional pixel drum harvester 112 is internal to the drum 100 and incorporates the transected / pixelated skin incision / plug (pixel graft) from the tissue of the pixel donor to provide a pixel drum A skin grafting operation is performed by aligning on the adhesive film 110 arranged inside 100. A narrow space for the internal blade 108 is created between the scalpet array 106 and the adhesive film 110.

  In one embodiment, the blade 108 is provided on the outside of the drum 100 and the scalpet array 106 where the base of the incised circular skin plug is traversed. In another embodiment, the external blade 108 is connected to the drum accelerator assembly 102 when the base of the skin incision is traversed. In an alternative embodiment, the external blade 108 is not connected to the drum accelerator assembly 102 when the base of the skin incision is traversed. Adhesive film 110 pulls out and aligns the transected skin segments and is then placed at the skin defect site of the patient. The blade 108 (whether internal or external) may be, but is not limited to, a fenestrated layer of blades aligned with the scalpet array 106.

  The conformable adhesive film 110 of the embodiment is quasi-porous so that when the film with aligned transversal skin segments is extracted from the drum and applied as a skin graft, leaching in the recipient skin defect occurs. It becomes possible. The tacky quasi-porous drum membrane 110 has elastic recoil properties, which allow the transversal / pixelated skin plugs to be brought closer together for implantation at the recipient's skin defect site. That is, the margins of each skin plug are brought closer together as a more uniform sheet after the adhesive film with the pixelated implant is extracted from the drum 100. Alternatively, the sticky quasi-porous drum membrane 110 can be extended to cover a large surface area of the recipient skin defect site. In one embodiment, a sheet of adhesive backer 111 may be applied between adhesive film 110 and drum harvester 112. As detailed herein, the drum array of scalpet 106, blades 108 and adhesive film 110 may be assembled as a sleeve for an existing drum 100.

  The internal drum harvester 112 of the embodiment pixel drum 110 is disposable and replaceable. Limitation and / or control of the use of disposable components may be achieved by means including, but not limited to, electronic, EPROM, mechanical, durable. The electronic and / or mechanical recording and / or limitation of the drum rotation speed of the disposable drum may be electronically or mechanically recorded, controlled and / or restricted together with the usage time of the disposable drum.

  During the intake portion of the drum dermatome approach, the PAD scarpet array is applied directly to the skin surface. In order to circumferentially cut the skin pixels, the drum dermatome is placed on the top of the scalpet array to load the underlying skin surface. As loading continues, the cut skin pixels are pushed through the holes in the scalpet array and captured on the adhesive film of the drum dermatome. A dermatome's cutting outrigger blade (disposed over the sculpt array) crosses the base of the extruded skin pixel. The membrane and pixelated skin hybrid are then removed from the dermatome drum and applied directly as a skin graft to the recipient skin defect.

  Referring to FIG. 11C, an embodiment includes a drum dermatome for use with a scalpet plate, as described herein. More specifically, FIG. 12A shows a drum dermatome disposed on a scalpel plate under an embodiment. FIG. 12B is another view of the drum dermatome disposed on the scalpet plate, under an embodiment. The drum dermatome's cutting outrigger blade is placed on top of the sculpt array where the extruded skin plug is traversed at its base.

  FIG. 13A is an isometric view of the application of a drum dermatome (eg, Paget dermatome) to a sculpt plate under an embodiment, wherein the adhesive film is prior to rolling the drum on the incubating plate. Applied to that drum of the dermatome. FIG. 13B is a side view of a portion of a drum dermatome, under an embodiment, showing the position of the blade relative to the sculpt plate. FIG. 13C is a side view of a portion of a drum dermatome, under an embodiment, showing different positions of the blade relative to the sculpt plate. FIG. 13D is a side view of a drum dermatome with an alternative position of the blade relative to the scalpet plate, under an embodiment. FIG. 13E is a side view of a drum dermatome with a transversal blade clip, under an embodiment, showing a transversal cut of the skin pixel by the blade clip. FIG. 13F is a bottom view of the drum dermatome along with the sculpt plate under an embodiment. FIG. 13G is a front view of a drum dermatome along with a sculpt plate under an embodiment. FIG. 13H is a back view of a drum dermatome along with a sculpt plate under an embodiment.

  Depending on the clinical application, the disposable adhesive film of the drum dermatome can be used to place / arrange the cut loose skin placement / arrangement and pixelated skin grafts.

  The embodiments described herein include pixel-on-lay sleeves (POSs) for use with dermatomes, such as, for example, Paget Dermatome and Reids Dermatome.

  FIG. 14A shows an assembly view of a dermatome with a pixel on ray sleeve (POS) under an embodiment. The POS comprises a dermatome and a blade, which are incorporated together with an adhesive backer, an adhesive and a scarpet array. Adhesive backers, adhesives and sculpt arrays are integrated into the device, but are not limited to this.

  FIG. 14B shows an exploded view of the dermatome with a pixel-on-lay sleeve (POS) under an embodiment. FIG. 14C shows, under an embodiment, a portion of the dermatome with a pixel on lay sleeve (POS).

  The POS is also referred to herein as a "sleeve" and provides a disposable drum dermatome onlay for partial excision of excess relaxed skin and partial skin graft of a skin defect. Onlay sleeves are used in conjunction with the Paget Dermatome or Reids Dermatome as a disposable component. The POS of the embodiment is a three-sided slip-on disposable sleeve that engages the drum dermatome. The device comprises an adhesive surface and a scalpel drum array with an internal traversing blade. The crossing blade of the embodiment includes a single-edged cutting surface that is swung across the inner peripheral surface of the scalpet drum array.

  In an alternative blade embodiment, a fenestrated cut layer covers the inner periphery of the scalpet array. Each of the window surfaces with the cutting surface is aligned with each individual scalpet. Instead of rocking to cross the base of the skin plug, the fenestrated cutting layer vibrates on the scalpel drum array. A narrow space for passage of the blade is created between the adhesive surface and the scalpet array. An insertion slot for an additional adhesive film is provided for multiple uptake during skin graft surgery. The protective layer on the adhesive film is peeled off in place by the drawn pull tab. The tab is lifted from the pulling slot on the opposite side of the sleeve assembly. As with the other pixel device embodiments, the adhesive film is quasi-porous for drainage at the recipient skin defect site. In order to transform the pixelated skin graft into a more continuous sheet, the membrane also has elastic recoil properties, thereby providing skin plugs closer together in the skin graft. Good.

  The embodiments described herein include a slip-on PAD configured as a disposable device with either Paget's Dermatome or Reids Dermatome. FIG. 15A shows a slip-on PAD sliding over a paget drum dermatome, under an embodiment. FIG. 15B shows an assembly view of a slip-on PAD installed on a paget drum dermatome, under an embodiment.

  The slip-on PAD of the embodiment is used (optionally) in combination with a perforated guide plate. FIG. 16A shows a slip-on PAD installed on a paget drum dermatome and used with a perforated template or guide plate under an embodiment. The porous guide plate is placed on the target skin site and held in place by the adhesive on the lower surface of the apron to maintain orientation. Paget dermatome with slip-on PAD rolls over the skin through the perforated guide plate.

  FIG. 16B shows skin pixel uptake by the paget drum dermatome and the installed slip-on PAD under an embodiment. For skin pixel uptake, the slip-on PAD is removed, adhesive tape is applied on the drum of the paget dermatome, the clip-on blade is attached to the outrigger arm of the dermatome, which blade then traverses the base of the skin pixel Used for The slip-on PAD of the embodiment (optionally) is used with standard surgical instruments such as ribbon retractors to protect the skin next to the donor site.

  Embodiments of the pixel device described herein include the pixel drum dermatome (PD2), which is a disposable device or device. The PD 2 comprises a cylinder or rotary / rotating drum coupled with a handle, the cylinder comprising a sculpted drum array. The inner blade is connected to the drum shaft / handle assembly and / or to an outrigger attached to the central shaft. With PAD and POS as described herein, multiple small pixelated ablations of the skin are performed directly on the area of skin relaxation so that skin tightening can be enhanced while minimizing visible scarring.

  FIG. 17A shows an example of a pixel drum dermatome applied to a target site on the skin surface under the embodiment. FIG. 17B shows another view of a portion of a pixel drum dermatome being applied to a target site on the skin surface, under an embodiment.

  The PD2 device applies the entire rotating / rotating drum to the skin surface. There, a "scarpet drum array" produces a plurality of small (eg, 1.5 mm) circular incisions at the target site. The base of each skin plug is then traversed by the internal blade. The inner blade is connected to the central drum accelerator / handle assembly and / or to an outrigger attached to the central accelerator. Depending on the density of the circular sculpts on the drum, variable proportions of the skin are traversed. While PD2 makes it possible to cross a portion of the surface area of the skin (eg, 20%, 30%, 40%, etc.) without leaving a visible scar in the area of excess skin relaxation, Is not limited to this.

  Another alternative embodiment of the pixel apparatus shown herein is a pixel drum harvester (PDH). Similar to the pixel drum dermatome, the added internal drum takes in a pixelated cross section of the skin and aligns it on the adhesive film, which is placed on the patient's recipient skin defect site. The conformable adhesive film is quasi-porous, which allows for leaching in the recipient skin defect when the film with aligned excised skin segments is extracted from the drum and applied as a skin graft. The elastic recoil properties of the membrane allow the pixelated skin segments to be closer together, thereby partially converting the pixelated skin graft into a sheet of graft tissue at the recipient site.

  The pixel array medical systems, devices or devices, and methods described herein elicit or enable cellular and / or extracellular responses that are essential to the clinical outcome achieved. For the pixel dermatome, physical contraction of the skin surface occurs due to pixelated ablation of the skin, ie the creation of a skin plug. In addition, subsequent skin tightening occurs due to the delayed wound healing response. As detailed herein, each pixelated ablation initiates a multi-phase mandatory wound healing sequence.

  The first phase of this sequence is the inflammatory phase, where mast cell degranulation releases histamine to the "scar". Histamine release causes capillary bed dilation and increases vascular permeability to the extracellular space. This initial wound healing response occurs on the first day and manifests as erythema on the skin surface.

  The second phase (of fibroplasia) begins within three to four days of the "wound". During this phase there is fibroblast metastasis and mitotic growth. Wound fibroplasia involves deposition of new collagen and myofibroblastic contraction of the wound.

  Histologically, deposition of new collagen can be identified microscopically as cell tightness and thickening of the dermis. This is a static process, but the wound tension is significantly increased. Another feature of fibroplasia is that it is a dynamic physical process that results in multi-dimensional contraction of the wound. This component feature of fibroplasia results from active cellular contraction of myofibroblasts. Morphologically, myoblastic contraction of the wound will be visualized as two-dimensional tightness on the skin surface. Overall, the effect of fibroplasia is dermal contraction with the enhanced framework by deposition as a static support scaffold material for neo-collagen. The clinical effect manifests as a delayed tightening of the skin with a smoothening of the touch over several months. In general, the clinical endpoint is the more youthful looking skin envelope of the treatment area.

  The third and final phase of the delayed wound healing response is maturation. During this phase, strengthening and remodeling of the treated area takes place due to the increased interlinking of the (dermal) collagen fiber matrix. This final stage may begin within 6 to 12 months after the "wound" and last for at least 1 to 2 years. Small pixelated ablation of the skin preserves the normal dermal architecture during this delayed wound healing process, which does not involve the creation of a noticeable scar. Such scarring often occurs with the surgical removal of larger skin. Finally, the release of epidermal growth hormone results in the associated stimulation and rejuvenation of the epidermis. A delayed wound healing response can be triggered with scar collagen deposition in tissues (such as muscle and fat) with minimal existing collagen matrix.

  In addition to skin tightening for aesthetic purposes, the pixel array medical systems, devices or devices described herein, and methods have additional medical related applications. In one embodiment, the pixel array device can cross variable portions of any soft tissue structure without resorting to standard surgical ablation. Specifically, reducing the area of actinic radiation damage to the skin through the pixel array device will reduce the incidence of skin cancer. For treatment of sleep apnea syndrome and snoring, pixelated mucosal reduction via the pixel array device (soft palate, base of tongue and side wall of the pharynx) will reduce the considerable unhealthiness associated with more standard surgery I will. For vaginal vault lidar trauma, pixelated skin and vaginal mucosal resection via pixel array device will reestablish normal prepartum shape and function without A & P ablation. Related female stress urinary incontinence can also be corrected in a similar manner.

  The pixel array dermatome (PAD) of the embodiment is a system or kit comprising a control device, also referred to herein as a skull pet device assembly, also referred to as a punch impact handpiece, and a skull pet device, also referred to as an end device. including. The sculpt device is removably coupled to the control device and includes a sculpt array provided within the sculpt device. Although the removable sculpt device of the embodiment is disposable and, as a result, configured to be used during a single surgery, the embodiment is not limited thereto.

  The PAD includes an apparatus comprising a housing configured to contain a scalpet device. The skull pet device includes a substrate and a skull pet array, and the skull pet array includes a plurality of skull pets arranged in a configuration on the substrate. The substrate and the plurality of sculpts are configured to exit the housing and enter the housing, and the plurality of sculpets are configured to generate a plurality of cut-out skin pixels at the target site upon exit. The proximal end of the control device is configured to be held by hand. The housing is configured to be removably coupled to a receiver that is a component of the control device. The control device includes a proximal end including a drive mechanism and a distal end including a receiver. Although the control device is configured to be disposable, alternatively, the control device is configured to perform at least one of cleaning, disinfecting, and sterilizing.

  The sculpt array is configured to exit upon activation of the drive mechanism. The sculpt device of the embodiment is configured such that, upon activation of the drive mechanism, the sculpt array exits the sculpt device and returns to the sculpt device. An alternative embodiment of the sculpt device is configured to cause the sculpt array to exit the sculpt device in response to activation of the drive mechanism and to return to the sculpt device in response to release of the drive mechanism. .

  FIG. 18 shows a side perspective view of the PAD assembly under an embodiment. The PAD assembly of the present embodiment includes a control device with a scalpet array and a control device with an actuator or trigger, the control device being configured in a hand-held manner. Although the control device is reusable, alternative embodiments include a disposable control device. The sculpt array of embodiments is configured to create or create an incision array (e.g., 1.5 mm, 2 mm, 3 mm, etc.) as detailed herein. Embodiments of the sculpt device include a spring loaded sculpt array configured to dissect the skin as detailed herein, but embodiments are not limited thereto.

  FIG. 19A shows a top perspective view of a scalpel device for use with a PAD assembly, under an embodiment. FIG. 19B shows a bottom perspective view of a scalpel device for use with a PAD assembly, under an embodiment. The scalpet device comprises a housing configured to receive a substrate coupled to or including the plunger. The housing is configured such that the proximal end of the plunger projects from the top of the housing. The housing is configured to be releasably coupled to the control device, and the length of the plunger is configured to project from the top surface by a distance to contact the control device and the actuator when the scalpet device is coupled to the control device Ru.

  The substrate of the skull pet device is configured to hold a number of skull pets forming a skull pet array. The sculpt array comprises a pre-specified number of sculpts as appropriate for the manner in which the sculpt device assembly is used. The scalpet device includes at least one spring mechanism, which is configured to provide a downward or impact or punching force upon activation of the scalpet array device. This force aids in the creation of an incision (pixelated skin ablation site) with a scalpet array. Alternatively, the spring mechanism may be configured to provide an upward or reverse force to assist in the retraction of the skull pet array.

  One or more of the scalpet devices and control devices of the embodiments include an encryption system (e.g., an EPROM, etc.). The encryption system is configured to prevent, but is not limited to, unauthorized use and piracy of sculpt devices and / or control devices.

  During surgery, the skull pet device assembly is applied once to the target area or, alternatively, continuously applied within the designated target treatment area of skin relaxation. As detailed herein, the pixelated skin ablation sites within the treatment area are then closed by applying Flexan sheeting, and these pixelated ablation directed closures are for aesthetic modification of the treatment site. It is done in the direction of providing maximization.

  An alternative embodiment PAD device includes a vacuum component or system for removing the incised skin pixel. FIG. 20 shows a side view of a punch impact device including a vacuum component, under an embodiment. The PAD of this example includes, but is not limited to, a vacuum system or component within the control device to aspirate and remove the cut skin pixels. The vacuum component is removably coupled to the PAD device, the use of which is optional. The vacuum component is configured or coupled to create a low pressure zone in or adjacent to one or more of a housing, a scalpel device, a scalpel array and a control device. The low pressure zone is configured to pick up the cut skin pixel.

  Another alternative embodiment PAD device includes a radio frequency (RF) component or system for generating skin pixels. The RF component is configured and coupled to provide or couple energy to energy in or adjacent to one or more of the housing, scalpel device, scalpel array and control device. The RF component is removably coupled to the PAD device, the use of which is optional. The energy provided by the RF component includes one or more of thermal energy, vibrational energy, rotational energy, acoustic energy, and the like.

  Yet another alternative embodiment PAD device includes a vacuum component or system and an RF component or system. The PAD of the present embodiment includes a vacuum system or component in the handpiece to aspirate and remove the cut skin pixel. The vacuum component is removably coupled to the PAD device, the use of which is optional. The vacuum component is configured or coupled to create a low pressure zone in or adjacent to one or more of a housing, a scalpel device, a scalpel array and a control device. The low pressure zone is configured to pick up the cut skin pixel. In addition, the PAD device includes an RF component, which provides or couples energy in or adjacent to one or more of the housing, scalpel device, scalpel array and control device Configured and coupled for that purpose. The RF component is removably coupled to the PAD device, the use of which is optional. The energy provided by the RF component includes one or more of thermal energy, vibrational energy, rotational energy, acoustic energy, and the like.

  As a specific example, the PAD of an embodiment includes an electrosurgical generator configured to more effectively cut the donor skin or skin plug while minimizing heat conduction damage to the adjacent skin. Thus, for example, the RF generator operates with a relatively high power level with a relatively short duty cycle. The RF generator is configured to supply one or more of a motorized impactor component, a cycling impactor, a vibrational impactor, and an ultrasonic transducer configured to provide additional pressing force for cutting.

  As described herein, the PAD with RF in this example also includes a vacuum component. The vacuum component of the present embodiment applies a vacuum that pulls the skin towards the scalpet (eg, into the lumen of the scalpet), thereby causing an RF-mediated incision of the skin within the partial ablation field. It is configured to stabilize and promote, but is not limited to. One or more of the RF generator and vacuum equipment are coupled to be under control of a processor executing a software application. In addition, as detailed herein, the PAD of the present embodiment may be used with a guide plate, but is not limited thereto.

  In addition to partial dissection at the donor site, partial skin tissue transplantation involves the introduction and placement (e.g., on adhesive film) of a skin plug for transfer to the recipient site. As with partial skin ablation, the use of a duty-driven RF cutting edge on the scalpet array makes it easier to cut the donor skin plug. The base of the dissecting scalpet is then traversed and incorporated as detailed herein.

  The timing of the vacuum assist component is controlled by the processor to provide a defined sequence with an RF duty cycle. Software control allows different variations to provide an optimal solution of the combined RF and vacuum assist sequence. Without limitation, these include an initial vacuum period prior to the RF duty cycle. Following the RF duty cycle, the period of time during the sequence of embodiments includes aspiration of the cut skin plug.

  Other potential control sequences of PAD include, but are not limited to, simultaneous duty cycles of RF and vacuum assist. Alternatively, the control sequence of the embodiment pulse or cycle the RF duty cycle in sequence and / or with changes in RF power or with use of a generator at a different RF frequency. Including.

  Another alternative control sequence involves a designated RF cycle that occurs at the depth of the partial incision. At low power, long duration RF duty cycles with an insulating shaft, the active cutting tip can create a thermally conductive injury at the deep interface between dermal and subcutaneous tissue. Deep burns cause a delayed wound healing sequence, which can secondarily tighten the skin without burning the skin surface.

  Software control allows different variations to provide an optimal solution of the RF cutting and electro-mechanical cutting and vacuum assist combination sequence. Examples include, but are not limited to, a combination of electro-mechanical cutting with vacuum assist, RF cutting with electro-mechanical cutting and vacuum assist, RF cutting with vacuum assist, and RF cutting with vacuum assist. Examples of synthetic software controlled duty cycles are a pre-cutting vacuum skin stabilization period, an RF cutting duty cycle with a vacuum skin stabilization period, an RF cutting duty cycle with vacuum skin stabilization and an electro-mechanical cutting period, Electro-mechanical cutting with vacuum skin stabilization period and post cutting RF duty cycle to conductively heat the deeper dermal and / or subdermal tissue layers and cause a wound healing response for skin tightening; And a post-cut vacuum period for skin tightening including, but not limited to.

  Another embodiment of the pixel array medical device described herein includes a device comprising a scalpel oscillating flat array and a motorized or manual (non-motorized) blade, as described herein. Used for skin tightening as an alternative to the drum / cylinder described. FIG. 21A shows a top view of a vibrating flat scalpel array and blade device under an embodiment. FIG. 21B shows a bottom view of a vibrating flat scalpel array and blade device under an embodiment. The blade 108 may be a fenestrated layer of blades aligned with the scalpet array 106. The instrument handle 102 is separated from the blade handle 103, and the adhesive film 110 can be peeled off from the adhesive backer 111. FIG. 21C is an enlarged view of a flat array when the scalpet array 106, the blade 108, the adhesive film 110, and the adhesive backer 111 are assembled under the embodiment. When assembled, a flat array of scalpets can be measured to provide uniform uptake or uniform ablation. In one embodiment, the flat array of scalpets may further include a feeder component 115 for the adhesive uptake membrane 110 and the adhesive backer 111. FIG. 21D is an enlarged view of a flat array of scalpels with a feeder component 115 under an embodiment.

  In another skin graft embodiment, the pixel graft is placed on the irradiated cadaver dermal matrix (not shown). When cultured on a dermal matrix, full thickness skin grafts are generated for patients who are immunologically identical to the pixel donor. In embodiments, the cadaveric dermal matrix may be cylindrically excised with a size similar to the entrapped skin pixel graft, in which case a systematic alignment of the pixelated graft within the cadaveric dermal framework Can. FIG. 22 shows a cylindrically cut cadaver dermal matrix resembling a size-incorporated skin pixel implant under an embodiment. In one embodiment, the percent incorporation of the donor site may be determined, in part, depending on the induction of normal dermal tissue at the skin defect site of the recipient. That is, the normal (smooth) surface topology of the skin graft is promoted. According to embodiments of the adhesive film or dermal matrix, the pixel drum harvester has the ability to incorporate large surface areas for implantation while significantly reducing or eliminating visible scars at the patient's donor site. Including.

  In addition to the pixel array medical devices described herein, embodiments include a drug delivery device. In most cases, parenteral administration of drugs is still achieved by injection with a syringe and needle. Transdermal drug local absorption through occlusive patches has been developed to avoid the negative features of the needle and syringe system. However, both of these drug delivery systems have major drawbacks. Human aversion to needle injection is not soft during its nearly two centuries of use. Variable systemic absorption of subcutaneous or intramuscular drug injection reduces the efficacy of the drug and also increases the probability of side effects occurring to the patient. Depending on the drug's liquid or aqueous carrier fluid, topically applied occlusive patches suffer from fluctuations in absorption through the epidermal barrier. Syringe / needle injection or surface anesthesia is not ideal for patients who require local anesthesia over the large surface of the skin. Syringe / needle "field" injection is often painful and can infuse excessive amounts of local anesthesia that can cause systemic toxicity.

  It is rare for surface anesthesia to provide the necessary level of anesthesia for skin related surgery.

  FIG. 23 is a drum array drug delivery device 200 according to an embodiment. The drug delivery device 200 has successfully overcome the limitations and drawbacks of other drug delivery systems. The device comprises a drum / cylinder 202 supported by an accelerator / handle assembly 204 and rotating about a drum rotation component 206. The handle assembly 204 of the embodiment further includes a reservoir 208 of the agent to be administered and a syringe plunger 210. The surface of the drum 202 is covered by a needle array 212 of uniform length. This allows the intradermal (or subdermal) injection depth to be uniform while better controlling the amount of drug injected into the patient's skin. During the procedure, the syringe plunger 210 pushes the drug out of the reservoir 208 and the pushed drug is injected into the sealed infusion chamber 214 in the drum 202 via the connection tube 216. When the needle array 212 is pressed against the patient's skin until the surface of the drum 202 strikes the skin, the drug is ultimately administered to the patient's skin at a uniform depth. The non-anesthetic skipping area is avoided and a more uniform pattern of skin anesthesia is generated. The rotating drum application of the drug delivery device 200 can also inject local anesthesia faster while reducing patient discomfort.

  FIG. 24A is a side view of a needle array drug delivery device 300 under an embodiment. FIG. 24B is a top isometric view of a needle array drug delivery device 300 according to an embodiment. FIG. 24C is a bottom isometric view of a needle array drug delivery device 300 according to an embodiment. The drug delivery device 300 comprises a flat array 312 of uniform length sharp needles disposed on a manifold 310 and is used for drug administration. In this exemplary embodiment, the drug for injection is held in a syringe 302 which is plugged into a disposable adapter with handle 306. The seal 308 can be used to ensure that the syringe 302 and the disposable adapter 306 are rigidly coupled to one another. When the syringe plunger 304 is pushed, the drug held by the syringe 302 is transported from the syringe 302 to the disposable adapter 306. When the needle array 312 is pushed onto the patient's skin until the manifold 202 strikes the skin, the drug is further administered to the patient's skin through the flat array 312 of sharp needles at a uniform depth.

  The use of the drug delivery device 200 may have the same number of clinical applications as the number of drugs that require percutaneous injection or absorption. As non-limiting examples, some of the potential applications include injection of local anesthesia, injection of neuromodulators such as botulinum toxin (botox), injection of insulin, injection of replacement of estrogen and corticosteroids ,including.

  In one embodiment, the syringe plunger 210 of the drug delivery device 200 may be powered by an electric motor, as a non-limiting example. In one embodiment, a fluid pump (not shown) attached to the drip bag and tube may be connected to the infusion chamber 214 and / or the reservoir 208 for continuous infusion. In one embodiment, the volume of the syringe plunger 210 in the drug delivery device 200 may be calibrated and programmable.

  Another application of pixel skin graft uptake with the PAD (Pixel Array Dermatome) device detailed herein is alopecia. Alopecia is a common cosmetic disease, which occurs in middle-aged men but is also found in women with aging baby boomers. The most common form of alopecia is male pattern baldness (MPB), which occurs in the area applied from the top of the scalp to the forehead. Androgenetic alopecia is a sex-linked trait and is inherited to boy grandchildren by the X chromosome from the mother. For men, only one gene is needed to represent this trait. Because the gene is recessive, female pattern baldness requires the inheritance of both X-linked genes from both the father and the mother. Trait expression varies from patient to patient, and is often expressed by age at onset and amount of forehead / part / occipital hair loss. The patient variation of MPB expression is dependent on the variability of genotype translation of this gender-linked trait. The need for hair transplantation is enormous as MPB is generated genetically. Other non-genetically related etiologies are found in more restrictive population segments. These non-genetic pathologies include trauma and bacterial infections, lupus erythematosus and radiation and anticancer drug treatment.

  Various treatment options have been proposed to the public. These include FDA approved coats such as minoxidil and finasteride. Their success has been limited as these drugs require the conversion of quiescent hair follicles into an active growth phase. Other treatments include wigs and hair weaving. The usual means is also surgical hair transplantation, which involves transferring hair plugs, strips and flaps from the hairy scalp to the hairless scalp. Conventional hair transplantation often involves transferring a plurality of single hair micrographs from a hairy scalp to the same patient's hairless scalp. Alternatively, the donor plug is first taken up as a hair strip and then divided into micrographs for transfer to the recipient scalp. Anyway, this multi-step approach is expensive and involves hours of surgery for the average patient.

  The conventional hair transplantation market has been hampered by long hair transplantation operations performed in several stages. A typical hair transplantation procedure involves the transfer of a hair plug from the donor site in the occipital scalp to the recipient site in the bald area of the scalp from the crown to the forehead. For many techniques, each hair plug is transferred individually to the recipient scalp. During surgery hundreds of plugs are implanted, which take several hours to do. The postoperative "take" or survival rate of the implanted hair plug is variable by factors that limit angiogenesis at the recipient site. Bleeding and mechanical damage due to exercise are key factors that reduce angiogenesis and the "take" of hair grafts.

  The embodiments described herein include a surgical instrument configured to transfer several hair grafts at one time, which are held together at the recipient site of the scalp and aligned there Do. The approach described herein using PADs of embodiments reduces the burden and time required by conventional instruments.

  FIG. 25 shows the composition of human skin. The skin contains two horizontal layers, called the dermis and the epidermis, which act as a biological barrier to the external environment. The epidermis is the envelope layer and contains a viable layer of epidermal cells. Epidermal cells migrate upward and "mature" into a nonviable layer called the stratum corneum. The stratum corneum is a lipid-keratin hybrid and functions as the main biological barrier. This layer is always peeled off and reconstituted in a process called desquamation. The dermis is the lower layer that is the main structural support of the skin and is largely extracellular and composed of collagen fibers.

  In addition to the horizontal stratified epidermis and dermis, the skin contains vertically aligned elements or cellular appendages. It comprises the pilosebaceous unit, which comprises the hair follicle and the sebaceous gland. Each of the pilosebaceous units comprises sebaceous glands and hair follicles. The sebaceous gland is closest to the surface and releases sebum (oil) to the shaft of the hair follicle. The base of the hair follicle is called a valve. The base of the bulb has a deep reproductive component called dermal papilla. The hair follicles are typically aligned at an oblique angle to the skin surface. The hair follicles of a given area of the scalp are aligned parallel to one another. The pilosebaceous units are common throughout the entire skin, but the density and activity within the area of the scalp of these units is a key determinant of the overall appearance of the hair.

  In addition to the pilosebaceous unit, the sweat glands extend vertically through the skin. They provide water-based leachate to aid in thermoregulation.

  Apocrine sweat glands in the axilla and inguinal region produce more irritating sweat, which causes body odor. For the rest of the body, the eccrine sweat glands excrete hypoallergenic sweat for thermoregulation.

  Hair follicles go through different physiological cycles of hair growth. FIG. 26 shows the physiological cycle of hair growth. The presence of testosterone in hereditary men produces a variable degree of alopecia in the scalp from the top of the head to the frontal head. Basically, the hair follicle goes into a resting state by entering the resting phase without returning to the growing phase. Androgenic alopecia occurs when the hair fails to return from telogen to growth.

  PADs of the embodiments are configured for bulk uptake of hairy plugs with bulk transplantation of hair-bearing plugs to hairless scalp. This shortens the conventional hair transplantation surgery. Generally, multiple small hair carrying plugs are captured and aligned in a single surgical step or process using the devices, systems and / or methods of the embodiments. The recipient site is also prepared by multi-pixelated excision of the hairless scalp using the same instrument. The plurality of hair plug grafts are collectively transferred to the prepared recipient site where they are collectively transplanted. As a result, hundreds of hair-bearing plugs can be transported from the donor site to the recipient site through the use of a simplified approach. Thus, hair transplantation using the embodiments described herein provides a solution that is a single surgery that is simpler, simpler and saves considerable time over cumbersome, multi-step conventional processes.

  Hair transplantation using the pixel dermatome of the embodiment promotes an improvement over the conventional standard hair follicle unit extraction (FUT) hair transplantation approach. Generally, under the method of the embodiment, the hair follicle to be taken in is taken from the occipital scalp of the donor. In doing so, the hair at the donor site is partially cut and the perforated plate of the embodiment is placed on the scalp and oriented to provide maximum yield. Figure 27 shows uptake of donor hair follicles under an embodiment. The sculpt of the sculpt array is configured to reach the subcutaneous fat layer to obtain a hair follicle. As detailed herein, when the hair plugs are dissected, they are incorporated onto the adhesive film by traversing the base of the hair plug with a transverse blade. By applying the adhesive film before crossing the base, the original mutual alignment of the hair plugs at the donor site is maintained. The aligned matrix of hair plugs on the adhesive film is then collectively implanted into the recipient sites of the scalp from the top of the recipient to the frontal region of the recipient.

  FIG. 28 illustrates the preparation of recipient sites under an embodiment. The recipient site is prepared by excising the hairless skin plug in a pattern that is systematically identical to the incorporated occipital scalp donor site. Under the embodiment, a recipient site is prepared for mass transplantation of hair plugs using the same equipment as used at the donor site. At that time, a scalp defect is generated in the recipient site. The scalp defect created at the recipient site has the same geometry as the plug incorporated onto the adhesive film.

  An adhesive film loaded with an incorporated hair plug is applied over the same pattern of scalp defects in the recipient site. Each row, each hair-bearing plug is inserted into its mirror image recipient defect. FIG. 29 shows the placement of the incorporated hair plug at the recipient site, under an embodiment. The alignment between the plugs is maintained. Thus, hair growing from a transplanted hair plug will line up as naturally as it did at the donor site. A more even alignment between the original scalp and the transplanted hair will also occur.

  Specifically, the donor site hair is partially cut to prepare the placement or placement of the multi-aperture plate on the scalp. Perforated plates are placed at the occipital scalp donor site to provide maximum yield. FIG. 30 shows the arrangement of the porous plate at the donor site of the occipital scalp under the embodiment. Bulk uptake of the hair plug is achieved using a spring-loaded pixelated device with an impact punch handpiece with a scalpel disposable end. Embodiments are configured for uptake of individual hair plugs using prefabricated FUE extraction devices or biopsy punches. The size of the pores of the porous plate supplied covers the ready-made technology.

  A sculpt comprising a sculpt array disposable end is configured to reach the subcutaneous fat layer to obtain a hair follicle. FIG. 31 shows the depth of penetration of the scalpet into the skin when the scalpet is configured to penetrate the subcutaneous fat layer to obtain hair follicles under the embodiment. When the hair plugs are incised, they are incorporated onto the adhesive film by crossing the base of the hair plug with a cutting blade, but not limited thereto. FIG. 32 shows hair plug uptake using a perforated plate at donor sites in the back of the head, under an embodiment. By applying the adhesive film of the embodiment, the original mutual alignment of the hair plugs is maintained. An adhesive film is applied before crossing the base of the ablated pixel, but is not limited thereto. The aligned matrix of hair plugs on the adhesive film is then collectively implanted into the recipient site of the scalp from the top of the head to the frontal area.

  Additional single-piece hair plugs may be incorporated through the perforated plate. This is used, for example, to create a visible hairline. FIG. 33 illustrates the generation of visible hairlines under an embodiment. The visible hairline is determined and made with manual FUT technology. Visual hairline and apex mass implantation may be performed simultaneously or as separate stages. If visible hairline and mass transplantation occur simultaneously, recipient sites are developed starting with the visible hairline.

  Transplantation of the incorporated hair plug involves preparing the recipient site by excising the hairless skin plug in an organized identical pattern to that of the incorporated occipital scalp donor site. FIG. 34 shows, under an embodiment, the preparation of donor sites to generate identical skin defects in recipient sites using patterned porous plates and spring loaded pixelated devices. The recipient sites of the embodiment are prepared for mass transplantation of hair plugs using the same perforated plate and spring loaded pixelated device as used at the donor site. A scalp defect is generated in the recipient site. These scalp defects have the same geometry as the plugs incorporated onto the adhesive film.

  An adhesive film loaded with an incorporated hair plug is applied over the same pattern of scalp defects in the recipient site. Each row, each hair follicle-bearing or hair-bearing skin plug is inserted into its mirror image recipient defect. FIG. 35, under an embodiment, shows the implantation of the incorporated plug by inserting the incorporated plug into the corresponding skin defect generated at the recipient site. The alignment between the plugs is maintained. Thus, hair growing from a transplanted hair plug will line up as naturally as it did at the donor site. A more even alignment between the original scalp and the transplanted hair will also occur.

  Although clinical endpoints vary from patient to patient, a higher percentage of "takes" in hair plugs as a result of improved angiogenesis is expected. FIG. 36 shows, under an embodiment, a clinical endpoint using a pixel dermatome device and method. The combination of better "takes", shorter duration of surgery and more natural looking results allow the pixel dermatome devices and techniques of the embodiments to overcome the shortcomings of conventional hair transplantation approaches.

  Embodiments of pixelated skin grafting for skin defects and pixelated skin ablation for skin relaxation are detailed herein. These embodiments remove skin pixel fields in areas of relaxed skin where skin tightening is desired. The skin defects produced by this procedure (e.g., in the range of about 1.5-3 mm in diameter) are small enough to provide primary healing without leaving visible scars. The closure of multiple skin defect wounds is directed to produce the desired contouring effect. Animal experiments with the pixel removal method have performed well.

  The pixel approach of the embodiment is performed under local anesthesia in an office setting, but is not limited thereto. The surgeon uses the instrument of the embodiment to rapidly remove an array of skin pixels (eg, circular, oval, square, etc.). The pain associated with the procedure is relatively small. Intradermal skin defects generated during surgery are closed by application of adhesive Flexan (3M) sheets, but are not limited to this. The Flexan sheet acts as a large butterfly-type bandage and is pulled in a direction that maximizes aesthetic contouring of the treatment area. A compressible elastic garment may be applied over the bandage to aid in aesthetic contouring. During recovery, the patient wears supportive clothing over the treatment area for a period of time (e.g., five days). After the initial healing, many small linear scars in the treatment area do not become visually noticeable.

  From the delayed wound healing response, additional skin tightening will continue to occur over several months. As a result, the pixel approach is the least invasive alternative for skin tightening in areas where large scars in conventional cosmetic surgery should be avoided.

  The pixel approach elicits cellular and extracellular responses that are essential to the clinical outcome achieved. Physical contraction of the skin surface area occurs due to partial ablation of the skin. This excision removes part of the skin directly in the relaxation area. In addition, subsequent skin tightening is achieved by the delayed wound healing response. Each pixelated ablation initiates a mandatory wound healing sequence. As already detailed herein, the healing response that is effective in embodiments comprises three phases.

  The first phase of this sequence is the inflammatory phase, where mast cell degranulation releases histamine to the "scar". Histamine release causes capillary bed dilation and increases vascular permeability to the extracellular space. This initial wound healing response occurs on the first day and manifests as erythema on the skin surface.

  Within a few days of the "wound", the second phase of healing or fibroplasia begins.

  During fibroplasia there is metastatic and mitotic proliferation of fibroblasts.

  Fibrosis has two key features. Deposition of new collagen and myofibroblastic contraction of the wound. Histologically, deposition of new collagen is microscopically identified as cell tightness and thickening of the dermis. Although this is a static process, skin tension is significantly increased. Myoblastic contraction is a dynamic physical process that causes two-dimensional tightness of the skin surface. This process results from active cell contraction of myofibroblasts and deposition of contraction proteins in the extracellular matrix. Overall, the effect of fibroplasia is dermal contraction and deposition of neo-collagen as a static support scaffold material with a reinforcing framework. The clinical effect manifests as a delayed tightening of the skin with a smoothening of the touch over several months. The clinical endpoint is the more youthful looking skin envelope of the treatment area.

  The third and final phase of the delayed wound healing response is maturation. During maturation, consolidation and remodeling of the treated area takes place due to the increased interlinking of the (dermal) collagen fiber matrix. This final stage may begin within 6 to 12 months after the "wound" and last for at least 1 to 2 years. Small pixelated ablation of the skin preserves the normal dermal architecture during maturation, but this does not involve the production of noticeable scarring. Such scarring often occurs with the surgical removal of larger skin. Finally, the release of epidermal growth hormone results in the associated stimulation and rejuvenation of the epidermis.

  Figures 37 to 42 are images of the results of the pixel approach performed on live animals under an embodiment. The embodiments described herein were used in animal models in this demonstration, and this experiment demonstrated that the pixel approach produces aesthetic skin firmness without leaving a visible scar. The experiment used a live pig model anesthetized for surgery. FIG. 37 is an image of skin on which engraving has been performed at the corners and midpoints of the area to be ablated according to the embodiment. For post-operative evaluation, the field margin of resection was distinguished by tattoo, but it is not limited to this. The procedure was performed to specify the area of partial ablation using a perforated plate (e.g., a 10x10 pixel array). Partial excision was performed using a biopsy punch (eg, 1.5 mm diameter). FIG. 38 is an image of a postoperative skin resection field under the embodiment. After pixel ablation, the pixelated ablation defect was closed (horizontally) with a membrane (eg, Flexan).

  At 11 days after surgery, all the resections in the area designated by the tattoo were cured first, and photographic and dimensional measurements were made. FIG. 39 is an image after 11 days from the operation under the embodiment, showing an image showing that the resection has been primarily cured along with the measured margin. At 29 days post surgery, photographic and dimensional measurements were subsequently taken. FIG. 40 is an image after 29 days from the operation under the embodiment, showing an image showing that primary ablation of resection and primary maturation of resection field are continued. is there. FIG. 41 is an image taken at 29 days after surgery, under an embodiment, showing the primary healing of the resection and the measured lateral maturation of the resected field along with the lateral dimensions It is.

  The photographic and dimensional measurements were repeated 90 days after surgery. The skin of the test area was completely smooth to the touch. FIG. 42 is an image taken 90 days after surgery under the embodiment, showing an image along with the transverse dimension measured that the resection is primary healing and primary maturation of the resection field is continued It is.

  Partial ablation as described herein may be performed intradermally or over the entire thickness of the dermis. The ability to cut the skin with a scalpet (eg, round, square, oval, etc.) is enhanced by the addition of additional forces. Additional forces include those applied to the skull pet or sculpt array, for example, forces include one or more of rotational, kinetic impact and vibratory forces, all of which are for partial excision of the skin It is detailed in the present specification.

  The sculpt device of the embodiments generally includes a sculpt assembly and a housing. The skull pet assembly includes a skull pet array, which includes a plurality of skull pets and a force or drive component. The sculpt assembly includes one or more alignment plates, which maintain and position the sculpt accurately according to the arrangement of the sculpt array, and force (eg, z-axis) from the operator on the target tissue to be resected Configured to communicate. The scalpet assembly includes a spacer, which is configured to maintain the alignment plate such that the alignment plates are a fixed distance apart from one another and coaxial with the scalpet array, but is not so limited.

  The shell is configured to maintain the spacer and the alignment plate and includes mounting points for the housing and drive shaft. Alignment plates and / or spacers are attached or connected at the location of the shell (eg, mating, welding (eg, ultrasound, laser etc), heat stakes etc) and thus a rigid assembly is provided, the sculpt array It has become difficult to use for falsification and other purposes. In addition, the shell protects the drive mechanism or gear and scalpet from contamination during use and can lubricate the gear (if necessary) to reduce torque requirements and extend gear life I assume.

  As an example of the application of force using the embodiments herein, the ability to cut the skin with a circular sculpt is enhanced by the addition of rotational torque. The downward axial force used to incise the skin is considerably reduced when applied with the rotational force. This enhanced ability is similar to having a surgeon cut through the skin with a standard scalpet. There, the surgeon incises the skin surface more efficiently by using a combination of movement across the skin (kinetic energy) and simultaneous application of compression (axial force).

  The amount of surface compression required to penetrate the skin is significantly reduced if vertical motion is used simultaneously. For example, dart throwing techniques for injection have been used in the past by health care providers for skin pricking. The “impactor” action exerted on the skin by the embodiment of the circular skullpet enhances the cutting ability of this modality by simultaneously using an axial compression force and an axial motion force. The axial compressive force used to incise the skin surface is substantially reduced when applied with kinetic forces.

  Conventional biopsy punches are for applications that are used only once in tissue removal. This is generally accomplished by pushing the punch directly into the tissue along its central axis. Similarly, partial ablation of the embodiment uses a scalpet having a circular configuration. While the sculpt of embodiments may be used in a stand-alone configuration, alternative embodiments are sculpts configured to assemble sculpts into arrays of different sizes and to remove multiple sections of skin. Including but not limited to arrays. The force used to pierce the skin with a partially excised scalpet is a function of the number of scalpets in the array, where the force used to pierce the skin also increases as the array size increases.

  The reduced force required to penetrate the skin significantly enhances the ability to cut the skin with a circular sculpt. Such reduction is provided by the rotational movement about the central axis and / or the addition of an impact force along the central axis. FIG. 43, under an embodiment, is a scalpet showing applied rotational and / or impact forces. This enhanced rotational configuration has an effect similar to having a surgeon cut through the skin with a standard scalpet. There, the surgeon incises the skin surface more efficiently by using a combination of movement across the skin (kinetic energy) and simultaneous application of compression (axial force). Impact force is similar to using a staple gun or by moving the hypodermic needle quickly before it hits the skin.

  A consideration in the configuration of the scalpet rotation is the amount of torque used to drive the plurality of scalpets at the desired speed. The physical size and power of the system used to drive the scalpet array increases as the required torque increases. The columns or rows or segments of the array may be driven individually or sequentially during application of the array in order to reduce the cutting force required by the sculpt array. Approaches to rotate the scalpet include, but are not limited to, gears, helices, slots, inner helices, pin drives, and friction (elasticity).

  A scalpet array configured for partial ablation using a combination of rotation and axial dissection uses one or more device configurations for rotation. For example, the sculpt array of devices may use one or more of a gear rotation or vibration mechanism, an outer spiral rotation or vibration mechanism, an inner spiral rotation or vibration mechanism, a slot rotation or vibration mechanism, and a pin drive rotation or vibration mechanism. It is configured to rotate, but is not limited to this. Each of the rotation mechanisms used in the various embodiments is detailed herein.

  FIG. 44, under an embodiment, shows an array including a gear skull pet and a gear skull pet. FIG. 45 is a bottom perspective view of a ablation device including a sculpt assembly with a gear sculpt array, under an embodiment. The device comprises a housing (denoted as transparent for clarity of detail) configured to include a gear skull pet array for application of rotational torque for scalpet rotation. FIG. 46 is a bottom perspective view of a sculpt assembly (housing not shown) with a gear sculpt array according to an embodiment. FIG. 47 is a detail view of a gear sculpt array according to the embodiment.

  A gear sculpt array includes the appropriate number of sculpts for the ablation technique in which the array is used, and a gear is connected to each sculpt. For example, the gear may be fitted on or around the skull pet, but the embodiment is not limited thereto. Gear sculpts are configured as a unit or array so that each sculpt rotates with the next sculpt. For example, when fitted, the gear sculpts are attached together to the alignment plate, where each sculpt engages with the next four sculpts and rotates with them, thus maintaining the correct alignment. The gear skull pet array is driven by at least one rotating outer shaft with gears at its distal end, but is not limited thereto. The rotating shaft is configured to provide or transmit an axial force, which presses the sculpt of the array against the skin during the incision.

  Alternatively, an axial force may be applied to the plate maintaining the scalpet.

  In an alternative embodiment, a friction drive may be used to drive or rotate the scalpet of the array. FIG. 48 shows, according to an embodiment, an array including sculpts of a friction drive configuration. The friction drive configuration includes an elastic ring around each sculpt, which is similar to the gear arrangement in the gear embodiment, and the friction between adjacent sculpt rings pushing against each other is similar to the gear array Cause the rotation of the skull pet.

  The ablation device includes a helical sculpt array, which includes but is not limited to outer and inner helical sculpt arrays. FIG. 49 shows an array including a helical sculpt (outward) and a helical sculpt (outward) under an embodiment. FIG. 50 shows, according to an embodiment, a side perspective view (left) of a sculpt assembly comprising a spiral sculpt array and a side perspective view of a resection device comprising a sculpt assembly with a spiral sculpt array. (Right) (housing shown). FIG. 51 is a side view of an ablation device (with the housing depicted as transparent for clarity of detail) including a sculpt assembly with a helical sculpt array assembly under an embodiment. FIG. 52 is a bottom perspective view of an ablation device (with the housing depicted as transparent for clarity of detail) including a sculpt assembly with a helical sculpt array assembly under an embodiment. . FIG. 53 is a top perspective view of an ablation device (with the housing depicted as transparent for clarity of detail) including a sculpt assembly with a helical sculpt array assembly under an embodiment. .

  The helical sculpt configuration comprises a sleeve configured to fit in the end region of the sculpt, the outer region of the sleeve comprising one or more helical screws. As each sculpt fits in the sleeve, the sculpted sleeve is configured as a unit or array such that each sculpt rotates with the next sculpt.

  Alternatively, helical screws may be formed on each skullpet or formed as a component of each skullpet.

  The helical sculpt array is configured to be driven by the push plate. The push plate vibrates up and down along a range of the central axis of the skull pet array. FIG. 54 is a push plate of a spiral sculpt array according to an embodiment. The push plate includes a number of alignment holes that correspond to a number of scalpets in the array. Each alignment hole includes a notch configured to engage a helical (outer) screw on the scalpet sleeve. When the push plate is driven, it causes rotation of each scalpet in the array. FIG. 55 shows a helical sculpt array with a push plate under an embodiment.

  The ablation device further comprises an inner spiral sculpt array. The device comprises a housing configured to include a helical scalpet array assembly for application of rotational torque for scalpet rotation. FIG. 56 shows an array including an inner spiral sculpt and an inner spiral sculpt, under an embodiment. The inner spiral sculpt includes a torsion angle rod (eg, solid, hollow, etc.) or insert that fits within the open end of the sculpt. Alternatively, the scalpet is configured to include a helical region. The twisting insert is held in place by gluing (eg, crimping, gluing, gluing, brazing, welding, gluing, etc.) a portion of the scalpet around the insert. Alternatively, the insert is held in place with an adhesive. The inner spiral sculpt is configured as a unit or array so that each sculpt is configured to rotate with the next sculpt. The spiral sculpt array is configured to be driven by a drive plate. The drive plate moves up and down or oscillates along the spiral region of each sculpt of the sculpt array. The drive plate includes a number of square alignment holes corresponding to a number of scalpets in the array. As the drive plate is driven up and down, it causes rotation of each scalpet in the array. FIG. 57 shows a helical sculpt array with a drive plate under an embodiment.

  FIG. 58 shows an array including a slot scalpet and a slot scalpet, under an embodiment. The slotted skullpet configuration comprises a sleeve configured to fit in the end area of the skullpet, the sleeve including one or more spiral slots.

  Alternatively, each sculpt includes a spiral slot without using a sleeve. The sleeved skullpets are configured as a unit or array so that the upper regions of the slots of each skullpet are aligned next to each other. The outer drive rod is aligned with the top of the slot and is fitted horizontally along the top. When the drive rod is driven downward, the result is rotation of the scalpet array. FIG. 59 shows, under an embodiment, a portion of a slotted sculpt array (eg, four (4) sculpts) with drive rods. FIG. 60 shows an exemplary slot sculpt array (eg, 25 sculpts) with drive rods, under an embodiment.

  FIG. 61 shows, according to an embodiment, a vibratory pin drive assembly with a scalpet. The assembly includes a lower plate and an intermediate plate connected or coupled to the sculpt and configured to maintain the sculpt. The upper plate or drive plate is disposed in the area above the scalpet and the middle plate and includes a drive slot or slot. The pin is connected or coupled to the top of the skull pet and the top of the pin extends over the top of the skull pet. The slot is configured to receive the pin and allow the pin to fit. The slots are positioned relative to the pins such that rotation or vibration of the upper plate causes the skullpet to rotate or oscillate through the trajectory of the pins in the slots.

  One or more components of the sculpt device include adjustments configured to control the amount (eg, depth) of sculpt exposure during deployment at the target site of the sculpt array. For example, the adjustment of the embodiment is configured to collectively control the deployment length of the scalpet of the skull pet array. The tailoring of the alternative embodiment is configured to collectively control the length of deployment or collection of sculpts of the sculpt array. In another exemplary embodiment, the adjustment is configured to individually control the deployment length of each of the individual sculpts of the collection of sculpts of the sculpt array. Scalpet depth control includes a number of mechanisms configured for adjustable control of the scarpet depth.

  The depth control of the embodiment includes adjustable collars or sleeves provided on each scalpet. The collar is configured to move (eg, slide, etc.) along the length of the scalpet, and to prevent the scalpet from invading the target tissue beyond the depth controlled by the position of the collar Configured Before being used in surgery, the user of the Scalpet device adjusts the position of the collar, which is one of manual adjustment, automatic adjustment, electronic adjustment, adjustment under air pressure adjustment and software control. Including the above.

  An alternative embodiment of depth control includes an adjustable plate configured to move along the length of the scalpet of the skull pet array. The plate is configured to prevent penetration of the scalpet array into the target tissue beyond the depth controlled by the position of the plate. In this way, the skull pet array is deployed into the target tissue by a depth equivalent to the length of the skull pet sticking out of the plate. Before being used in surgery, the position of the plate is adjusted by the user of the Scalpet device, which is one of manual adjustment, automatic adjustment, electronic adjustment, adjustment under air pressure adjustment and software control. Including the above.

  As an example of depth control adjustment using a plate, variable length skull pet exposure may be controlled through adjustment of the skull pet guide plate of the skull pet assembly, but is not limited thereto. FIG. 62 shows variable skull pet exposure control with the skull pet guide plate under the embodiment. Alternative embodiments control scalpet exposure from within the skull pet array handpiece, and / or control skull pet exposure under one or more of software, hardware and mechanical controls. .

  Embodiments include mechanical scalpet arrays in which axial force and rotational force are applied manually by pressure from a device operator. FIG. 63, under an embodiment, shows a sculpt assembly including a sculpt array (eg, helical) configured to be manually driven by an operator.

  Embodiments include and / or are coupled to or coupled to a rotational source adapted to provide rotational (e.g., RPM) and rotational torque suitable for dissecting the skin in combination with axial forces. Be done. The appropriate rotation of the scalpet is set according to the best balance between the rotational speed and the increasing cutting efficiency and the increasing friction loss. Suitable rotations for each sculpt array configuration include the size of the array (the number of sculpts), sculpt cut surface geometry, sculpt and alignment plate material selection, use of gear materials and lubricants, and skin machinery Based on one or more of

With regard to the forces to be considered in the construction of the sculpt and sculpt array described herein, FIG. 64 shows the force exerted on the sculpt via application to the skin. The parameters considered in determining the force that can be applied under the embodiment include:
Average sculpt radius: r
Skull pet speed: ω
Scalpet axial force: F _n (Scarpet is applied perpendicular to the skin)
Skin friction coefficient: μ
Friction force: F _f
Skull pet torque: τ
Motor power: P _hp

The torque used to rotate the scalpet during the first application is the axial force (applied perpendicular to the surface of the skin), the coefficient of friction between the scalpet and the skin, Is a function of This frictional force initially acts on the cut surface of the scalpet. In the first application to scarpet's skin:
F _f = μ · F _n
τ = F _f · r
P _hp = τ · ω / 63025

  The initial force for the scalpet to penetrate the skin is a function of the sharpness of the scalpet, the axial force, the tension of the skin and the coefficient of friction between the skin and the scalpet. After the skull pet is pierced into the skin, the frictional force is increased due to the additional frictional force acting on the side wall of the scalpet.

  Embodiments of ablation devices include motion impaction devices and methods for non-rotational piercing of the skin. The approach to push the skullpet directly into the skin is axial force pressing, single axial force pressing plus kinetic impact, and high speed movement of the skullpet to strike the skin Penetrating, including but not limited to. FIG. 65 shows steady axial force compression using a scalpel, according to an embodiment. The steady axial force pressure places the scalpet in direct contact with the skin. Once placed, a continuous and steady axial force is applied to the scalpet until the scalpet penetrates the skin and through the dermis to the subcutaneous fat layer.

  FIG. 66 represents, under the embodiment, the compression plus motion impact force by a steady single axial force using a scalpet. A steady single axial force pressure plus motional impact places the scalpet in direct contact with the skin. Contact is maintained by applying an axial force. The distal end of the scalpet is struck by another object, thereby providing additional kinetic energy along the central axis. These forces cause the scalpet to pierce the skin and penetrate the dermis to the subcutaneous fat layer.

  FIG. 67 shows that the sculpt is moved at a certain speed and applied to the skin and pierced under the embodiment. Scalpets are placed a short distance from the target area of the skin. By applying kinetic power to the scalpet, the desired speed to penetrate the skin is achieved. By exercise, the scalpet penetrates the skin and penetrates the dermis to the subcutaneous fat layer.

  Embodiments of the sculpt include various cutting surfaces and blade geometries that are suitable for the dissection method of the method that includes the sculpt. Scalpet blade geometries include, but are not limited to, for example, straight edges (eg, cylinders), bevels, multi-needle tips (eg, saw blades, etc.), and sinusoidal. As an example, FIG. 68 shows the tips of multiple needles under the embodiment.

  Skullpets, for example, include one or more types of square skullpets. Square sculpts include, but are not limited to, square sculpts without multiple pointed tips and square sculpts with multiple pointed tips or teeth. FIG. 69 shows, under an embodiment, a square skull pet without teeth (left) and a square skull pet with multiple teeth (right).

  The partial ablation device of the embodiment includes the use of a square sculpt assembled on a sculpt array, the sculpt having a plurality of pointed tips for piercing the skin through direct non-rotational motion impact. make it easier. The square shape of the incorporated skin plug provides an edge-to-edge and vertex-apex approximation of the collected skin plug onto the adhesive film. A closer approximation of the skin plug provides a more even appearance of skin graft at the recipient site. In addition, each incorporated component skin plug will have an additional surface area (e.g., 20-25 percent).

  Additionally, the sculpt includes one or more types of oval or round sculpts. Round sculpts include, but are not limited to, round sculpts with beveled tips, round sculpts without multiple pointed tips or teeth, and round sculpts with multiple pointed tips or teeth . FIG. 70 shows a side view, a front view (or a back view) and a side perspective view of a round scalpet with beveled tip under an embodiment. FIG. 71 shows a round scalpet with serrated edges under an embodiment.

  The cutting device of the embodiment is configured to include a push pin corresponding to the scalpet. FIG. 72 shows a side view of an ablation device (the housing is depicted as being transparent for clarity), including an embodiment of a sculpt array and a sculpt assembly with push pins. FIG. 73 shows, under an embodiment, a top perspective cross-sectional view of the ablation device (the housing is depicted as being transparent for clarity of detail) including a scalpet array and a scalpet assembly with a push pin. Show. FIG. 74 shows a side view and a top perspective view of a sculpt assembly including a sculpt array and a push pin, under an embodiment.

  The push pin of the embodiment is configured, for example, to remove a skin plug that is being maintained. An alternative embodiment push pin is configured to inject into a partial defect of the recipient site. Another alternative embodiment push pin is configured to place the skin plug into the pixel canister of the docking station for partial skin tissue implantation.

  Embodiments herein include the use of a vibrating component or system, which is for facilitating a skin incision with a rotating torque / axial force, and using the vibration to rotate. It is intended to facilitate the skin incision with a direct impact without FIG. 75 is a side view of a ablation device including a sculpt assembly with a sculpt array assembly connected to a vibration source, under an embodiment.

  Embodiments herein include an electrodynamic scalpet array generator. FIG. 76 shows, under an embodiment, a sculpt array driven by an electrodynamic source or sculpt array generator. The functions of the generator are powered but not electronically controlled. However, the embodiment is not limited to this. The platform of the embodiment includes control software.

  Embodiments include supplemental energy or force configured to reduce the axial force used to incise the skin (or other tissue surface such as a mucous membrane) by the sculpt of the sculpt array, and And / or coupled or connected to it. Auxiliary energy and forces include, but are not limited to, one or more of rotational torque, rotational kinetic energy of rotation (RPM), vibration, ultrasound, and electromagnetic energy (eg, RF, etc.).

  Embodiments herein include a scalpet array generator comprising and / or coupled to an electromagnetic radiation source. The electromagnetic radiation sources include, for example, one or more of radio frequency (RF) sources, laser sources, and ultrasound sources. Providing electromagnetic radiation assists in sculpting.

  Embodiments are described in the following: a scalpet mechanism configured as a "sewing machine" skull pet, or repeatedly sculpts out and in under one or more of manual control, electro-dynamic control and electronic control. Or sculpt array. This embodiment includes a moving sculpt or sculpt array for cutting the sites row by row. For example, ablation may take the form of a stamp-like approach. In this approach, the sculpt or sculpt array may move or the array may be rolled over the surface to be treated, and a desired ablation density may be achieved with sculpt array ablation at a given travel distance .

  The partial ablation device described herein is configured for partial ablation and implantation. There, the introduction of the partially incised skin plug is carried out by means of a vacuum which brings the plug into the lumen of each sculpt shaft. The skin plug is then inserted into the separate docking station described herein by the proximal pin array. The proximal pin array pushes the skin plug out of the shaft of the skull pet.

  FIG. 77 is an illustration of an ablation device that includes a vacuum system, under an embodiment. The vacuum system comprises a vacuum tube and a vacuum port on / in the device housing and is configured to create a vacuum in the housing by drawing air from the housing. Embodiments of the vacuum are configured to provide a vacuum stent / fixture of the skin to the scalpet incision, which can improve depth control and enhance cutting efficiency.

  The vacuum of the alternative embodiment is configured for vacuum uptake or intake of the skin plug and / or the hair plug through one or more of the scalpet lumen and the array manifold housing. FIG. 78 shows, under an embodiment, a vacuum manifold applied to a target skin surface to remove / incorporate cut-out skin / hair plugs. The vacuum manifold is configured to apply directly to the skin surface and is coupled or connected to a vacuum source. FIG. 79 shows, under an embodiment, a vacuum manifold with an integrated wire mesh applied to a target skin surface to remove / incorporate cut-out skin / hair plugs.

  Additionally, an external vacuum manifold is used in conjunction with a suction assisted liposuction device to transcutaneous subcutaneous fat on the surface through a partially excised skin defect in a field partially generated for treatment of cellulite. It can be removed. FIG. 80 shows, under an embodiment, a vacuum manifold with integrated wire mesh configured to vacuum remove subcutaneous fat.

  The external vacuum manifold may be configured to include and be arranged with an integrated docking station (described herein) that incorporates a skin plug for implantation. The docking station may be one or more of static, extensible, and / or retractable.

  The partial ablation device described herein comprises a separate docking station configured as a platform for collecting partially taken-in skin plugs into a more uniform skin sheet for skin grafting . The docking station comprises a porous grid matrix, which comprises pores of the same pattern and density as the scarpets of the scalpet array. Retention canisters located below each hole are configured to retain and maintain the array of skin plugs taken. In one embodiment, the skin surface is upward at the level of the hole. In an alternative embodiment, the docking station may be partially retractable, thereby allowing the docked skin plug to be tighter before being trapped on the adhesive film. The partial skin graft captured on the adhesive film is then degreased with an integral or non-integral crossing blade. In another alternative embodiment, the adhesive film itself has elastic recoil properties, such that the capture skin plugs are in a tight array or arrangement. Regardless of the embodiment, the partial skin graft / adhesion membrane contraction hybrid is applied directly to the recipient site defect.

  Embodiments include a retractable docking station or tray that receives the plug and arranges the plug when the incorporated skin and / or hair plug is removed or ejected from the scalpet via the push pin. Configured to maintain. FIG. 81 depicts an embodiment of a retractable docking station and a skin pixel inserted. The docking station is formed of an elastic material, but is not limited thereto. The docking station is configured to extend from the first shape to a second shape that aligns the pixel receptacles with the scalpel array on the handpiece. FIG. 82 is a top view of the extended configuration (left) and the non-extended configuration (right) of the (e.g., resilient) docking station under the embodiment, under the embodiment.

  The pixels are ejected from the skull pet array into the docking station, which continues until the docking station is full, and then the docking station is relaxed to its pre-stretched shape, thereby bringing the pixels closer together. it can. A flexible semipermeable membrane with adhesive on one side is stretched and placed on the docking station (sticky side down). As the pixel sticks to the membrane, it is lifted from the docking station. The film returns to its normal non-stretched state, which has the effect of pulling the pixels closer together. The membrane is then placed on top of the recipient defect.

  The ablation devices described herein include the administration of a medicament through the ablation defect generated by the ablation devices described herein. In this case, the excision site is configured to be used as a topically applied infusion site for administration or application of a medicament for adipocyte reduction (lipolysis) during or after excision surgery.

  The embodiments herein may be configured for hair grafting, wherein the hair grafting incorporates the hair plug into the scalpet at the donor site with vacuum and the cut-in hair plug partially cut away Including direct bolus injection into recipient site defect (without separate collection reservoir). Under this embodiment, the donor sculpt array disposed on the occipital scalp has a relatively larger diameter than the sculpt that is a component of the sculpt array disposed to generate the defect at the recipient site. Have a sculpt to have. After incorporation of the hair plug at the donor site, the defects generated at the recipient site are plugged using the incorporated incorporated hair plug in the scalpet array.

  Due to the elastic contraction of the dissected dermis, the elastically contracted diameter of the hair plug taken in at the occipital scalp is that of the resected defect of the recipient site at the parietal-frontal-occipital scalp Would be similar to the diameter that was shrunk. In one embodiment, the hair plug incorporated into the donor sculpt array is pushed directly by the proximal pin in the sculpt's lumen and the pattern of partial defects generated by the recipient site sculpt array It may be the same pattern as The sculpts of the sculpt array (including donor hair plugs) placed at the donor site are aligned (eg, visually) in the same pattern as the partially excised field of the defect at the recipient scalp site . Once aligned, the proximal pin in the shaft of each skull pet travels down along the shaft of the skull pet, pushing the hair plug into the partially excised defect of the recipient site. This provides for simultaneous implantation of multiple hair plugs into the recipient site. This method of mass implanting a hair plug into a partially excised recipient site (e.g. of a bald scalp) maintains hair shaft alignment with the other mass implanted hair plugs of the recipient scalp site The probability is higher. Directional occlusion of the donor site field is performed with the most medically effective vectors, but is not limited thereto.

  The partial ablation device described herein is configured for tattoo removal. Many patients want the removal of dye tattoos for various reasons later in life. In general, tattoo removal involves the removal of dye that has penetrated into the dermis. Conventional tattoo removal approaches are described from thermal removal of the dye to direct surgical resection. Laser thermal removal often causes depigmentation and surface scarring. Surgical removal of the tattoo requires linear scars that can not be avoided by surgery. For many patients, the tradeoff between tattoo removal and the sequelae of the surgery can be marginal.

  Using partial ablation to remove the tattoo, it is possible to minimize visible scarring while partially removing a significant portion of the dermal pigment. The partial ablation extends beyond the boundaries of the tattoo so that the ablation mixes with the non-resected skin and the non-tattoo skin. Most notably, blurring of the tattoo's pattern occurs, even though it may or may not be possible to remove all of the residual dye. In one embodiment, a first partial excision is performed using a sculpt array, and a subsequent partial excision is performed with a single sculpt excision for the remaining dermal pigment. As with the other applications described herein, directional occlusion is performed with the most medically effective vectors.

  The partial ablation device described herein is configured for the treatment of cellulite. This aesthetic distortion has for decades been resisting effective treatment because of its multi-pathological mechanism of action. Cellulite is a combination of skin relaxation due to aging or weight loss, and growth and enhancement of superficial fat vesicle formation. The scaly appearance of the skin is common in the buttocks and the left and right thighs. Effective treatment should resolve each contributing factor of strain.

  The partial excision device described herein is configured for partial excision of the skin to tighten the treated skin while simultaneously reducing the protruding fat vesicles contributing to the cobblestone surface morphology. . The superficial fat vesicles are percutaneously aspirated using a locally applied vacuum through the same partially resected defect created for skin tightening. In one embodiment, a clear manifold suction cannula is applied directly to the partially resected skin surface. The appropriate vacuum pressure used in the Suction Assisted Liposuction (SAL) unit is determined by visually measuring that the appropriate amount of subcutaneous fat is aspirated. The appropriate duration of manifold application is also a factor to be monitored in surgery. When combined with partial skin tightening, only a relatively small amount of fat is aspirated to provide a smoother surface morphology. As with the other applications described herein, partially excised fields are closed with directional occlusion.

  The partial ablation device described herein is configured for correction of abdominal streaks and scars. Visible scarring is a strain that requires a clear distinction of scars from adjacent normal skin. Scar differentiation is produced by changes in texture, changes in pigment and changes in trajectory. In order to make the scar less visible, these three components of the scar must be resolved in scar correction, which can reduce the visual impact considerably. Severe scarring, referred to as contracture over joints, can limit the range of motion. Usually, scar correction is performed surgically, where the scar is cut into an oval and carefully closed by careful joining of the non-scarred skin excision margin. However, surgical correction reintroduces the current surgical scar and replaces the existing scar with the current surgical scar. Current surgical scars may manifest or may only be partially obscured by Z or W plastic surgery.

  Scars are diagnostically divided into hypertrophic and hypoplastic types. Hypertrophic scars often have raised contours and irregular texture, and are more deeply pigmented. In contrast, nonviable scars have a contour that is recessed below the level of the next normal non-scarring skin. In addition, the color is bluish (bleached) and the texture is smoother than the normal next skin. Histologically, hypertrophic scars have abundant irregular dermal scar collagen with hyperactive melanocytes. Non-viable scars have little dermal collagen and little or no melanocyte activity.

  The partial ablation device described herein is configured for partial scar correction of scars and does not reintroduce additional surgical scars, but rather rather blurs the visual impact of distortion. Instead of linear scars caused by surgery, partial ablation of scars reduces pigment components, texture components and contour components as a whole. Partial corrections are made along the direction of the scar line and also extend beyond the scar border usually to the skin. Partial correction of scarring involves direct partial excision of scar tissue, with a microinterlacing of normal non-scarring skin and residual scarring. Basically, micro W plastic surgery is performed along the entire length of the scar. As with other applications, partially excised fields are closed with directional closure. One example of the use of partial correction involves the correction of apomicary postpartum abdominal striatum. The striated indented scar epithelium and microinterlacing of the dermis with the normal skin next to it significantly reduce this distorted, linear, discolored appearance.

  The partial ablation device described herein is configured for vaginal repair for postpartum relaxation and prolapse. Transvaginal delivery of term fetuses involves, in part, considerable stretching of the vaginal opening and passage. During birth, longitudinal extension of the vaginal tract occurs with cross-sectional expansion of the labia, vaginal opening and vaginal fornix. For many patients, birth trauma results in permanent stretching of the vaginal tract along the longitudinal and cross-sectional directions. Vaginal repair for prolapse is typically performed as anteroposterior resection of the vaginal mucosa with insertion of a prosthetic mesh. For patients with severe prolapse, this procedure may be necessary and additional support of the anterior and posterior vaginal walls may be needed. However, many patients with postpartum vaginal relaxation may be candidates for less invasive surgery.

  The partial excision device described herein is configured to partially excise the vaginal mucosa circumferentially and narrow the distended vaginal tract at the labia and vaginal opening. If the vaginal tract is stretched, a pattern of partial ablation may be performed in the longitudinal direction. Directional occlusion of partial fields may be assisted by vacuum tampons. The vacuum tampon acts as a stent to form the partially excised vaginal tract into a pre-natal state.

  The partial ablation device described herein is configured for the treatment of snoring and sleep apnea. Although there are several health problems with snoring, the noisy voice effects that may be exerted on the relationship with the sleeping partner may be significant. Usually, snoring is due to the phonetic oscillations of intraoral and pharyngeal soft tissue structures in the oral cavity, pharyngeal cavity and nasal cavity while exhaling and inhaling. More specifically, vibration of the soft palate, turbinate, pharyngeal side wall and base of the tongue are anatomical key configurations that cause snoring. For many surgical and medical devices, success in improving the situation has been limited. Surgical reduction of the soft palate often suffers from long and painful healing due to bacterial contamination of the incision site.

  The partial ablation device described herein is configured to partially resect the oropharyngeal mucosa to reduce age-related mucosal redundancies (and relaxation) in the oral cavity and pharyngeal parenchyma structure You will not be bothered by long-term bacterial contamination of the excised site. The reduction in size and relaxation of these structures reduces the vibrations caused by the passage of air. Anteroposterior direction of the soft palate using an intraoral dental retainer (which is locked to the teeth and wrapped around the posterior surface of the soft palate) that is porous (to apply local anesthesia to the partial resected field) Provide directional occlusion. The more serious condition, called sleep apnea syndrome, has serious health problems due to hypoxia caused by upper airway obstruction during sleep.

  Although CPAP has become the standard treatment for sleep apnea syndrome, selective partial ablation of the base of the tongue and the pharyngeal side wall significantly reduces sleep-related upper airway obstruction.

  The partial ablation device described herein is configured for partial skin culture / stretching, referred to herein as "Culturespansion". The ability to organically grow the skin would be a major accomplishment for patients with large skin defects such as burns and trauma and large congenital skin malformations such as port wine nevus and large "seawatering" nevus. While conventional abilities have remained to be able to extend the viability of the skin taken in, one report has shown that wound healing has occurred with organotypic skin cultures. It has been reported that better substrates, better culture media, and more effective filtration of metabolic byproducts improve culture results. The use of gene expression proteinomics for growth hormone and wound healing stimulation is also promising. However, to date, there has been no report that the skin has grown organically.

  Partial incorporation of autologous donor skin for skin grafting according to embodiments provides an opportunity for organ culture of skin that has not existed before. Placement of the partially incorporated skin graft on the retractable docking station as provided by the embodiments described herein allows the skin plugs to come into juxtaposition contact with each other Do. The induction of the primary wound healing process can convert partial skin grafts into sheets by known or soon to be developed organoleptic methods. In addition, mechanical skin stretching can be used to significantly increase the surface area of organically preserved / nurtured skin. The ex vivo substrate device repeats incrementally and continuously stretches throughout the thickness of the organoleptically cultured skin, without limitation, with an extensible docking station including a partially incorporated skin plug. A separate substrate (eg, curved, flat, etc.) expander that can be controlled to provide. In addition, organ skin stretch can be used to provide a continuous and synergistic wound healing stimulus for organ development. The probability that progressive and continuous stretching will peel the epidermis from the dermis (basal membrane) is low. In addition, organotypic skin stretching helps to avoid the risk of surgery and the pain associated with in vivo skin stretching.

  The partial ablation device described herein enables a method for organ stretching of the skin. The method involves the autologous partial uptake of skin from the donor site of the patient. For example, using a square sculpt array, during transport, the joints between the sides and the apex of the partially incorporated skin plug are provided. The method includes transferring the partial skin plug to a retractable docking station, which maintains the array of skin plugs and provides juxtaposition of the skin plugs. The docked skin plug is trapped in the porous adhesive film, which maintains alignment and juxtaposition. The quasi-elastic recoil properties of the adhesive film provide additional contact and juxtaposition of the skin plug. The method involves the transfer of the adhesive membrane / partial graft hybrid to the culture bay. The bay contains a substrate and a culture medium, which maintains viability and promotes organ wound healing and growth. After healing of the skin plug margin, the entire substrate is placed in a culture bath with a mechanical expander substrate. Organ stretching begins in a progressive and continuous manner. The stretched full thickness skin is autografted into the patient's recipient site defect.

  Organic skin stretching can be performed on non-partial skin grafts, and more generally can be performed on any other tissue structure as organ stretching. The use of mechanical stimulation to elicit a wound healing response for organ culture can be an effective additive.

  The embodiments described herein, along with one or more of the devices and methods detailed herein, and the devices and methods detailed in the related applications incorporated herein by reference, And / or used as their component. In addition, the embodiments described herein can be used in devices and methods for partial skin and fat ablation.

  Embodiments include novel minimally invasive surgical techniques with significant advantages over conventional orthopedic surgery. Applying a partial excision of the skin as a new stand-alone procedure in the anatomic area beyond the limits of conventional orthopedic surgery due to the small trade-off between the visibility of the incision scar and the amount of improvement obtained . Also, applying partial ablation of the skin as an adjunct to established orthopedic procedures such as liposuction and using partial ablation significantly reduces the incision length required for a particular application. Shortening incisions has applicability in both the cosmetic and the cosmetic aspects of orthopedic surgery. Without limitation, both the procedural development of partial ablation and the development of the device are detailed herein.

  The embodiments described herein are configured to remove multiple small sections of skin without leaving a scar, instead of conventional linear ablation of the skin. Removal of multiple small sections of skin includes removal of loose excess skin without visible scarring. As an example, FIG. 83 shows removal of loose excess skin without apparent scarring under an embodiment. Removal of multiple small sections of skin also includes skin tightening without obvious scarring. For example, FIG. 84, under an embodiment, shows tightening the skin without apparent scarring. Removal of multiple small sections of skin further includes partial skin tightening, where the clinical endpoint produces a three-dimensional contouring of the skin envelope. FIG. 85 shows, under an embodiment, a three-dimensional contouring of the skin envelope.

  The clinical effectiveness of the surgical procedure requires a thorough understanding of the underlying process, which reliably leads to the clinical endpoint. A number of operating mechanisms are described herein for partial skin tightening and contouring. The main motion mechanism identified is the conversion of two-dimensional partial skin firmness to three-dimensional aesthetic contouring (see, eg, FIG. 3). Secondary action mechanisms that cooperate with each other contribute to their principled clinical endpoint. In the present specification, according to the ability to achieve a clinical endpoint, a contributing operating mechanism is described, but not limited thereto.

  The density of partial ablation within the contoured partial field is a major determinant of two-dimensional skin firming that contributes to three-dimensional contouring. In general, density is the percentage of partially excised skin within a partial field, but is not limited thereto. FIG. 86 shows, under an embodiment, variable partial ablation densities at the treatment area. Varying the density of partial ablation ("partial density") can provide more selective skin tightening and contouring while providing a smoother transition to non-partial ablation areas. Thus, for example, the transition to a non-partial ablation area includes, but is not limited to, a reduction in partial density.

  Another mechanism of action associated with partial skin removal is partial removal of fat. FIG. 87 shows partial ablation of fat under an embodiment. Directly beneath the skin is a subdermal fat layer and a subcutaneous fat layer, and anatomically contiguous with the skin plug to be resected, partially varying amounts of fat (based on depth and / or amount) It can be excised. In one embodiment, by controlling one or more of the depth of ablation at the target site and the amount of fat that is resected, the variable amount of fat that is partially resected, and thus the amount of skin tightening and contouring Control. Thus, by changing the density of partial ablation ("partial density") by controlling one or more of partial density, ablation depth and the amount of fat that is ablated, it is smoother to non-partial ablation areas More selective skin tightening and contouring can be provided while providing a smooth transition. Thus, for example, the transition to a non-partial ablation area includes, but is not limited to, a reduction in the combination of partial density, ablation depth and amount of fat to be ablated.

  An additional modality of partial fat removal is percutaneous vacuum removal of fat (PVR) directly through a partial defect of the skin. In the embodiments herein, a number of clinical applications of partial fat resection are envisioned. The most important aesthetic application of partial fat resection is the reduction of cellulite. The combined sequential application of partial skin excision and partial fat excision directly solves the pathology underlying this aesthetic variant. Skin relaxation and protruding fat vesicles, which cause visible surface crocking of the skin form, are each resolved with the application of this minimally invasive ablation ability. Figure 88 shows the crocking of the skin surface.

  In addition, other common applications include the ability to alter three-dimensional contour abnormalities by a combined continuous approach of partial skin firming and inward contouring from partial lipectomy. Preoperative topographical contour mapping of partial fields helps to provide more predictable clinical outcomes. In particular, topographical mapping of two-dimensional partial skin ablation is combined with variable marking of fat ablation. FIG. 89 shows a deeper level topographic mapping of partial fat resection under an embodiment. The mapping also includes feathering or transition zones to non-resected areas where the partial density is reduced. Depending on the patient's pre-operative topographical marking, a variable amount of fat is partially excised in series with partial skin ablation.

  A correction target area having a convex contour is subjected to deeper partial fat resection. The concave (or concave) area to be corrected is corrected using partial skin ablation. The total result within the mapped partial field is the global smoothing of the 3D contour with 2D tightening of the skin.

  The use of synthetic partial excision is most effective in reducing the length required by conventional orthopedic incisions and in removing iatrogenic incisional skin surplus ("dog ears"). Standard excision of the skin disorder does not require additional scarring of the obliteration, but is considerably reduced in the linear dimensions required for occlusion of the excised lesion (see FIG. 94).

  An additional operating mechanism associated with partial skin ablation is the size of the overall contour pattern of the partial ablation field. The total amount of skin that is partially excised also depends on the size of the field that is partially excised. The larger the field, the more skin tightening occurs with the specified density of partial ablation. FIG. 90 shows a plurality of treatment contours according to the embodiment.

  The mechanism of patterning contour involves selective curvilinear patterning of each specific anatomical area for each specific patient. Topographical analysis with digitally acquired images of the patient, including a drawn (and redrawn for enhanced contour) digital wire mesh program, selects the anatomical region selected and the patient's Useful for formatting size and curvilinear contours. Standard aesthetic orthopedic cut patterns for particular anatomical areas also lend themselves to the format of partial cut patterns. FIG. 91 shows a curvilinear treatment pattern under the embodiment. FIG. 92 shows, under an embodiment, a digital image of a patient with a drawn digital wire mesh program.

  The directional occlusion of the partial ablation field of the embodiment provides the ability to selectively tighten the skin to achieve enhanced aesthetic contouring. For most applications, the occlusion occurs at a right angle to the Langer skin score but may be made in different directions that can achieve maximum aesthetic contours, such as occlusion based on static skin tension. FIG. 93 shows directional occlusion of a partial ablation field, under an embodiment. Directional occlusion may be in accordance with known occlusion vectors used in conventional orthopedics. (For example, the facial lift of the facelift / facelift of the face is upwards (corresponding to the horizontal occlusion of the partial field) and the neck component below the neck lower jaw angle is (more vertical of the partial field Multiple occlusions of directional occlusion may be used in more complex topographical regions, such as the face and neck).

  Embodiments include directed partial ablation of the skin, which enhances the effectiveness of the surgery. This process is performed by pre-stretching the skin at right angles to the preferred direction of maximal skin ablation. FIG. 94 shows a directional partial ablation of skin under an embodiment.

  Embodiments include aesthetic contouring that results from mechanical tension (or vectors) generated from adjacent partial fields adjacent to the target contour. This effect on partial fields is based on orthopedic surgery directed at a distance from the target contour. In addition, variable topographical transitions of ablation density within the field and along the pattern contour are realized, thereby providing selective contouring and a smoother transition to non-resected areas.

  Additionally, variable topographical transitions of sculpt size ablation within patterned contours (and with different sculpt sizes in the array) provide selective two-dimensional skin tightening and three-dimensional contouring .

  The embodiments described herein produce a selective wound healing sequence with promoting primary healing during the post-operative period and promoting delayed secondary contraction of the skin during the collagen growth phase. The promotion of accurate bonding of the skin margin is inherent to the multiple (partial) ablation of small segments of skin. That is, the skin margin is more closely aligned prior to occlusion than in the case of larger linear incisions in the skin as is normal for standard orthopedic incisions. The occurrence of subsequent wound contraction is also inherent to the partially resected field. There, the extension of the pattern of partial ablation provides a directional wound healing response along the longitudinal direction of the partial ablation pattern.

  Clinical methods of partial skin ablation include methods of directional occlusion. Depending on the anatomical area, the directional occlusion of the skin defect due to the cut in the partial excision field achieves maximum esthetic contouring along resting skin lines, along Langer skin secant, In the direction of The direction in which occlusion is most easily achieved may be used as an indicator for the most effective vector of directional occlusion. For many applications, the use of Langer skin secant is used as an indicator to provide maximum aesthetic tightening. According to Dr. Langer's original work, the partially excised defect will extend in the direction of the Langer skin score. In the anatomic area, directional occlusion is performed at a right angle to the Langer skin score, where the skin margin of each partial ablation defect is closest.

  In continuous partial surgery performed subsequent to or subsequent to an orthopedic incision, the most important capabilities provided by the embodiments herein include the ability to shorten the incision. The need to obliterate skin tumors is reduced both in the application of this technique and in the length of the incision. Thus, the need to cut out the lateral part of the tumor resection is alleviated by partial resection in that same lateral direction. FIG. 95 shows, under an embodiment, shortening of the incision through successive partial procedures.

  As the partial field according to the embodiment heals without visible scarring, the total result is that the cut scar length is significantly reduced. Other applications within this category are thoracic reduction, shortening of conventional plastic surgery incisions used in breast fixation and abdominal surgery. The lateral extent of these incisions can be shortened without creating a "dog ear" skin surplus that might otherwise occur with incisions of the same length. FIG. 96 is an exemplary illustration of "dog ear" skin surplus in chest reduction and abdominal surgery. For example, it is no longer necessary to extend the incision beyond the lateral lower breast for chest reduction, or beyond the iliac crest for abdominal surgery. A partial review of the post-operative "dog ear" skin surplus may also be performed without extending the existing incision.

  Embodiments include synthetic procedures that provide aesthetic enhancement at both partially excised harvest and recipient sites. The most obvious application of this method is the use of partial incorporation of the cervical beard for hair transplantation in the parietal and frontal areas. This procedure provides the dual benefit of creating an aesthetic contouring along the anterior neck and regenerating the scalp with the hair.

  Embodiments include individual partial procedures in anatomical areas that are not currently resolved by orthopedics due to the small trade-off between visibility of the surgical incision and the amount of aesthetic improvement. There are several examples in this category. For example, patella, upper arm, elbow, bra skin surplus of the back, all thighs, thigh side, groin.

  Embodiments include ancillary partial procedures used in a non-continuous manner with conventional orthopedic incisions. This category includes suction-assisted lipectomy that removes subcutaneous fat by suction in areas of lipodystrophy such as the buttocks side and the thigh side. However, many patients have existing skin relaxations that are exacerbated by aspiration lipectomy. Tightening the skin envelope across these areas by partial ablation has several advantages for these patients. Many patients with skin relaxation and lipodystrophy, which otherwise would not qualify for the method, are candidates for liposuction. Greater contour reduction may be performed without iatrogenic skin relaxation for patients with existing skin relaxation but with more pronounced lipodystrophy. The procedure may be performed as a single synthetic procedure of smaller partial excision, or as a step-wise procedure.

  Directional occlusion of partial fields is performed without sutures and is achieved with the application of an adhesive stent membrane as detailed herein. The partial field is closed with an adhesive film using a number of methods. An exemplary method includes anchoring the membrane outside the perimeter of the partial field. Tension is applied to the opposite side of the adhesive film. The body of the adhesive film is applied to the partial field, one row at a time, to the remaining skin in the field. The direction of application follows the selected vector of directional occlusion. The direction of application is sometimes perpendicular to the Langer skin score but is not limited thereto, and any direction of application that provides maximum aesthetic contouring may be selected.

  Another method involves selectively closing partial fields utilizing the elasticity of the adhesive stent dressing. By this method, the end of the elastic stent dressing is stretched or introduced beforehand and then the stent dressing is applied to the partial field. When the end of the membrane is released, the elastic contraction of the stent dressing causes the partial defect to close in the direction perpendicular to the elastic contraction.

  The embodiments detailed herein include the skin pixel array dermatome, also referred to herein as "sPAD". The sPAD is an array of a plurality of multi-scarpets including a plurality of independent circular sculpts. The circular configuration allows to make the incision easier by applying a rotational torque to the skin. As described herein, a coupling or linkage of the scalpet to an electromechanical power source is provided as a series of gears between each sculpt and the drive shaft. In addition, the vacuum generated within the housing is configured for stent stabilization during the incision. The same vacuum capability can also be applied as a pneumatic assist that applies additional axial (Z-axis) forces during the cutting duty cycle. Another application of vacuum is the removal of an incised skin plug in a partial field.

  As detailed herein, the sPAD includes a number of configurations. FIG. 97 is an sPAD including a single shaving scalpet with depth control, under an embodiment. FIG. 98 is an sPAD including a standard single sculpt under the embodiment. FIG. 99 is an sPAD that includes a pen-style gear reduction handpiece, under an embodiment. FIG. 100 is an sPAD including a 3 × 3 centerless array according to the embodiment.

  An instrument including a surgical drill is provided for use in conjunction with the spAD. FIG. 101 is an sPAD including a cordless surgical drill for a large array, under an embodiment. FIG. 102 is an sPAD including a drill mounted 5 × 5 centerless array, under an embodiment.

  Embodiments include a vacuum assisted pneumatic ablation (VAPR) array sPAD, also referred to herein as "VAPR sPAD". FIG. 103 shows an sPAD including a vacuum assisted pneumatic cut spADD according to an embodiment. The VAPR sPAD uses a vacuum pressure configured to drive the scalpet from the sPAD to the treatment site. The VAPR sPAD is coupled or connected to the drill through a drill array coupling (DAC). FIG. 104, under an embodiment, is a VAPR sPAD engaged with a drill via a DAC. The DAC secures the VAPR sPAD's housing to the drill. The hexagonal tube, on the other hand, allows the VAPR sPAD drive shaft to slide up and down during the procedure. An externally supplied vacuum (not shown) is coupled or connected to the VAPR sPAD via a vacuum port.

  Figure 105 shows the VAPR sPAD in the prepared state (left) and that in the extended treatment state (right) under an embodiment. With the vacuum and drill in operation, a single treatment cycle involves placing the VAPR sPAD at the treatment site and creating a seal between the housing and the treatment site. Once this seal is established, the vacuum pulls the piston with the rotating gear to the treatment site. After the desired depth of cut has been achieved, the SPAD is withdrawn from the treatment site. This breaks the seal and the spring in the sPAD returns it to the ready state. The cycle can be repeated for the new treatment site.

  Embodiments include a spring assisted vacuum ablation (SAVR) spAD, which operates in the same manner as a VAPR sPAD. FIG. 106 shows the SAVR sPAD in prepared (left) and retracted (right) states under an embodiment. The SAVR sPAD is coupled or connected to the drill via a DAC. The vacuum port is attached to a separate vacuum supply. The drive shaft slides up and down in a tube attached to the drill.

  In the SAVR sPAD, the positions of the spring and the vacuum are generally reversed from those of the VAPR sPAD. The spring and vacuum port are both provided on the proximal side of the piston, but is not limited thereto. The vacuum pulls the skin pixel through the scalpet and thus helps to remove it from the treatment site. The spring enters the treatment site and provides an axial force for the rotating scalpet to ablate the skin. The sculpt extends outside the housing in the array ready state.

  The treatment cycle begins with the placement of the scalpet across the desired treatment location. The vacuum is turned on and the drill is applied downward. As a result, the piston and the scalpet are returned into the housing (retracted state). The drill rotates and the skull pet rotates. A spring force coupled to the rotation of the scalpet causes ablation. The vacuum pulls up the pixels generated by the ablation and then the housing. Once the desired cutting depth is achieved, the SAVR sPAD can be lifted from the treatment site and the cycle repeated.

  The embodiments described herein include, but are not limited to, devices or devices and procedures that allow for repeated incorporation of skin grafts from the same donor site while eliminating heterotypicization of the donor site. Includes cosmetic surgery skin tightening equipment and procedures. Embodiments herein include devices configured for partial ablation and corresponding methods or procedures including single sculpt and multi-scarpet array platforms using vacuum manifolds. Additional disclosures of corresponding devices configured for partial ablation and corresponding methods or procedures are found in the related applications, each of which is incorporated herein by reference in its entirety. With respect to the use of vacuum in the partially ablated field, the vacuum manifold is configured to apply a vacuum into the cavity in the scalpet (or in the multi-scarpet array). Alternatively, the vacuum manifold is configured to apply vacuum outside the cavity as a component of the scalpet assembly or as a separate manifold device applied directly to the partial field skin.

  The application of the vacuum volume of the scalpet assembly includes the aspiration removal of a partially incised skin plug (eg, FIGS. 108, 112 and 113).

  Additionally, application of the vacuum volume of the scalpet assembly includes vacuum stabilization of the skin surface during partial ablation (eg, FIGS. 109 and 114). Additional applications of vacuum volume of the scalpet assembly include partial vacuum assisted fat ablation of the subdermal fat layer and the subcutaneous fat layer (eg, FIG. 114).

  FIG. 107A is a side cross-sectional view of a negative pressure suction device configured to engage or attach in series with a vacuum manifold and a scalpel array, under an embodiment. FIG. 107B is an isometric cross-sectional view of a negative pressure suction device configured to engage or attach in series with a vacuum manifold and a scalpel array, under an embodiment. FIG. 107C is a perspective side view of a negative pressure suction device configured to engage or attach in series with a vacuum manifold and a scalpel array, under an embodiment.

  FIG. 108A is a side cross-sectional view of a scalpet array for use with a negative pressure aspirator, under an embodiment. FIG. 108B is an isometric sectional view of a scalpet array for use with a negative pressure aspirator, under an embodiment. FIG. 108C is a perspective side view of a scalpet array for use with a negative pressure aspirator, under an embodiment.

  FIG. 109A is a side cross-sectional view of a vacuum manifold configured to engage or be connected to a negative pressure aspirator, under an embodiment. FIG. 109B is an isometric cross-sectional view of a vacuum manifold configured to engage or be connected to a negative pressure aspirator, under an embodiment. FIG. 109C is a perspective side view of a vacuum manifold configured to engage or be connected to a negative pressure aspirator, under an embodiment. A negative pressure aspirator is connected or connected in series with the vacuum manifold, and a device such as a suction device specially adapted for partial excision and a conventional surgical aspirator and a suction device especially used for suction assisted lipectomy (SAL) Configured as one or more of them. In one embodiment, the intraluminal vacuum sculpt or sculpt array has a rotating component to enhance both the skin incision and liposuction and pruritus capabilities.

  The vacuum transfer of the device of the embodiment is controlled by an aperture component configured to be operated by an operator of the device. FIG. 110 is an illustrative side view of a device with a vacuum component configured for manual control through an aperture, according to an embodiment. Alternatively, the vacuum component is electrically controlled. For example, the on and off cycles of the vacuum source are at least partially computer controlled (e.g., computer controlled duty cycle). Also, an electronic controller may be used to cycle through changes in the rotational (RPM) component of the scalpet assembly. Also, the length of the scalpet may be one or more of manual control and computer control.

  An embodiment vacuum manifold includes a "slip-on" overlapping container in the area of the distal end of the handpiece (e.g., Fig. 109). The vacuum manifold also extends distally to the scalpet to serve as a depth guide. Various depth-guided vacuum manifolds solve variable dermal depth at different clinical applications and different anatomic sites. In one embodiment, the plastic manifold is produced as a single process disposable with separate vacuum ports incorporated into the manifold. In an alternative embodiment, the vacuum capability is an "in-line" or "in-series" configuration of the handpiece, and vacuum can be applied internally through the handpiece and can extend to a length near the scalpet, or Branching through separate lateral apertures of the scalpet. FIG. 111A is an isometric view of a handpiece configured to include or incorporate vacuum, under an embodiment. FIG. 111B is an isometric cutaway view of a handpiece configured to include or incorporate a vacuum, under an embodiment.

  FIG. 112 is a side cross-sectional view of a single sculpt device applied to a target tissue site, under an embodiment. FIG. 113 is an isometric cross-sectional view of a single sculpt device applied to a target tissue site, under an embodiment. FIG. 114A is a side cross-sectional view of a multi-scarpet device applied to a target tissue site, under an embodiment. FIG. 114B is an isometric cross-sectional view of a multi-scarpet device applied to a target tissue site, under an embodiment. Various embodiments of the skull pet device include one or more skull pets. Embodiments of the skull pet type include one or more of a slot skull pet and a slot blunt micro tip cannula. FIG. 115 is an exemplary slot scalpet, under an embodiment. FIG. 116 is an exemplary slotted blunt microtip cannula under an embodiment.

  Under the embodiments herein, the ability to partially aspirate subdermal / subcutaneous fat has several applications depending on the target anatomical area. These applications include, but are not limited to, repairing aesthetic features such as the mental man and the lower jaw angle by planarizing the concave three-dimensional contour and the inward contouring of the anatomical region. For these applications, lateral slot aperture scalpels and blunt tip lateral slot aperture partial cannulas are described herein (eg, FIGS. 114 and 115). The blunt tip cannula is configured to be used in anatomical regions where there are significant vascular and neural structures beneath the partial lipectomy field. Regardless of the type of scalpet / cannula, the combination of rotary function and vacuum capability of the system can provide a more efficient means of suction and scratching the subdermal / subcutaneous fat layer.

  Embodiments include, without limitation, a partial marking system configured as a guide to ensure sufficient partial ablation density. For example, the guide includes a stencil and / or a tacky translucent porous plastic film guide (ASPPMP) configured to be used as a partial ablation guide. The stencil marking system includes a stencil (e.g., ink or the like) that includes a grid pattern of circles or dots that is temporarily applied to the target site prior to surgery. FIG. 117 is an exemplary ink stencil marking system, under an embodiment. The circle or dot includes at least one of a positive or negative stencil in a grid pattern, and the ink material is biocompatible and configured to not thin or blur during preparation of the patient or during surgery Be done.

  The ASPPMP marking system comprises an adhesive translucent porous plastic film. FIG. 118 shows an adhesive translucent porous plastic film under the embodiment. The porous plastic film is also configured to serve as a depth guide ensuring that the prescribed depth of partial ablation is not exceeded. FIG. 119A is a side view of an ASPPMP in use as a depth guide with a single sculpt device under an embodiment. FIG. 119B is a top isometric view of an ASPPMP in use as a depth guide with a single sculpt device, under an embodiment.

  Clinical applications of single-sculpet and multi-scarpet array platforms include aesthetic contouring, which is generated by a combination of skin tightening and inward contouring of the embodiment, but is not limited thereto. The ability to partially ablate skin and fat during surgery gives rise to significant capabilities over conventional electromagnetic devices and aesthetic orthopedic surgery. This is because partial ablation involves removing the skin directly (in the area of skin relaxation) without leaving a visible scar. The enhanced ability of the embodiment to partially excise the skin can be combined with partial subdermal / subcutaneous lipectomy to restore a more youthful aesthetic contour.

  FIG. 120 shows, under an embodiment, partial ablation of the skin and partial subdermal / subcutaneous lipectomy. An example of a partial excision of the skin and a partial subdermal / subcutaneous lipectomy is, without limitation, treatment of the guy (under the chin). FIG. 121 shows a side view of a guy as a target area of partial skin excision and partial subdermal / subcutaneous lipectomy under the embodiment. FIG. 122 shows a bottom view (looking up) of a partially resected field guy as a target area of a partially resected skin and partially subdermal / slip lipectomy under an embodiment. The presence of skin relaxation and the salification of the below-the-mouth fat pad are the main components of this aesthetic variant. Each patient will have variable amounts of each soft tissue component requiring selective modification that is tailored or configured for each particular patient. More specifically, the convex contour of the heresy is mainly caused by lipodystrophy of the sub-mandibular fat pad, and the disappearance of the cervical jaw angle is mainly due to skin relaxation.

  Typically, the patient exhibits variable amounts of submental guy skin relaxation and lipodystrophy, thus embodiments use patient planning and marking for specific surgery. The combined ability of the embodiment assembly correlates well with the need to change the specific soft tissue component of the aesthetic variant. For patients with more severe skin relaxation, the guy and the larger horizontal alignment treatment area on the side of the neck are marked for partial skin ablation. FIG. 123 shows, under an embodiment, the horizontal alignment treatment area on the guy and the side of the neck for intense skin relaxation.

  For patients with more severe lipodystrophy, a wider partial lipectomy (through a partial excision skin defect) is marked in the treatment area. Also, the depth of partial fat resection may be selectively altered to resolve this convex contour profile topography feature. FIG. 124 shows, under an embodiment, a wider partial fat excision in the mentality for severe lipodystrophy.

  Clinical applications of single-scarpet and multi-scarpet array platforms include directional occlusion items. Accurate occlusion of the incision is an important principle used in orthopedic surgery to promote primary healing (primary healing) to reduce scarring. However, the direction of occlusion is also important for aesthetic contouring. An appropriate vector of skin firmness takes into account the anatomical structure to be enhanced aesthetically. For more complex aesthetic contours, such as the face and neck, multiple vectors of skin tightening are used during surgery.

  FIG. 125 shows an example directional occlusion face and neck vector, under an embodiment. In addition to skin tightening vectors, various occlusion lines also limit tension during occlusion. The occlusion line includes that described by Karl Langer, and Figure 126 shows the Langer's line of occlusion. The occlusion of the skin incision as shown by the Langer line promotes primary healing as it reduces the tension of the occlusion. When there is a match between the skin tightening vector and the Langer's line, the resulting aesthetic contour and primary healing work together to provide optimal clinical performance.

  Embodiments herein include a staged surgery algorithm configured to provide a more uniform embodiment that produces predictable clinical performance. Many of the surgical procedures (and series of steps) herein are unique advances in partial resection surgery. Without limitation, a surgical algorithm is included for partial ablation of the guy.

  According to the procedure of the embodiment, first, the patient is marked in a sitting state before the operation. For patients with relatively large skin relaxations, the area drawn for partial excision is wider, extending to the side of the neck. For patients with relatively little or no skin relaxation, the partially excised area delineated is limited to the area where the lipodystrophy of the sub-mandibular fat pad is producing a convex contour profile. For patients with both skin relaxation and lipodystrophy, both areas are individually depicted as components of a single synthetic treatment profile. FIG. 127, under an embodiment, shows the marked target area of the neck and a sub-mental nerve lipectomy partial resection.

  In order to avoid partial field density reduction, a local anesthesia field block is administered to the isolated area of the guy / neck. Then, as detailed herein, dot / circle stencils are applied to ensure the partial ablation density is sufficient. FIG. 128 shows an exemplary marking stencil, under an embodiment. These steps may be reversed if stenciling is performed prior to injection of local anesthesia. The swelling of the stenciled skin can be compensated for in the larger drawn treatment area. A partial skin resection is then performed within the bounds of the entire partitioned treatment area.

  Partial lipectomy is limited to topographically contoured lipodystrophy areas (eg, FIG. 127) and may be performed during partial skin resection or as a subsequent procedural step. Transitions beyond the delineated contours and bleach hand feathering are performed to clear the boundaries of the partial ablation. Directional occlusion of the partial defect is performed with an absorbent adhesive bandage (preloaded) stretched to a suitable vector of occlusion / skin firmness.

  The bandage (e.g., Flexzan, etc.) may be pre-mounted by first applying one end of the bandage to a lateral anchor point beyond the partial field. Once locked, a load is then applied to the opposite end of the bandage. The load is maintained during application. An alternative attachment technique is to first apply an opposite load on each lateral end of the elastic bandage, i.e. the bandage is first stretched along the longitudinal axis of the material prior to application. While the load is maintained, the elastic bandage is completely applied to the partial field. When the load is released, the elastic recoil closes the partial field defect along the specified vector. In a guy with a skin relaxation in front of the neck, a two-way occlusion with two vectors is made, but embodiments are not limited thereto.

  FIG. 129 shows an exemplary directional occlusion vector for a guy and anteroposterior, under an embodiment. The vector in front of the neck (under the guy) is more lateral and is used to emphasize the neck lower jaw angle. For the guy, the occlusion vector (indicated by the Langer line) is vertical. The sterile bandage is then applied and the surgery is finished. Also, applying a compression garment can provide compression and vectoring support during the postoperative phase.

  Embodiments include partial scar repair. Since the beginning of this specialized surgery, reducing the visible impact of existing scarring variants has been a major focus of orthopedics. Different surgical techniques were used depending on the type of scar variant. A commonly used technique is an oval incision of the scar with a stratified occlusion. Other techniques, such as Z plastic surgery and W plastic surgery attempt to reduce linear scars. FIG. 130 shows Z and W plastic scar repair. However, these conventional techniques lengthen the deformity of the scar. Partial scar repair is configured to reduce the visual impact of the scar without lengthening the scar.

  For linear scar variants, embodiments include partial decontouring techniques in which partial ablation combined with each other along each margin of the scar is performed. In order to maximize de-contouring, directional occlusion of the partial field perpendicular to the linear scar is performed. FIG. 131 shows an example of a partial decontouring technique for scar resection, under an embodiment.

  Under the embodiment, additional decontouring is generated by freehand partial ablation beyond the scar margin. Embodiments include partial techniques for wide hypotrophic scars resulting from ablative biopsy incisions of skin disorders. A partial scar incision is made within the scar margin to reduce the width of the scar variant. Directional occlusion as detailed herein is performed. FIG. 132 shows an example of partial scar resection of a wide hypotrophic scar according to an embodiment. Other alternative embodiments combine both partial scar repair techniques, where the combined repair is performed as a single surgery or as a planned series of surgeries, but is not limited thereto I will not.

  Additional embodiments include the application of partial excision to shortening the incision required to excise the lesion. This novel ability is also applicable to shortening the longer orthopedic incisions used to cut excess skin. If the lateral direction of each incision is partially resected using the devices and methods described herein, the elliptical deployment of the incision (to avoid "dog's ear" skin surplus) is no longer necessary.

  Partial surgery can be performed simultaneously with the main open surgery or as a planned repair that follows. The partial ablation of the embodiment may also be used for existing dog ears surplus after incision. One example is the reduction of the lower breast incision required for chest reduction and chest repositioning. FIG. 133 shows an example including shortening of a lower breast incision when applied to chest reduction and / or chest relocation according to an embodiment. The incision is more difficult to see because the incision no longer extends beyond the lower breast.

  The embodiments described herein include partial skin grafts. This involves the occlusion of a full thickness skin defect, which has also been the main focus of orthopedic surgeons. Large defects that can not be closed by direct occlusion require a more complicated approach. Two conventional approaches developed by orthopedics are flap occlusion and skin grafting. FIG. 134 shows an exemplary flap closure. Local or remote flap occlusion requires a stalk or true blood supply taken with the flap at the donor site. Flap closure of skin defects is also complicated by the formation of additional scars at the donor site.

  Skin grafting (split thickness or full thickness) is another approach used to close large full thickness skin defects. Using a skin graft approach requires a donor site for skin graft, and the site is associated with significant scarring and unhealthyness.

  A few decades after these two orthopedic approaches have been used, a novel third approach is described in the embodiment of the present description. Partial skin grafts can avoid the side effects associated with sheet-like skin grafts, since they have a unique ability to avoid donor site atrophy associated with sheet-like skin grafts. Partial skin grafts also provide the additional ability to subsequently introduce skin grafts from the same donor site. FIG. 135 shows an example including partial skin graft incorporation to be applied to the donor site, under an embodiment.

  Partial skin grafting is particularly important for patients with extensive burns where donor site availability is extremely limited. This unique ability of continuous uptake at the same donor site is also important for patients with lower extremity skin defects caused by circulatory failure. Patients, such as patients with venous congestion, ischemic and diabetic ulcers, are at risk of maintaining lower extremity defects, especially if the skin coverage of vascular dysfunction ulcers is not properly obtained. Many of these patients must perform a series of skin grafts before skin coverage can be obtained. The unhealthiness associated with this long-term skin grafting process involving multiple donor sites can be particularly frustrating to patients with other serious body diseases. The partial skin grafting described herein, combined with the ability to take continuous skin grafting from the same donor site, eliminates any visible donor site variants, thus being unique to these patients. Potential treatment options are provided. Compared to split-thickness skin graft donor sites, directional occlusion of partial donor sites provides more rapid healing, thereby dramatically reducing donor site unhealth and scars.

  Because the partial skin graft of the embodiment is full thickness, the durability of skin coverage is also improved over split thickness skin graft. For wound healing at these failed recipient sites, application of partial skin grafts can be made without the formation of partial skin segments (pixels) on a more uniform sheet. In this clinical setting, "side angiogenesis" occurs between the individual partial skin segments and the recipient bed. FIG. 136 shows an example including angiogenesis of a partial skin graft at a recipient site, under an embodiment. The recipient site acts as a living docking station that configures the partial skin segment in a side direction with the recipient bed.

  For other non-insufficiency and more visible skin defects, embodiments include the option of first forming a partially incorporated skin segment at a mechanical docking station into a more uniform graft. FIG. 137 shows an exemplary docking station including a docking tray and an adjustable slide, under an embodiment. In this clinical setting, "bottom up angiogenesis" occurs from the recipient bed to the deep part of the dermis (eg, Figure 136). In each clinical setting, compression stent dressings provide additional support and immobilization to promote "take" of angiogenesis or skin grafting.

  Since the advent of bovine collagen injected fillers, the use of abiotic injections has played a dominant role in the market for fillers. The embodiments described herein include the novel collagen infusion filler composition, the manufacture and use of which comprises the novel cosmetic surgery method of partial skin ablation detailed herein and in the related applications. Including. The novel fillers of the embodiments herein are referred to as, but not limited to, autologous self dermal matrix (LADMIX) injectable fillers, or "LADMIX". LADMIX contains a biocollagen injectable that is configured as a specific appendage to the partial excision of the skin, where a partially excised dermal plug (here "pixel", "skin pixel") Or "skin plug") is used as donor tissue to produce bioautologous dermal injectable fillers. Although the dermal matrix itself is not "live", the presence of biofibroblasts in the infused filler continues to produce collagen as a viable biodermal filler. Because the filler material is from the patient's own skin, filler resorption is minimized and contour correction is maintained longer than conventional artificial fillers. Furthermore, immune biologic or foreign body reactions are also minimized or avoided.

  FIG. 138 shows a face having target tissue that includes, for example, wrinkles and sags. LADMIX injection offers significant advantages over these commonly occurring cosmetic variants. Under the embodiments herein, a partially resected skin plug that would otherwise be discarded is taken in situ from the skin surface. Figure 139 shows a partially dissected field (containing a skin plug) under an embodiment. Simultaneous combined surgery of partial skin tightening and LADMIX filler injection may be performed, but is not limited to this.

  The skin plug is taken in situ from the partially incised field by applying an adhesive substrate, such as double-sided adhesive dermatome tape, and / or as detailed in the specification and related applications. FIG. 140, under an embodiment, is a detailed view of partial skin ablation defect incorporation. As detailed herein, the outward facing of the epidermis is maintained during the intake process. The skin plug may be incorporated with a membrane directly attached to the dermatome, or the plug may be separately incorporated into the membrane and then applied to the dermatome. FIG. 141 shows an example under the embodiment and with the skin plug incorporated with a membrane applied directly to the drum dermatome, as detailed herein. FIG. 142 shows the removal of the epidermal component by crossing the dermatome-generated skin plug with the dermatome outrigger blade, under an embodiment. FIG. 143 shows, under an embodiment, that skin plugs are individually incorporated onto the membrane and then the membrane is applied to the dermatome (eg, a drum).

  The incorporated dermal plug is collected for fragmentation into a LADMIX preparation or composition. The device used for fragmentation is configured to mechanically mince the dermal plug into a viscous fluid that minimizes fibroblast degradation. FIG. 144 shows, under an embodiment, an uncompressed moselizer configured to mechanically cut the dermal plug into a viscous liquid.

  The LADMIX preparation is mounted on a syringe with a large diameter injection needle. Prior to infusion, local anesthesia (eg, 1% xylocaine with epinephrine) is infused into the wrinkle / slack variant line. Local anesthesia injection provides both anesthesia and line lifting, and line lifting makes LADMIX filler injection easier. Injection of LADMIX filler is performed, for example, with a large diameter needle and syringe with the needle tip facing down. The needle tip is inserted into the longitudinal axis of the line, but is not limited thereto. FIG. 145 shows infusion of LADMIX filler at a target tissue site, under an embodiment. While the LADMIX filler is being injected, the filler pocket is cut out automatically by advancing the needle along the deformed streak. The injected self-filler is then manually massaged to form a smooth surface contour. The modified surface contour is then stented and maintained by applying a sterile strip over the post-injection streaks.

  An exemplary embodiment of the scalpet device includes a multi-scarpet array that includes a multifunctional chamber and is configured for simultaneous ablation and collection of multiple pixels. The collection chamber, also referred to herein as the "chamber", is configured to preserve the viability and volume of the self-injectable filler, and is further configured to serve one or more functions, including, for example: ablated pixels Collection chamber or receptacle, a scoring chamber for scoring collected dermal plugs, a mixing chamber for mixing the scored tissue with hyaluronic acid or saline, and / or for transporting the scored pixel solution subcutaneously Act as a transfer vessel or loading station, etc.

  If a multifunctional chamber is configured or used for the collection chamber function, it passively collects the incorporated dermal plug by pushing the plug into the chamber. At the end of this phase of the duty cycle, the multifunctional port is configured for short term vacuum extraction of the dermal plug within the lumen of the scalpet. Otherwise, the chamber is maintained at atmospheric pressure to pressure the viability of the dermal plug. In order to avoid reverse gear particle contamination, an "O-ring" is included in the distal region of the central drive shaft (e.g., on the integrating plate). During the initial partial ablation pass, first, a separate removable (vacuum assisted) epidermal extraction chamber may be used, although embodiments are not limited thereto.

  When the multifunction chamber is configured or used for the scoring chamber function, it receives a rotating scoring blade coupled or attached to the central drive shaft.

  During the intake phase of the duty cycle, the central sculpt drive shaft and scoring blade retract proximally to avoid continuous scoring of the incorporated dermal plug. During the duty cycle scoring phase, the central drive shaft and scoring blade are advanced distally for a predetermined period of time.

  When the multifunction chamber is configured or used for the mixing chamber function, it receives carrier fluid via the syringe through the multifunction chamber port. The carrier fluid may comprise one or more of physiologically active factors such as saline, hyaluronic acid, hydrogels and dermal growth factors.

  If a multifunctional chamber is configured or used for the syringe loading chamber function, it can be used to draw or extract composition into the syringe via the multifunctional port for later injection into the target or recipient site. Configured for

  More specifically, FIG. 146 shows an example of a scalpel device including a multifunctional chamber under the embodiment. The multi-scarpet array of the sculpt device of this exemplary embodiment includes, but is not limited to, a centerless 3 × 3 multi-scarpet array configured for simultaneous ablation and collection of eight (8) pixels I will not. The device is a handpiece engaged with or including a central drive shaft or pinion coupled to a drive system (e.g., a gear or the like) and including a handpiece for driving the rotation of eight scalpets (3 There is no sculpt at the center position of the × 3 array). A vacuum is applied through the vacuum port of the drive system housing (e.g., a gearbox, etc.) to minimize and / or remove the transfer of gear debris to the pixel chamber, although embodiments are not limited thereto. The collection chamber or chamber is configured to serve one or more of the functions including, for example: a collection receptacle for an ablated pixel, a mixing chamber for mincing the pixel and mixing with hyaluronic acid or saline, and / or Act as a transfer vessel to deliver the rendered pixel solution subcutaneously. The size (eg, diameter, etc.) of the collection chamber is selected based on, for example, the volume or number of pixels to be collected in the collection chamber.

  The housing includes or is coupled to the end cap of the distal end of the scalpet device, and the end cap of the embodiment is removable, but is not limited thereto. The length of the end cap may vary depending on the depth of ablation desired. Alternatively, the end cap is attached via an internal spring configured to extend the end cap over the scalpet when not in use. Once the end cap is attached, a vacuum tube is connected to the vacuum port of the drive system housing. This ensures effective removal of gear debris and, in combination with the mesh buffer plate, ensures that the ablated pixel is free of unwanted material. The scalpet device and / or the vacuum are configured to draw the ablated pixel through the scalpet (e.g., the lumen and the proximal end region) and into the collection chamber, but is not so limited. FIG. 147 shows an exemplary vacuum flow path through the scalpet device, under an embodiment.

  FIG. 148 shows an exemplary scalpet device following collection of pixels into a collection chamber, under an embodiment. After a complete dermal plug or pixel intake procedure and / or part of the collection into the chamber is completed, the handpiece with the sculpt array attached is inverted, thereby proximate the pixel in the collection chamber It is possible to collect at the end. The end cap is removed and the vacuum fitting and the clamping screw are replaced by two plugs. FIG. 149 shows an inverted handpiece with pixels in the collection chamber under an embodiment. The collection chamber is configured to receive or contain saline and / or other desired solution or composition, which is added to the pixel. An alternative end cap with a luer or similar fitting plug is attached and the handpiece with the chamber is returned to its original orientation. FIG. 150 shows the reverse handpiece with an alternative end cap and fitting plug attached, under an embodiment.

  The handpiece is then removed from the chamber, the scoring blade is fixed and then reattached to the collection chamber. FIG. 151 shows a handpiece with a scoring blade mounted and positioned in a collection chamber with pixel solution under an embodiment. The pixel solution is cut to the desired viscosity using a cutting blade to form a LADMIX filler. The incisor is then removed and the syringe is attached to the end cap. LADMIX filler is drawn into the syringe from the collection chamber, and LADMIX filler is ready to be injected into the target tissue site using a needle attached to the syringe. FIG. 152 shows the LADMIX filler drawn into the syringe under the embodiment. FIG. 153 shows the syringe and attached needle ready for injection of LADMIX filler into the target tissue site, under an embodiment.

  Incorporating tissue in an embodiment for use in preparing LADMIX involves removing the epidermis, thereby avoiding the formation of epidermal inclusion cysts at the recipient injection site. Epidermal removal and dermal plug incorporation are accomplished using methods including, but not limited to, epidermal peel, epidermal skin excision, vacuum assisted two-pass techniques, and two-pass techniques with injection. Each of these methods is detailed herein.

  Exfoliation of the epidermis from the dermis involves blistering the skin within the entire partial field or at individual partial sites. FIG. 154 shows skin blisters formed within an entire partial field, under an embodiment. FIG. 155 shows the partial field after removal of blister tissue overlapping the entire partial field, under an embodiment. FIG. 156 illustrates the formation of multiple skin blisters under an embodiment. FIG. 157 shows, under an embodiment, multiple partial fields after removal of blister tissue overlapping the partial fields. The blisters of the embodiments are performed using vacuum assisted mechanical oscillatory shear with heating. The blister of an alternative embodiment is performed using vacuum assisted mechanical oscillatory shear without heating. Yet another alternative embodiment of skin blistering involves topical anesthesia at the epidermal / dermal junction or surface injection of normal saline with the use of a short multi-needle injection manifold. Additional alternatives include vacuum assisted and / or mechanical shearing and / or heating, although embodiments are not limited thereto.

  As detailed herein, following skin blistering, dermal plug uptake is applied with a single pass of either a single sculpt system or multiple sculpt arrays. FIG. 158 shows, under an embodiment, incorporating a dermal plug in a blistered area using a single scalpet system or multiple skull pet arrays.

  The removal of the epidermis and the incorporation of the dermal plug in an alternative embodiment comprises skin ablation of the epidermis from the dermis. Although the entire partial donor field is dermatomed with a standard skin ablation system, embodiments are not limited thereto. Alternatively, removal of the epidermis is achieved by skin ablating individual partial sites with small turning bars operated by the single sculpt console described herein.

  Another alternative embodiment of epidermal removal and dermal plug incorporation involves the use of a vacuum assisted two-pass method or process. The first partial excision pass is performed superficially to remove a small portion of the papillary dermis and the epidermis (incorporating the papillary dermis into the dermal plug to be incorporated, a high density of fibers in that portion of the dermis) Important because blast cells are present). The second partial uptake pass takes place at full thickness through the dermis. The elastic recoil of the first partial pass skin defect margin provides additional clearance of the partial defect skin edge of the second intake pass. As with the other methods described herein, the dissected dermal plug is then vacuum extracted and collected, for example, into an in-line scale volumetric collection canister.

  Embodiments of the vacuum assisted two-pass method provide an additional method of providing skin margin clearance. An additional margin clearance method is used during the second partial uptake pass, where the scalpet / array is first inserted into the partial defect without rotation. Once fully inserted into the first pass partial defect, then rotation of the console for the second intake pass is initiated.

  Additional alternative embodiments of epidermal removal and dermal plug uptake include the use of a vacuum assisted two-pass method with local anesthesia or body surface injection of normal saline. This minimizes the unwanted ablation of the papillary dermis during the first pass.

  Regardless of the method used for removal of the epidermis and uptake of the dermal plug, the incorporated dermal plug is collected in the collection canister as described herein. FIG. 159 shows, under an embodiment, a collection vessel or canister including an incorporated dermal plug. When uptake is complete, the dermal plug is removed from the collection canister and inserted into the nick container. FIG. 160 shows an nick container or canister including an incorporated dermal plug under an embodiment. The nick container is configured to be used in scribing or cutting the dermal plug into small pieces configured for injection, but is not limited thereto.

  Embodiments of the scoring are performed with minimal trauma to preserve live fibroblasts. To this end, the incisor includes one or more of a manual, rotation, vibration, and reciprocating high-sharpness blade without compression fragmentation. FIG. 161 shows an embodiment of a manual scorer that includes a blade device configured to move up and down and / or rotate. FIG. 162 shows, under an embodiment, a powered scorer that includes a blade or cutting device configured to rotate under power. Rotation is applied to the blade by one or more of an electric motor, a pneumatic motor, and a manual or mechanical operating device, but is not limited thereto.

  Embodiments of the scored container are also configured to be used as a mixing chamber in which carrier fluid / gel is added to dermal tissue. Carrier fluids of embodiments include one or more of hyaluronic acid, hydrogels, normal saline, and the like. In order to reduce surface loss and trauma to the infusate, the nick container of the embodiment is configured as a loading chamber that includes a plunger and port that directly mounts the live autologous composition to the infusing syringe. Prior to injection into the recipient site, the syringe may also be placed in a centrifuge to separate fluidised fat from the dermal composition. Use of a friction reducing syringe (eg, glass, plastic, etc.) further reduces trauma to the live autologous composition during injection.

  The LADMIX incorporation of embodiments is configured to enable the use of skin that has been dissected during orthopedic surgery such as facelift, abdominal surgery, breast fixation and / or chest reduction. The combined surgery of the embodiment includes, but is not limited to, placing (and sticking) the cut skin on the paget dermatome with adhesive film tape during the same orthopedic surgery. The skin is directed downwards so that the epidermis touches the dermatome tape, but is not limited thereto. The epidermis is then removed by setting the dermatome to the surface setting. The subcutaneous tissue may then be removed manually by machine delipidation or in a second pass with a deep setting dermatome. The separated dermal layer of the incised skin is then incised as described herein.

  In an embodiment, infusion of LADMIX is performed simultaneously with or while partial skin ablation. Combining these two operations together as a single operation provides the unique ability of cosmetic enhancement. The combined surgery takes the live dermis composition from the partial scar repair field, which provides a unique ability to treat concave scar deformities. Surgery is also applicable to certain identifiable physiological condition states, an example of which is the treatment of stress urinary incontinence in women.

  Surgery or methods using LADMIX are configured for application to a number of different clinical methods and applications including, but not limited to, one or more of cosmetic surgery, reconstructed scarring, and physiological disease states. In general, surgery involves taking or acquiring a detailed picture of the patient or subject prior to surgery. The patient is marked in either a standing or sitting position prior to surgery. For example, although the overall size of the partial ablation field is determined by using a 4 to 1 rule, the embodiment is not limited thereto. Smaller topographically marked portions within the field may also be used to serve as donor sites for dermal plug uptake.

  Preoperative sedative and prophylactic antibiotics are provided to the patient and / or surgery as appropriate (eg, intravenous injection, oral etc.) and the patient is taken to the operating room where appropriate anesthesia is administered depending on the surgery to be performed there Be done. The surgical area is prepared and draped in a sterile manner. Then, local anesthesia or tummy anesthesia is injected at the surgical site. Using dilute solutions of xylocaine with epinephrine (eg, 0.5% xylocaine with 1/200000 part of epinephrine for field block, or 0.25% xylocaine with 1/400000 part of epinephrine for tumestatic anesthesia) Provide anesthesia (and a vasoconstrictor to reduce blood flow).

  A marking system template or stencil is then applied to the surgical site. The marking system template of the embodiment includes a perforated and notched plate, which is configured to utilize the corners of the plate to define a full partial density ablation at the donor site. FIG. 163 is an exemplary marking system template under an embodiment. The peripheral notch is configured for orientation during application of the template, and the porosity indicates the density of the partial ablation, where the operator "fills in" the partial ablation in between with the freehand. Furthermore, the marking template is configured to be used in marking the surgical site, for example with ink or direct partial marking ablation through a larger porosity in the template.

  Partial ablation of embodiments includes the staggered technique of partial ablation to reduce the contouring of rows and columns of the partial ablation field. As detailed herein, within the donor area of the field, two-pass technology is used for dermal uptake. The partial field is then closed with Flexzan or other elastic absorber, with a directional occlusion vector providing maximum aesthetic contouring. The sterile bandage is then applied to the combined partial skin / lip / dermal donor site.

  The incorporated dermal plug is then processed and infused into previously marked recipient sites during the same surgery to preserve the viability of the live autologous filler. After local anesthesia instillation, a recipient pocket of the infusate is generated by first advancing the large diameter needle of the syringe along the length of the previously marked concave profile. FIG. 164 shows, under an embodiment, generation of recipient pockets for injection. The large diameter needle then retracts slowly while the self-filler is injected along the entire length of the generated pocket. FIG. 165 is a recipient pocket with implanted filler, under an embodiment.

  More specifically, exemplary surgical protocols that include LADMIX infusate are detailed. The donor site and the recipient site are marked while the patient is secured prior to surgery. The donor site in this example comprises the non-hairy lower right abdomen (RLQ) of the belly. The recipient site will be the scar of left appendage and RLQ appendectomy

  While the patient is in the operating room, administer a subdermal field block (eg, 0.5% xylocaine with 1/20000 part of epinephrine) to the donor site of RLQ in the belly. Other infiltrates (without blisters) injected superficially at the junction of the dermis and epidermis are also administered through the partitioned area. Both the recipient site on the left hand and the recipient site on the concave appendectomy scar receive a normal subdermal field block using the same local anesthesia. Donor sites and recipient sites are prepared and draped in a sterile manner.

  The first pass of partial excision at the donor site does not involve an in-line filter in the vacuum line, but using a scalpet (eg, 2 mm internal diameter), a depth stop / vacuum manifold (eg, 1 mm depth stop / vacuum manifold) It takes place in This initial pass is done to remove the epidermis, with as few dermal papilla layers as possible.

  The second dermal uptake pass at the donor site, with the inline filter in place, using a scalpel (eg 1.5 mm internal diameter), depth stop / vacuum manifold (eg 4-6 mm depth stop / vacuum) It takes place on a manifold). The filter should be inserted as close to the manifold as possible. Periodically empty the scalpet / manifold with normal saline. This is to collect and moisten all incorporated dermal plugs into the filter.

  The incorporated dermal plug is removed from the filter and placed in an incisor. There, a small amount of normal saline is added. Striking the dermal plug with normal saline produces an autologous composition, but is not limited thereto. The composition is loaded (by aspiration) into the filler injection syringe using a short blunt tip 17 gauge needle. The composition is then infused into the recipient site using a 22 gauge cannula.

  First, a sample of the composition is placed on a microscope slide for viability staining to determine the viability of the incorporated fibroblasts. The first recipient site on the left hand side is infused, for example, using a technique developed by Dr. Stephen Yoelin. The cannula is first advanced without injection to create a pocket. The composition is then injected as the cannula is retracted backwards in the pocket.

  If a sufficient amount of infusion is available after the infusion of the first recipient site, it is infused into the second recipient site of the concave appendectomy scar. Three months later, the injected appendectomy scars are excised for histologic evaluation and assessed as long-term biostructure and the viability of the injected composition.

  For example, as determined by the Langer wire, directional occlusion of the RLQ donor site may be performed with the application of Flexzan using a single locking technique. Both recipient infusion sites are hand treated for smooth contours. A sterile strip (1/2 inch) is then applied longitudinally to the recipient site as a stent. Apply 4x4 regular bandages and ABD pads on Flexzan at the donor site.

  Clinical applications of LADMIX fillers as described herein include aesthetic applications, reconstructive applications, and physiological applications, although embodiments are not limited thereto. Aesthetic applications include, but are not limited to, streaks, wrinkles, sags and general aesthetic contours. Wrinkles include aesthetic variants that arise from attachment to the facial muscles and are accentuated during anatomic area activity. Wrinkles between groin are the aesthetic wrinkle variants most often pointed out. The LADMIX composition can be used to treat wrinkles, for example, by injecting LADMIX directly into the skin and between the muscles.

  The streaks are usually caused by linear atrophy of the dermal collagen matrix. Intradermal injection of LADMIX is effective for the long-term improvement of aesthetic variants.

  The noticeable sagging, especially the lines of law, is partly due to the progressive skin relaxation of this structure. Injection of LADMIX along the margin of the statute line with the upper lip and nose groove provides a more youthful transition between these two structures.

  With respect to women's general aesthetic contouring, the prominent erythematous skin junction of the upper lip can be interpreted as aesthetically enhanced from a social perspective. LADMIX injection along the erythematous skin junction of the upper lip provides long term emphasis on this anatomical structure. There is also the possibility for long lasting lip enhancement.

  Reconstruction applications of LADMIX include, but are not limited to, applications including scarring and soft tissue contour variants. In addition, these applications require an understanding of the anatomic basis of the deformity.

  For example, a concave scar variant has scar attachment to a deeper tissue layer. In most cases, release of the underlying scar adhesion is required during the same surgery, including a subdermal injection of LADMIX composition.

  Many concave soft tissue contour variants result from traumatic lipolysis of the subcutaneous fat layer. After release of the concave profile, an injection should be made between the skin and the underlying subcutaneous tissue.

  Physiological applications of LADMIX include, but are not limited to, female urinary incontinence, gastroesophageal reflux, vocal cord modulation, and the like. When applied to the treatment of female urinary incontinence, infusion of autologous autologous collagen filler provides longer lasting physiological support than non-living xenograft infusions. FIG. 166 shows an infusion of LADMIX to treat female urinary incontinence under an embodiment.

  Patients with reflux esophagitis are resistant to pharmacological management to reduce gastric acid. Injections of various curing agents were tried, with some having good results and some having bad results. Injection of LADMIX into the distal esophagus sphincter reduces reflux of gastric contents. Combining the pharmacological management of gastric acid with endoscopic LADMIX infusion (as a sequel) can synergistically reduce the symptoms and development of reflux esophagitis.

  The LADMIX described herein is used for the clinical application of vocal cord modulation. Poor or incomplete juxtaposition of the vocal cords can cause various vocal difficulties. Submucosal injection of LADMIX into the vocal cords provides better directional voice modulation in selected patients.

  Embodiments include methods comprising identifying a donor site of interest. The method comprises removing a portion of the epidermis in the donor site. The method includes incorporating a plurality of dermal plugs within the donor site. The method comprises forming an injectable filler by incising the dermal plug. The method comprises injecting the injectable filler into the recipient site of interest. The recipient site is different from the donor site.

Embodiments include identifying a donor site of interest, removing a portion of the epidermis within the donor site, incorporating multiple dermal plugs within the donor site, and engraving the dermal plug. Forming an injectable filler by: injecting the injectable filler into the recipient site of interest, wherein the recipient site is different from the donor site. Including.
The injectable filler comprises a living-self dermal matrix (LADMIX) injectable filler.
The injectable filler comprises biological fibroblasts.
Removing the portion of the epidermis comprises removing the portion of the epidermis in the area of the donor site.
Removing the portion of the epidermis comprises removing the portion of the epidermis in a plurality of areas of the donor site.
Removing the portion of the epidermis comprises exfoliating the epidermis from the dermis in at least one region of the donor site.
Said exfoliating comprises blistering the skin.
The exfoliating comprises blistering the skin at the donor site.
The exfoliating includes vibratory shear.
The oscillatory shear comprises at least one of vacuum and heating.
The exfoliating comprises a body surface injection.
The surface injection comprises at least one of saline and anesthesia.
Removing the portion of the epidermis comprises skin ablation of the epidermis from the dermis in at least one area of the donor site.
The incorporation of the plurality of dermal plugs comprises partially excising at least one dermal plug from at least one region of the donor site.
The incorporation of the plurality of dermal plugs comprises partially excising at least one dermal plug from each of the plurality of areas of the donor site.
Incorporating the plurality of dermal plugs comprises applying at least one partial ablation at the donor site.
The application of the at least one partial ablation comprises applying a staggered partial ablation at the donor site.
The application of the at least one partial ablation at the donor site comprises applying a first partial ablation and applying a second partial ablation.
The application of the first partial ablation involves ablation of the epidermis.
The application of the second partial ablation involves partial ablation through the dermis.
The second partial resection comprises a partial thickness partial ablation through the dermis.
The second partial excision comprises a full thickness partial excision through the dermis.
The partially defective skin edge of the application of the second partial ablation includes additional clearance to the partially defective skin edge of the application of the first partial ablation.
The method comprises inserting at least one scalpet into the at least one donor region;
Rotating the at least one sculpt when fully inserted.
The partial excision includes positioning a housing including a sculpt assembly at a target site, the sculpt assembly including a sculpt array and at least one guide plate, the sculpt array including a plurality of sculpts. And at least one guide plate maintains an arrangement of the plurality of sculpts.
At least one sculpt of the sculpt array includes a cylindrical sculpt including a cutting surface at a distal end of the sculpt.
Said partial excision comprising: exposing said sculpt array from said housing to the tissue of said target site; and, if delivered, generating a plurality of incisional dermal plugs at said target site This involves applying the force of the drive system of the sculpt assembly to the sculpt array. The partial ablation includes applying a rotational force to the skull pet array, wherein the rotational force is configured to rotate a set of at least one of the plurality of scalpets.
The plurality of skull pets are configured to passively push the dermal plug through the plurality of lumens of the plurality of skull pets.
The method comprises: transporting a vacuum to the target site through the housing, wherein the vacuum comprises a pressure that is relatively lower than atmospheric pressure, and transporting the plurality of cut dermis using the vacuum. And obtaining a plug.
Partial ablation involves returning the scalpet array from the target site into the housing.
The method includes obtaining the plurality of cut dermal plugs using a sticky substrate.
The method includes crossing the dissected dermal plug with a cutting member.
The partial excision includes applying a sculpt array to a target skin site, the sculpt array comprising a plurality of sculpts placed on an harvesting plate, and the harvesting plate is a porous plate.
Partial excision includes circumferentially incising a dermal plug at the target skin site by applying a load through the scalpet array to the underlying skin surface including the target skin site.
Applying the load includes applying the load with a dermatome.
The dermatome comprises a flat dermatome.
The dermatome comprises a drum dermatome.
The partial ablation involves obtaining a plurality of cut dermal plugs on an adhesive substrate, wherein the cut dermal plugs are pushed through the scalpet array.
The method comprises bonding the adhesive substrate to the dermatome.
The partial excision comprises traversing the base of the dissected dermal plug extruded through the sculpt array.
Crossing involves crossing at a cutting member.
The cutting member is coupled to the drum dermatome.
The method includes collecting the plurality of dermal plugs introduced at the donor site.
The method comprises collecting the plurality of dermal plugs in a collection chamber coupled to the sculpt array.
The collection chamber receiving the dermal plug, collecting the dermal plug, scoring the dermal plug, mixing the dermal plug with a carrier, and a composition comprising the dermal plug among a needle and an injection cannula Are configured for at least one of mounting a chamber for mounting on at least one of
The collection chamber comprises a pressurized chamber.
The collection chamber includes a non-pressurized chamber.
The collection chamber is configured for engraving, and the engraving includes engraving the dermal plug in the collection chamber.
Said incorporating comprises partial excision by applying a rotational force to said scalpet array, and said engraving comprises the dermis in said collection chamber with at least one blade configured to rotate by said rotational force. Including engrave plug.
Forming the injectable filler comprises mixing the incised dermal plug with a carrier, wherein the collection chamber is configured as a mixing chamber for the mixing.
The injecting comprises injecting with at least one of a needle and an injection cannula, the collection chamber being configured as a loading chamber for the at least one of the needle and the injection cannula.
The collecting comprises removing the plurality of dermal plugs from the donor site.
The engraving includes engraving the dermal plug with at least one blade.
The scribing includes at least one of a manual scribing and an electrical scribing.
The scribing includes rotating scribing.
The scribing may include reciprocating scribing.
The scribing includes vibration scribing.
The ticking eliminates the compression tick.
Said engraving involves compression subdivision.
Forming the injectable filler includes mixing the incised dermal plug with a carrier.
The carrier contains a fluid.
Carrier contains gel.
The carrier comprises hyaluronic acid.
The carrier contains a hydrogel.
The carrier comprises saline.
The carrier comprises a bioactive agent.
The bioactive agent comprises a dermal growth factor.
The method comprises centrifuging the injectable filler.
The injecting comprises injecting from a syringe.
The injecting is performed simultaneously with the removing.
The injection is performed during the same procedure as the removal.
The donor site includes fields within a larger working site.
Identifying the donor site includes applying a template to a working site within the donor site.
The template is configured to mark the work site.
The template includes at least one of porosity and peripheral notches.
The porosity is configured to indicate a density of at least one of the plurality of dermal plugs.
The peripheral notch is configured to direct subsequent application of the template.
The marking comprises marking the working site through the porosity with at least one of an ink and a dye.
The marking involves direct partial marking ablation through the porosity.
The method includes applying at least one bandage to the target site subsequent to the incorporating.
The at least one bandage applies a force to close the target site.
The at least one bandage applies a directional force to control the direction of closure at the target site.
The injecting comprises creating a pocket for the injectable filler at the recipient site.
The method includes placing the injectable filler in the pocket.
The injecting comprises advancing the needle to inject the injectable filler.
The injecting includes creating the pocket by advancing at least one of a needle and an injection cannula to the area next to the recipient site.
The injecting comprises retracting the needle from the pocket while injecting the injectable filler.
The recipient site comprises an aesthetic variant.
The recipient site contains at least one of streaks, wrinkles and sags.
The recipient site comprises the erythematous skin junction of the upper lip.
The recipient site comprises at least one of a scar and an indented scar.
The recipient site includes at least one of contour deformities, soft tissue contour deformities and post-traumatic concave contour deformities.
The recipient site includes at least one site adjacent to at least one of the urethra and the bladder.
The recipient site comprises at least one site next to the esophageal sphincter.
The recipient site includes at least one site next to the vocal cords.
Embodiments include methods comprising removing a portion of the epidermis in a donor site of interest. The method includes incorporating a plurality of dermal plugs within the donor site. The method comprises forming an injectable filler by incising the dermal plug. The method includes configuring the injectable filler for injection into the recipient site of interest. The recipient site is different from the donor site.
Embodiments include removing a portion of the epidermis in a donor site of interest, incorporating a plurality of dermal plugs in the donor site, and forming an injectable filler by incising the dermal plug. Configuring the injectable filler for injection into the recipient site of interest, wherein the recipient site is different than the donor site.
Embodiments include methods comprising excising skin from a donor site of interest. The method includes removing a portion of the epidermis from the resected skin. The method comprises separating the dermal layer of the resected skin by removing subcutaneous adipose tissue. The method includes forming an injectable filler by incising the dermal layer. The method comprises injecting the injectable filler into the recipient site of interest. The recipient site is different from the donor site.
Embodiments separate the dermal layer of the resected skin by resecting the skin from a donor site of interest, removing a portion of the epidermis from the resected skin, and removing subcutaneous adipose tissue. Forming an injectable filler by incising the dermal layer, and injecting the injectable filler into the target recipient site, wherein the recipient site is different from the donor site , Injecting, and the like.
Embodiments include a composition comprising a plurality of dermal plugs taken from a tissue of interest at a donor site. The dermal plug is inscribed. An injectable filler is formed by mixing the carrier including the carrier containing at least one of fluid and gel with the incised dermal plug. The injectable filler is configured for injection into the subject.
Embodiments include a composition comprising a plurality of dermal plugs taken from a tissue of interest at a donor site. The dermal plug is inscribed. The composition is a carrier comprising at least one of a fluid and a gel, wherein the carrier is mixed with the incised dermal plug to form an injectable filler, and the injectable filler is injected into the subject. Includes a carrier, configured for.
The injectable filler comprises a living-self dermal matrix (LADMIX) injectable filler.
The injectable filler comprises biological fibroblasts.
The plurality of dermal plugs are taken from a plurality of donor sites.
The plurality of dermal plugs are taken directly from the subject.
The plurality of dermal plugs are taken from the tissue following removal of the tissue from the subject.
The plurality of dermal plugs do not include the epidermis.
The epidermis is removed in at least one area of the donor site.
The epidermis is removed by peeling the epidermis from the dermis in the at least one area.
Said exfoliating comprises blistering the skin.
The exfoliating includes vibratory shear.
The oscillatory shear comprises at least one of vacuum and heating.
The exfoliating comprises a body surface injection.
The surface injection comprises at least one of saline and anesthesia.
The epidermis is removed by skin resection.
The plurality of dermal plugs are introduced by partially excising at least one dermal plug from at least one region of the donor site.
The plurality of dermal plugs are introduced by partially excising at least one dermal plug from each of the plurality of areas of the donor site.
The plurality of dermal plugs are introduced via application of at least one partial ablation at the donor site.
The application of the at least one partial ablation comprises applying a staggered partial ablation at the donor site.
The application of the at least one partial ablation includes applying a first partial ablation and applying a second partial ablation.
The application of the first partial ablation involves ablation of the epidermis.
The application of the second partial ablation comprises partial ablation through the dermis.
The second partial resection comprises a partial thickness partial ablation through the dermis.
The second partial excision comprises a full thickness partial excision through the dermis.
The partially defective skin edge of the application of the second partial ablation includes additional clearance to the partially defective skin edge of the application of the first partial ablation.
When at least one sculpt is inserted into the at least one donor area and fully inserted, it rotates.
A housing containing a sculpt assembly is positioned at the donor site, the sculpt assembly including a sculpt array and at least one guide plate, the sculpt array including a plurality of sculpts, and the at least one guide plate Maintaining the plurality of skull pet configurations.
At least one sculpt of the sculpt array includes a cylindrical sculpt including a cutting surface at a distal end of the sculpt.
The sculpt array is ejected from the housing into the tissue at the donor site and the plurality of dermal plugs are generated at the donor site.
At least one set of the plurality of scalpets is rotated.
The plurality of dermal plugs are passively pushed through the plurality of lumens of the plurality of scalpets.
The plurality of dermal plugs are captured by a vacuum at the donor site, the vacuum comprising a pressure relatively lower than ambient pressure.
The scalpet array retracts from the donor site to the housing.
The plurality of dermal plugs are captured using an adhesive substrate.
The dissected dermal plug is transected using a cutting member.
A skull pet array is applied to the donor site, and the skull pet array includes a plurality of skull pets disposed on the infesting plate.
The plurality of dermal plugs are circumferentially cut at the donor site through the load applied by the scalpet array at the lower skin surface including the donor site.
The load is applied at the dermatome.
The dermatome includes at least one of flat dermatome and drum dermatome. The plurality of dermal plugs are extruded through the skull pet array, and the plurality of dermal plugs are captured on the adhesive substrate.
The adhesive substrate is coupled to the dermatome.
The bases of the plurality of dermal plugs extruded through the scalpet array are traversed.
The bases of the plurality of dermal plugs extruded through the scalpet array are traversed by a cutting member coupled to the drum dermatome.
The plurality of dermal plugs are collected in a collection chamber coupled to the sculpt array.
The collection chamber receiving the plurality of dermal plugs, collecting the plurality of dermal plugs, engraving the plurality of dermal plugs, mixing the plurality of dermal plugs with a carrier, and the plurality of dermal plugs It is configured for at least one of mounting a chamber for mounting a composition including at least one of a needle and an injection cannula.
The collection chamber includes at least one of a pressure chamber and a non-pressure chamber.
The plurality of dermal plugs are inscribed in the collection chamber.
The plurality of dermal plugs are cut with a rotating blade.
The carrier is mixed with the engraved dermal plug in the collection chamber.
At least one of a needle and an injection cannula is used for injection, and the collection chamber is configured as a loading chamber for the at least one of the needle and the injection cannula.
The plurality of dermal plugs are cut with at least one blade.
The scribing includes at least one of a manual scribing and an electrical scribing.
The scribing includes at least one of rotational scribing, reciprocating scribing, vibratory scribing, and compression fragmentation.
The ticking eliminates the compression tick.
The carrier comprises at least one of a fluid and a gel.
The carrier comprises at least one of hyaluronic acid, hydrogel and saline.
The carrier comprises a bioactive agent.
The bioactive agent comprises a dermal growth factor.
The injectable filler is centrifuged.
The injectable filler is injected from a syringe.
The injectable filler is injected during the same procedure as the incorporation of the plurality of dermal plugs.
The donor site includes fields within a larger working site.
A template is applied to the donor site and the plurality of dermal plugs are introduced at the donor site.
The donor site is marked using the template.
The template includes at least one of porosity and peripheral notches.
The porosity is indicative of the density of at least one of the plurality of dermal plugs.
The peripheral notch directs later application of the template.
The donor site is marked through the porosity with at least one of an ink and a dye. The donor site is marked using direct partial marking ablation through the porosity.
Following uptake of the plurality of dermal plugs, at least one bandage is applied to the donor site.
An occlusion force is applied by the at least one bandage.
Directional force is applied by the at least one bandage to control the direction of the occlusion.
The injectable filler is configured to be injected into the target recipient site, wherein the recipient site is different from the donor site.
A pocket is created at the recipient site for receiving the injectable filler.
The pocket is created when advancing at least one of a needle and an injection cannula to the area next to the recipient site.
The injectable filler is injected into the pocket using the at least one of the needle and the injection cannula.
The recipient site is adjacent to at least one of: cosmetic deformation, streaks, wrinkles, erythematous skin junction of upper lip, scarring, concave scarring, contour deformity, soft tissue contour deformity, post-traumatic concave contour deformity, urethra and bladder At least one site, at least one site next to the esophageal sphincter, and at least one site next to the vocal cords.
Embodiments include a system including a hand piece configured to releasably engage the proximal end of a housing. The handpiece includes a drive system. The system includes a distal end of the housing and a scalpet assembly configured to releasably engage the drive system. The sculpt assembly includes a sculpt array including a plurality of sculpts configured to rotate using the force transmitted from the drive system. The scalpet array is configured to introduce a plurality of dermal plugs from a donor site via partial ablation. The system includes a collection chamber engaged with the housing and configured to collect the plurality of dermal plugs generated by the scalpet assembly.
The collection chamber is further configured to accommodate formation of an injectable filler by cutting the dermal plug and mixing the dermal plug with a carrier. The injectable filler is configured for injection into the subject.
An embodiment is a hand piece configured to releasably engage a proximal end of a housing, the hand piece including a drive system, a distal end of the housing and the drive system A sculpt assembly configured to releasably engage with the sculpt assembly, the sculpt assembly including a plurality of sculpts configured to rotate using force transmitted from the drive system. A sculpt assembly including: the sculpt array configured to receive a plurality of dermal plugs from a donor site via partial ablation; and a collection chamber engaged with the housing, the collection chamber being the skull Collect the multiple dermal plugs generated by the pet assembly Configured, the collection chamber is further configured to accommodate formation of an injectable filler by cutting the dermal plug and mixing the dermal plug with a carrier, wherein the injectable filler is configured for injection into the subject , A collection chamber.
The injectable filler comprises a living-self dermal matrix (LADMIX) injectable filler.
The injectable filler comprises biological fibroblasts.
The carrier comprises at least one of a fluid and a gel.
The carrier comprises at least one of hyaluronic acid, hydrogel and saline.
The carrier comprises a bioactive agent.
The bioactive agent comprises a dermal growth factor.
The housing includes a vacuum port configured for coupling to a vacuum source, the vacuum including a pressure relatively lower than ambient pressure, and the housing configured to capture the plurality of dermal plugs using the vacuum. Be done.
The plurality of dermal plugs are collected in the collection chamber.
The collection chamber includes at least one of a pressure chamber and a non-pressure chamber.
The system comprises an end cap configured to releasably engage the distal end of the housing, the end cap including a fitting and a plug configured to engage at least one of the medical devices The end cap replaces the scalpet assembly after collection of the plurality of dermal plugs.
The fitting includes a luer taper fitting.
The system comprises a scoring blade configured to releasably engage the drive system for rotation using a force transmitted from the drive system, the scoring blade following collection of the plurality of dermal plugs. Replace the skull pet assembly.
The plurality of dermal plugs are inscribed in the collection chamber.
The scoring blade includes at least one blade.
The scoring blade comprises a plurality of blades.
The scribing includes at least one of rotational scribing, reciprocating scribing, vibratory scribing, and compression fragmentation.
The ticking eliminates the compression tick.
The collection chamber is configured to mount a composition including the dermal plug to at least one of a syringe and an injection cannula engaged with the fitting.
The at least one of the syringe and the injection cannula is provided for the injection.
The injectable filler is injected during the same procedure as the taking of the plurality of dermal plugs.
The injectable filler is configured to be injected into the target recipient site, wherein the recipient site is different from the donor site.
A pocket is created at the recipient site for receiving the injectable filler.
The pocket is created when advancing at least one of a needle and an injection cannula to the area next to the recipient site.
The injectable filler is injected into the pocket using the at least one of the needle and the injection cannula.
The recipient site is adjacent to at least one of: cosmetic deformation, streaks, wrinkles, erythematous skin junction of upper lip, scarring, concave scarring, contour deformity, soft tissue contour deformity, post-traumatic concave contour deformity, urethra and bladder At least one site, at least one site next to the esophageal sphincter, and at least one site next to the vocal cords.
The sculpt array is ejected from the housing into the tissue at the donor site and the plurality of dermal plugs are generated at the donor site.
The plurality of dermal plugs are passively pushed through the plurality of lumens of the plurality of scalpets.
The plurality of dermal plugs are taken from a plurality of donor sites.
The plurality of dermal plugs do not include the epidermis.
The epidermis is removed in at least one area of the donor site.
The epidermis is removed by peeling the epidermis from the dermis in the at least one area.
Said exfoliating comprises blistering the skin.
The exfoliating includes vibratory shear.
The oscillatory shear comprises at least one of vacuum and heating.
The exfoliating comprises a body surface injection.
The surface injection comprises at least one of saline and anesthesia.
The epidermis is removed by skin resection.
The plurality of dermal plugs are introduced by partially excising at least one dermal plug from at least one region of the donor site.
The plurality of dermal plugs are introduced by partially excising at least one dermal plug from each of the plurality of areas of the donor site.
The plurality of dermal plugs are introduced via application of at least one partial ablation at the donor site.
The application of the at least one partial ablation comprises applying a staggered partial ablation at the donor site.
The application of the at least one partial ablation includes applying a first partial ablation and applying a second partial ablation.
The application of the first partial ablation involves ablation of the epidermis.
The application of the second partial ablation comprises partial ablation through the dermis.
The second partial resection comprises a partial thickness partial ablation through the dermis.
The second partial excision comprises a full thickness partial excision through the dermis.
The partially defective skin edge of the application of the second partial ablation includes additional clearance to the partially defective skin edge of the application of the first partial ablation.
When at least one sculpt is inserted into the donor site and fully inserted, it rotates.
The donor site includes fields within a larger working site.
The system comprises a template configured for application to the donor site.
The donor site is marked using the template.
The template includes at least one of porosity and peripheral notches.
The porosity is indicative of the density of at least one of the plurality of dermal plugs. The peripheral notch directs later application of the template.
The donor site is marked through the porosity with at least one of an ink and a dye. The donor site is marked using direct partial marking ablation through the porosity.
The system comprises at least one bandage configured for application to the donor site subsequent to the incorporation of the plurality of dermal plugs.
The at least one bandage is configured to apply an occlusion force.
The at least one bandage is configured to apply a directional force to control the direction of the occlusion.
The drive system includes a gear drive system.
The drive system includes a friction drive system configured to generate a frictional force through a compression component of at least one of the plurality of scalpets, wherein the frictional force is at least one of the plurality of skullpets It is configured to rotate a set of
The drive system comprises a helical drive system.
The drive system includes a slot drive system including a drive rod configured to engage a slot component of the sculpt array, the drive rod configured for up and down movement relative to the sculpt array.
The drive system includes an oscillatory drive system configured to vibrate at least one scalpet of the skull pet array.
The scalpet assembly is configured to transmit an axial force to the target site. The axial force includes continuous axial force and impact force.
At least one sculpt of the sculpt array includes a cylindrical sculpt including a cutting surface at a distal end of the sculpt.
The cutting plane includes sharp edges.
The cutting surface includes a serrated edge.
The cutting plane includes at least one curvature.
The system includes a vibrating system coupled to the sculpt array.
The system comprises an electromagnetic system engaged to the sculpt array, the electromagnetic system configured to apply electromagnetic energy to the sculpt array, the electromagnetic energy comprising radio frequency (RF) energy, laser Energy and / or ultrasonic energy.

  Throughout the description, words such as "comprise" and "comprising" are not meant to be exclusive or exhaustive, unless the context explicitly requires otherwise. It is to be understood in the inclusive sense, ie, in the sense of "including, but not limited to". Words using the singular or plural number also include the plural or singular number respectively. Further, the words "in the present specification", "below", "above", "below", and words having similar meanings, as used herein, refer to the entire application as a whole, and particular parts of this application. It does not refer to When the word "or" is used with reference to a list of two or more items, the word covers all of the following interpretations of the word; any of the items in the list, of the items in the list All and any combination of items in the list.

  The above description of the embodiments is not intended to be exhaustive or to limit the systems and methods to the precise forms disclosed. Although specific embodiments and examples of medical devices and methods are described herein for illustrative purposes, as one of ordinary skill in the art would recognize, it is within the scope of the systems and methods. Various equivalent modifications are possible. The teachings on the medical devices and methods provided herein may be applied to other systems and methods as well as the systems and methods described above.

  The elements or acts of the various embodiments described above can be combined to provide further embodiments. These and other changes can be made to the medical devices and methods in light of the above detailed description.

  In general, the terms used in the following claims should not be construed as limiting the medical devices and methods and corresponding systems and methods to the specific embodiments disclosed in the specification and claims. It should be construed to encompass all systems operating under the claims. Thus, the medical device and method and the corresponding system and method are not limited by the present disclosure, but instead the scope is completely determined by the claims.

  While certain embodiments of the medical device and method and corresponding system and method are presented below in certain claim forms, the inventors are concerned with the medical device and method and any claim forms Various aspects of corresponding systems and methods are envisioned. Accordingly, the inventors reserve the right to add additional claims after filing the present application to pursue additional claim forms for the medical device and method as well as other aspects of the corresponding system and method. .

Claims (248)

Identifying the target donor site,
Removing a portion of the epidermis within the donor site;
Incorporating multiple dermal plugs within the donor site;
Forming an injectable filler by incising the dermal plug;
Injecting the injectable filler into the recipient site of interest, wherein the recipient site is different from the donor site.   The method according to claim 1, wherein the injectable filler comprises a bioautologous dermal matrix (LADMIX) injectable filler.   3. The method of claim 2, wherein the injectable filler comprises biological fibroblasts.   The method according to claim 1, wherein removing the portion of the epidermis comprises removing the portion of the epidermis in the area of the donor site.   The method according to claim 1, wherein removing the portion of the epidermis comprises removing the portion of the epidermis in a plurality of areas of the donor site.   The method according to claim 1, wherein removing the portion of the epidermis comprises exfoliating the epidermis from the dermis in at least one region of the donor site.   7. The method of claim 6, wherein the exfoliating comprises blistering the skin.   7. The method of claim 6, wherein the exfoliating comprises blistering skin at the donor site.   7. The method of claim 6, wherein said exfoliating comprises oscillatory shear.   10. The method of claim 9, wherein the oscillatory shear comprises at least one of vacuum and heating.   The method according to claim 6, wherein the exfoliating comprises a body surface injection.   The method according to claim 11, wherein the surface injection comprises at least one of saline and anesthesia.   The method according to claim 1, wherein removing the portion of the epidermis comprises skin ablation of the epidermis from the dermis in at least one area of the donor site.   The method of claim 1, wherein incorporating the plurality of dermal plugs comprises partially excising at least one dermal plug from at least one region of the donor site.   15. The method of claim 14, wherein incorporating the plurality of dermal plugs comprises partially excising at least one dermal plug from each of the plurality of areas of the donor site.   The method of claim 1, wherein incorporating the plurality of dermal plugs comprises applying at least one partial ablation at the donor site.   17. The method of claim 16, wherein the application of the at least one partial ablation comprises applying a staggered partial ablation at the donor site.   17. The method of claim 16, wherein the applying the at least one partial ablation at the donor site comprises applying a first partial ablation and applying a second partial ablation.   19. The method of claim 18, wherein the application of the first partial ablation comprises ablation of the epidermis.   19. The method of claim 18, wherein the application of the second partial ablation comprises partial ablation through the dermis.   21. The method of claim 20, wherein the second partial ablation comprises partial thickness partial ablation through the dermis.   21. The method of claim 20, wherein the second partial ablation comprises a full thickness partial ablation through the dermis.   21. The method of claim 20, wherein the partially defective skin edge of the second partial ablation application comprises additional clearance to the partially defective skin edge of the first partial ablation application. Inserting at least one sculpt into the at least one donor area;
21. The method of claim 20, including rotating the at least one sculpt when fully inserted.   The partial excision includes positioning a housing including a sculpt assembly at a target site, the sculpt assembly including a sculpt array and at least one guide plate, the sculpt array including a plurality of sculpts. 17. The method of claim 16, including and maintaining the at least one guide plate arrangement of the plurality of sculpts.   26. The method of claim 25, wherein at least one sculpt of the sculpt array comprises a cylindrical sculpt including a cutting surface at a distal end of the sculpt.   Said partial excision comprising: exposing said sculpt array from said housing to the tissue of said target site; and, if delivered, generating a plurality of incisional dermal plugs at said target site 26. The method of claim 25, wherein applying the force of the drive system of the sculpt assembly to the sculpt array.   28. The method of claim 27, wherein the partial ablation includes applying a rotational force to the sculpt array, wherein the rotational force is configured to rotate a set of at least one of the plurality of scalpets. .   29. The method of claim 28, wherein the plurality of sculpts passively push the dermal plug through the plurality of lumens of the plurality of sculpts.   Carrying the vacuum to the target site through the housing, wherein the vacuum comprises a pressure relatively lower than atmospheric pressure, carrying, and obtaining the plurality of cut dermis plugs utilizing the vacuum 28. The method of claim 27, further comprising:   28. The method of claim 27, wherein the partial ablation comprises returning the sculpt array from the target site into the housing.   32. The method of claim 31, comprising obtaining the plurality of cut dermal plugs using an adhesive substrate.   33. The method of claim 32, comprising crossing the dissected dermal plug with a cutting member.   Said partially excision comprises applying a sculpt array to a target skin site, said sculpt array comprising a plurality of sculpts placed on an infesting plate, said infesting plate being a porous plate A method according to Item 16. The partial excision is
35. The method of claim 34, comprising circumferentially cutting a dermal plug at the target skin site by applying a load through the scalpet array to the underlying skin surface including the target skin site.   36. The method of claim 35, wherein the applying comprises applying the application at a dermatome.   37. The method of claim 36, wherein the dermatome comprises flat dermatome.   37. The method of claim 36, wherein the dermatome comprises a drum dermatome.   36. The method of claim 35, wherein the partial excision comprises obtaining a plurality of cut dermal plugs on an adhesive substrate, wherein the cut dermal plugs are extruded through the sculpt array.   40. The method of claim 39, comprising bonding the adhesive substrate to the dermatome.   40. The method of claim 39, wherein the partial ablation comprises crossing the base of an incision dermal plug extruded through the sculpt array.   42. The method of claim 41, wherein the crossing comprises crossing with a cutting member.   43. The method of claim 42, wherein the cutting member is coupled to the drum dermatome.   The method of claim 1, comprising collecting the plurality of dermal plugs introduced at the donor site.   The method of claim 1, comprising collecting the plurality of dermal plugs in a collection chamber coupled to the sculpt array.   The collection chamber receiving the dermal plug, collecting the dermal plug, scoring the dermal plug, mixing the dermal plug with a carrier, and a composition comprising the dermal plug among a needle and an injection cannula 46. The method of claim 45, configured for at least one of mounting a chamber for mounting on at least one of.   46. The method of claim 45, wherein the collection chamber comprises a pressurized chamber.   46. The method of claim 45, wherein the collection chamber comprises a non-pressurized chamber.   46. The method of claim 45, wherein the collection chamber is configured for engraving and the engraving includes engraving the dermal plug in the collection chamber.   Said incorporating comprises partial excision by applying a rotational force to said scalpet array, and said engraving comprises the dermis in said collection chamber with at least one blade configured to rotate by said rotational force. 50. The method of claim 49, including engraving a plug.   46. The method of claim 45, wherein forming the injectable filler comprises mixing the incised dermal plug with a carrier, wherein the collection chamber is configured as a mixing chamber for the mixing.   Said injecting comprises injecting using at least one of a needle and an injection cannula, wherein said collection chamber is configured as a loading chamber for said at least one of said needle and said injection cannula. Method described in 45.   The method of claim 1, wherein the collecting comprises removing the plurality of dermal plugs from the donor site.   The method according to claim 1, wherein the engraving comprises engraving the dermal plug with at least one blade.   55. The method of claim 54, wherein the scribing includes at least one of a manual scribing and a motorized scribing.   55. The method of claim 54, wherein the scribing includes rotational scribing.   55. The method of claim 54, wherein the scribing comprises a reciprocating scribe.   55. The method of claim 54, wherein the scribing comprises vibratory scribing.   55. The method of claim 54, wherein the scribing eliminates compression scribing.   55. The method of claim 54, wherein the engraving comprises compression fragmentation.   The method of claim 1, wherein forming the injectable filler comprises mixing the incised dermal plug with a carrier.   62. The method of claim 61, wherein the carrier comprises a fluid.   62. The method of claim 61, wherein the carrier comprises a gel.   62. The method of claim 61, wherein the carrier comprises hyaluronic acid.   62. The method of claim 61, wherein the carrier comprises a hydrogel.   62. The method of claim 61, wherein the carrier comprises saline.   62. The method of claim 61, wherein the carrier comprises a bioactive agent.   68. The method of claim 67, wherein the bioactive agent comprises a dermal growth factor.   The method of claim 1, comprising centrifuging the injectable filler.   The method of claim 1, wherein the injecting comprises injecting from a syringe.   The method of claim 1, wherein the injecting is performed simultaneously with the removing.   The method of claim 1, wherein the injecting is performed during the same procedure as the removing.   The method of claim 1, wherein the donor site comprises a field within a larger working site.   The method of claim 1, wherein identifying the donor site comprises applying a template to a working site within the donor site.   75. The method of claim 74, wherein the template is configured to mark the work site.   76. The method of claim 75, wherein the template comprises at least one of porosity and peripheral notches.   77. The method of claim 76, wherein the porosity is configured to indicate a density of at least one of the plurality of dermal plugs.   77. The method of claim 76, wherein the peripheral notch is configured to direct a later application of the template.   76. The method of claim 75, wherein the marking comprises marking the work site through the porosity with at least one of an ink and a dye.   76. The method of claim 75, wherein the marking comprises direct partial marking ablation through the porosity.   The method of claim 1, further comprising applying at least one bandage to the target site subsequent to the incorporating.   82. The method of claim 81, wherein the at least one bandage applies a force to close the target site.   82. The method of claim 81, wherein the at least one bandage applies a directional force to control the direction of closure at the target site.   The method of claim 1, wherein the injecting comprises creating a pocket for the injectable filler at the recipient site.   85. The method of claim 84, comprising placing the injectable filler in the pocket.   86. The method of claim 85, wherein the injecting comprises advancing the needle to inject the injectable filler.   86. The method of claim 85, wherein the injecting comprises generating the pocket by advancing at least one of a needle and an injection cannula to an area next to the recipient site.   90. The method of claim 87, wherein the injecting comprises retracting the needle from the pocket while injecting the injectable filler.   The method of claim 1, wherein the recipient site comprises an aesthetic variant.   The method of claim 1, wherein the recipient site comprises at least one of streaks, wrinkles and sags.   The method of claim 1, wherein the recipient site comprises a erythema skin junction of the upper lip.   The method according to claim 1, wherein the recipient site comprises at least one of scarring and dented scarring.   The method according to claim 1, wherein the recipient site comprises at least one of contour deformities, soft tissue contour deformities and post-traumatic concave contour deformities.   The method according to claim 1, wherein the recipient site comprises at least one site adjacent to at least one of the urethra and the bladder.   The method of claim 1, wherein the recipient site comprises at least one site next to the esophageal sphincter.   The method of claim 1, wherein the recipient site comprises at least one site next to the vocal cords. Removing a portion of the epidermis in the target donor site;
Incorporating multiple dermal plugs within the donor site;
Forming an injectable filler by incising the dermal plug;
Configuring the injectable filler for injection into the recipient site of interest, wherein the recipient site is different from the donor site. Removing the skin from the target donor site;
Removing a portion of the epidermis from the resected skin;
Separating the dermal layer of the resected skin by removing subcutaneous adipose tissue; forming an injectable filler by scoring the dermal layer;
Injecting the injectable filler into the recipient site of interest, wherein the recipient site is different from the donor site. A plurality of dermal plugs introduced from a target tissue at a donor site, wherein the plurality of dermal plugs are engraved;
A carrier comprising at least one of a fluid and a gel, wherein said carrier is mixed with said incised dermal plug to form an injectable filler, said injectable filler being configured for injection into said subject And a carrier.   100. The composition of claim 99, wherein the injectable filler comprises a bioautologous dermal matrix (LADMIX) injectable filler.   101. The composition of claim 100, wherein the injectable filler comprises biological fibroblasts.   100. The composition of claim 99, wherein the plurality of dermal plugs are taken from a plurality of donor sites.   100. The composition of claim 99, wherein the plurality of dermal plugs are directly taken from the subject.   100. The composition of claim 99, wherein the plurality of dermal plugs are taken from the tissue following removal of the tissue from the subject.   100. The composition of claim 99, wherein the plurality of dermal plugs do not include the epidermis.   106. The composition of claim 105, wherein the epidermis is removed in at least one area of the donor site.   107. The composition of claim 106, wherein the epidermis is removed by peeling the epidermis from the dermis within the at least one area.   108. The composition of claim 107, wherein said exfoliating comprises blistering the skin.   108. The composition of claim 107, wherein said exfoliating comprises oscillatory shear.   110. The composition of claim 109, wherein the oscillatory shear comprises at least one of vacuum and heating.   108. The composition of claim 107, wherein said exfoliating comprises surface injection.   111. The composition of claim 110, wherein said surface injection comprises at least one of saline and anaesthesia.   106. The composition of claim 105, wherein the epidermis is removed by skin excision.   100. The composition of claim 99, wherein the plurality of dermal plugs are incorporated by partially excising at least one dermal plug from at least one region of a donor site.   115. The composition of claim 114, wherein the plurality of dermal plugs are incorporated by partially ablating at least one dermal plug from each of a plurality of areas of the donor site.   100. The composition of claim 99, wherein the plurality of dermal plugs are introduced via application of at least one partial ablation at the donor site.   117. The composition of claim 116, wherein the application of the at least one partial ablation comprises applying a staggered partial ablation at the donor site.   117. The composition of claim 116, wherein the application of the at least one partial ablation comprises applying a first partial ablation and applying a second partial ablation.   119. The composition of claim 118, wherein the application of the first partial ablation comprises ablation of the epidermis.   119. The composition of claim 118, wherein the application of the second partial ablation comprises partial ablation through the dermis.   121. The composition of claim 120, wherein the second partial ablation comprises partial thickness partial ablation through the dermis.   121. The composition of claim 120, wherein the second partial excision comprises a full thickness partial excision through the dermis.   121. The composition of claim 120, wherein the partially defective skin edge of the second partial ablation application comprises additional clearance to the partially defective skin edge of the first partial ablation application.   121. The composition of claim 120, wherein at least one sculpt is inserted into the at least one donor region and rotates when fully inserted.   A housing containing a sculpt assembly is positioned at the donor site, the sculpt assembly including a sculpt array and at least one guide plate, the sculpt array including a plurality of sculpts, and the at least one guide plate 117. The composition of claim 116, wherein said plurality of scalpet configurations are maintained.   126. The composition of claim 125, wherein at least one sculpt of the sculpt array comprises a cylindrical sculpt including a cutting surface at a distal end of the sculpt.   126. The composition of claim 125, wherein the sculpt array is ejected from the housing into the tissue at the donor site and the plurality of dermal plugs are generated at the donor site.   128. The composition of claim 127, wherein at least one collection of the plurality of sculpet rotates.   129. The composition of claim 128, wherein the plurality of dermal plugs are passively pushed through the plurality of lumens of the plurality of scalpets.   128. The composition of claim 127, wherein the plurality of dermal plugs are captured by a vacuum at the donor site, the vacuum comprising a pressure relatively less than ambient pressure.   128. The composition of claim 127, wherein the sculpt array is retracted from the donor site to the housing.   132. The composition of claim 131, wherein the plurality of dermal plugs are captured using an adhesive substrate.   133. The composition of claim 132, wherein the dissected dermal plug is traversed using a cutting member.   117. The composition of claim 116, wherein a sculpt array is applied to the donor site, and the sculpt array comprises a plurality of sculpts disposed on an incubating plate.   135. The composition of claim 134, wherein the plurality of dermal plugs are circumferentially dissected at the donor site through the load applied by the scalpet array at the lower skin surface comprising the donor site.   136. The composition of claim 135, wherein the load is applied at the dermatome.   137. The composition of claim 136, wherein the dermatome comprises at least one of flat dermatome and drum dermatome.   136. The composition of claim 135, wherein the plurality of dermal plugs are extruded through the sculpt array and the plurality of dermal plugs are trapped on an adhesive substrate.   139. The composition of claim 138, wherein the adhesive substrate is bonded to the dermatome.   139. The composition of claim 138, wherein the base of the plurality of dermal plugs extruded through the scalpet array is traversed.   141. The composition of claim 140, wherein a base of the plurality of dermal plugs extruded through the scalpet array is traversed with a cutting member coupled to the drum dermatome.   117. The composition of claim 116, wherein the plurality of dermal plugs are collected in a collection chamber coupled to the sculpt array.   The collection chamber receiving the plurality of dermal plugs, collecting the plurality of dermal plugs, engraving the plurality of dermal plugs, mixing the plurality of dermal plugs with a carrier, and the plurality of dermal plugs 143. The composition of claim 142, configured for at least one of mounting a chamber for mounting a composition comprising at least one of a needle and an injection cannula.   143. The composition of claim 142, wherein the collection chamber comprises at least one of a pressure chamber and a non-pressure chamber.   143. The composition of claim 142, wherein the plurality of dermal plugs are cut in the collection chamber.   146. The composition of claim 145, wherein the plurality of dermal plugs are cut with a rotating blade.   143. The composition of claim 142, wherein the carrier is mixed with the incised dermal plug in the collection chamber.   143. The composition of claim 142, wherein at least one of a needle and an injection cannula is used for injection and the collection chamber is configured as a loading chamber for the at least one of the needle and the injection cannula.   100. The composition of claim 99, wherein the plurality of dermal plugs are cut with at least one blade.   150. The composition of claim 149, wherein the scribing comprises at least one of manual scribing and electric scribing.   150. The composition of claim 149, wherein the scribing comprises at least one of rotational scribing, reciprocating scribing, vibratory scribing, and compression fragmentation.   150. The composition of claim 149, wherein the scoring eliminates compression scoring.   100. The composition of claim 99, wherein the carrier comprises at least one of a fluid and a gel.   100. The composition of claim 99, wherein the carrier comprises at least one of hyaluronic acid, hydrogel and saline.   100. The composition of claim 99, wherein the carrier comprises a bioactive agent.   156. The composition of claim 155, wherein the bioactive agent comprises a dermal growth factor.   100. The composition of claim 99, wherein the injectable filler is centrifuged.   100. The composition of claim 99, wherein the injectable filler is injected from a syringe.   100. The composition of claim 99, wherein the injectable filler is injected during the same procedure as the incorporation of the plurality of dermal plugs.   100. The composition of claim 99, wherein the donor site comprises a field within a larger working site.   100. The composition of claim 99, wherein a template is applied to the donor site and the plurality of dermal plugs are incorporated at the donor site.   162. The composition of claim 161, wherein the donor site is marked using the template.   163. The composition of claim 162, wherein the template comprises at least one of porosity and peripheral notches.   164. The composition of claim 163, wherein the porosity is indicative of a density of at least one of the plurality of dermal plugs.   164. The composition of claim 163, wherein the peripheral notch directs later application of the template.   163. The composition of claim 162, wherein the donor site is marked through the porosity with at least one of an ink and a dye.   163. The composition of claim 162, wherein the donor site is direct partial marking ablation through the porosity.   100. The composition of claim 99, wherein at least one bandage is applied to the donor site subsequent to the incorporation of the plurality of dermal plugs.   169. The composition of claim 168, wherein an occlusive force is applied by the at least one bandage.   171. The composition of claim 168, wherein the direction of the occlusion is controlled by the application of a directional force by the at least one bandage.   100. The composition of claim 99, wherein the injectable filler is configured to be injected into the recipient site of interest, wherein the recipient site is different than the donor site.   172. The composition of claim 171, wherein the recipient site is created with a pocket for receiving the injectable filler.   173. The composition of claim 172, wherein the pocket is generated when advancing at least one of a needle and an injection cannula to the area next to the recipient site.   173. The composition of claim 172, wherein the injectable filler is injected into the pocket using the at least one of the needle and the injection cannula.   The recipient site is adjacent to at least one of: cosmetic deformation, streaks, wrinkles, erythematous skin junction of upper lip, scarring, concave scarring, contour deformity, soft tissue contour deformity, post-traumatic concave contour deformity, urethra and bladder 172. The composition of claim 171, wherein the composition comprises at least one of at least one site, at least one site next to the esophageal sphincter, and at least one site next to the vocal cords. A hand piece configured to releasably engage the proximal end of the housing, the hand piece including a drive system;
A sculpt assembly configured to releasably engage the distal end of the housing and the drive system, wherein the sculpt assembly is configured to rotate using the force transmitted from the drive system. A sculpt assembly comprising a sculpt array comprising a plurality of sculpts, said sculpt array being adapted to introduce a plurality of dermal plugs from a donor site via partial ablation;
A collection chamber engaged with the housing, wherein the collection chamber is configured to collect the plurality of dermal plugs generated by the scalpet assembly, the collection chamber further cutting the dermal plug into the dermal plug A collection chamber configured to accommodate formation of an injectable filler by mixing with a carrier, wherein the injectable filler is configured for injection into the subject.   178. The system of claim 176, wherein the injectable filler comprises a bioautologous dermal matrix (LADMIX) injectable filler.   178. The system of claim 177, wherein the injectable filler comprises biological fibroblasts.   178. The system of claim 176, wherein the carrier comprises at least one of a fluid and a gel.   178. The system of claim 176, wherein the carrier comprises at least one of hyaluronic acid, hydrogel and saline.   178. The system of claim 176, wherein the carrier comprises a bioactive agent.   182. The system of claim 181, wherein the bioactive agent comprises a dermal growth factor.   The housing includes a vacuum port configured for coupling to a vacuum source, the vacuum including a pressure relatively lower than ambient pressure, and the housing configured to capture the plurality of dermal plugs using the vacuum. 179. The system of claim 176.   178. The system of claim 176, wherein the plurality of dermal plugs are collected in the collection chamber.   178. The system of claim 176, wherein the collection chamber comprises at least one of a pressure chamber and a non-pressure chamber.   An end cap configured to releasably engage the distal end of the housing, the end cap including a fitting and a plug configured to engage at least one of the medical devices; 178. The system of claim 176, wherein an end cap replaces the scalpet assembly after collection of the plurality of dermal plugs.   191. The system of claim 186, wherein the fitting comprises a luer taper fitting.   The sculpt comprising a scoring blade configured to releasably engage the drive system for rotation using a force transmitted from the drive system, the scoring blade following collection of the plurality of dermal plugs. 187. The system of claim 186, which replaces an assembly.   191. The system of claim 188, wherein the plurality of dermal plugs are inscribed in the collection chamber.   190. The system of claim 188, wherein the scoring blade comprises at least one blade.   190. The system of claim 188, wherein the scoring blade comprises a plurality of blades.   190. The system of claim 188, wherein the scribing includes at least one of rotational scribing, reciprocating scribing, vibratory scribing, and compression fragmentation.   190. The system of claim 188, wherein the scribing eliminates compression scribing.   191. The system of claim 186, wherein the collection chamber is configured to mount a composition comprising the dermal plug to at least one of a syringe and an injection cannula engaged with the fitting.   197. The system of claim 194, wherein the at least one of the syringe and the injection cannula is provided for the infusion.   196. The system of claim 195, wherein the injectable filler is injected during the same procedure as the taking of the plurality of dermal plugs.   196. The system of claim 195, wherein the injectable filler is configured to be injected into the target recipient site, wherein the recipient site is different than the donor site.   200. The system of claim 197, wherein the recipient site is created a pocket for receiving the injectable filler.   200. The system of claim 198, wherein the pocket is generated when advancing at least one of a needle and an injection cannula to a region next to the recipient site.   200. The system of claim 198, wherein the injectable filler is injected into the pocket using the at least one of the needle and the injection cannula.   The recipient site is adjacent to at least one of: cosmetic deformation, streaks, wrinkles, erythematous skin junction of upper lip, scarring, concave scarring, contour deformity, soft tissue contour deformity, post-traumatic concave contour deformity, urethra and bladder 196. The system of claim 197, comprising at least one of: at least one site; at least one site next to the esophagus sphincter; and at least one site next to the vocal cords.   178. The system of claim 176, wherein the sculpt array is ejected from the housing into the tissue at the donor site and the plurality of dermal plugs are generated at the donor site.   178. The system of claim 176, wherein the plurality of dermal plugs are passively pushed through the plurality of lumens of the plurality of scalpets.   178. The system of claim 176, wherein the plurality of dermal plugs are taken from a plurality of donor sites.   178. The system of claim 176, wherein the plurality of dermal plugs do not include the epidermis.   205. The system of claim 205, wherein the epidermis is removed in at least one area of the donor site.   208. The system of claim 206, wherein the epidermis is removed by peeling the epidermis from dermis in the at least one area.   208. The system of claim 207, wherein the exfoliating comprises blistering the skin.   208. The system of claim 207, wherein the exfoliating comprises oscillatory shear.   210. The system of claim 209, wherein the oscillatory shear comprises at least one of vacuum and heating.   208. The system of claim 207, wherein said exfoliating comprises surface injection.   222. The system of claim 211, wherein said surface injection comprises at least one of saline and anesthesia.   206. The system of claim 205, wherein the epidermis is removed by skin resection.   178. The system of claim 176, wherein the plurality of dermal plugs are introduced by partially excising at least one dermal plug from at least one region of the donor site.   215. The system of claim 214, wherein the plurality of dermal plugs are introduced by partially ablating at least one dermal plug from each of a plurality of areas of the donor site.   178. The system of claim 176, wherein the plurality of dermal plugs are introduced via application of at least one partial ablation at the donor site.   217. The system of claim 216, wherein the applying the at least one partial ablation comprises applying a staggered partial ablation at the donor site.   217. The system of claim 216, wherein applying the at least one partial ablation comprises applying a first partial ablation and applying a second partial ablation.   219. The system of claim 218, wherein the application of the first partial ablation comprises ablation of the epidermis.   219. The system of claim 218, wherein the application of the second partial ablation comprises partial ablation through the dermis.   221. The system of claim 220, wherein the second partial ablation comprises partial thickness partial ablation through the dermis.   221. The system of claim 220, wherein the second partial ablation comprises a full thickness partial ablation through the dermis.   219. The system of claim 220, wherein the partially defective skin edge of the second partial ablation application includes additional clearance to the partially defective skin edge of the first partial ablation application.   221. The system of claim 220, wherein at least one sculpt rotates when it is inserted into the donor site and fully inserted.   178. The system of claim 176, wherein the donor site comprises a field within a larger work site.   178. The system of claim 176, comprising a template configured for application to the donor site.   226. The system of claim 226, wherein the donor site is marked using the template.   236. The system of claim 227, wherein the template comprises at least one of porosity and peripheral notches.   230. The system of claim 228, wherein the porosity is indicative of the density of at least one of the plurality of dermal plugs.   230. The system of claim 228, wherein the peripheral notch directs later application of the template.   236. The system of claim 227, wherein the donor site is marked through the porosity with at least one of an ink and a dye.   236. The system of claim 227, wherein the donor site is direct partial marking ablation through the porosity.   178. The system of claim 176, comprising at least one bandage configured for application to the donor site subsequent to the incorporation of the plurality of dermal plugs.   234. The system of claim 233, wherein the at least one bandage is configured to apply an occlusion force.   234. The system of claim 233, wherein the at least one bandage is configured to apply a directional force to control the direction of the occlusion.   178. The system of claim 176, wherein the drive system comprises a gear drive system.   The drive system includes a friction drive system configured to generate a frictional force through a compression component of at least one of the plurality of scalpets, wherein the frictional force is at least one of the plurality of skullpets 178. The system of claim 176, configured to rotate a set of.   178. The system of claim 176, wherein the drive system comprises a helical drive system.   179. The drive system includes a slot drive system including a drive rod configured to engage a slot component of the sculpt array, wherein the drive rod is configured for up and down movement relative to the sculpt array. System described.   178. The system of claim 176, wherein the drive system comprises a vibratory drive system configured to vibrate at least one sculpt of the sculpt array.   178. The system of claim 176, wherein the sculpt assembly is configured to transmit an axial force to the target site.   423. The system of claim 421, wherein the axial force comprises continuous axial force and impact force.   178. The system of claim 176, wherein at least one sculpt of the sculpt array comprises a cylindrical sculpt including a cutting surface at a distal end of the sculpt.   243. The system of claim 243, wherein the cutting surface comprises a sharp edge.   243. The system of claim 243, wherein the cutting surface comprises a serrated edge.   243. The system of claim 243, wherein the cutting plane comprises at least one curvature.   178. The system of claim 176, comprising a vibration system coupled to the sculpt array.   An electromagnetic system engaged with the skull pet array, comprising an electromagnetic system configured to apply electromagnetic energy to the skull pet array, the electromagnetic energy comprising radio frequency (RF) energy, laser energy and 178. The system of claim 176, comprising at least one of sonic energy.

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