JP7075568B2 - Pixel Array Medical Systems, Devices and Methods - Google Patents

Description

Related application

This application claims the benefits of US Patent Application No. 62 / 456,775 filed February 9, 2017.
This application claims the benefits of US Patent Application No. 62 / 504,844 filed May 11, 2017.
This application is a continuation of US Patent Application No. 12 / 972,013 filed on December 17, 2010, and is currently US Patent No. 8,900,181, filed on December 1, 2014. This is a partial continuation application of US Patent Application No. 14 / 556,648.
This application is a partial continuation of US Patent Application No. 15 / 812,952 filed November 14, 2017.
This application is a partial continuation of US Patent Application No. 14 / 099,380 filed December 6, 2013.
This application is a partial continuation of US Patent Application No. 15 / 821,258 filed November 22, 2017.
This application is a partial continuation of US Patent Application No. 14 / 505,090 filed October 2, 2014.
This application is a partial continuation of US Patent Application No. 14 / 505,183 filed October 2, 2014.
This application is a partial continuation of US Patent Application No. 15 / 821,325 filed November 22, 2017.
This application is a partial continuation of US Patent Application No. 14 / 840,274 filed on August 31, 2015.
This application is a partial continuation of US Patent Application No. 14 / 840,284 filed on August 31, 2015.
This application is a partial continuation of US Patent Application No. 14 / 840,267 filed on August 31, 2015.
This application is a partial continuation of US Patent Application No. 14 / 840,290 filed on August 31, 2015.
This application is a partial continuation of US Patent Application No. 14 / 840,307 filed on August 31, 2015.
This application is a partial continuation of US Patent Application No. 15 / 016,954 filed February 5, 2016.
This application is a partial continuation of US Patent Application No. 15 / 017,007 filed February 5, 2016.
This application is a partial continuation of US Patent Application No. 15 / 431,230 filed February 13, 2017.
This application is a partial continuation of US Patent Application No. 15 / 431,247 filed February 13, 2017.

The embodiments described herein relate to medical systems, instruments or devices, and methods, and more specifically to medical instruments and methods that apply to the surgical management of burns, skin defects, and hair transplantation.

The aging process is most visually represented by the progression of sagging skin relaxation. This lifelong process can begin to stand out as early as the thirties of a lifetime and gradually worsens over the next few decades. Histological studies have shown that sagging dilation or age-related relaxation of the skin is partly due to progressive skin atrophy associated with reduced tensile strength of the skin. Age-related skin atrophy, combined with the downward force of gravity, results in a two-dimensional stretch of the skin envelope. A clinical symptom in this histological process on the body is extra skin relaxation. The most affected areas are the head and neck, upper arm, breast, lower abdomen and knee areas. The most noticeable part of all parts is the head and neck. In this area, the noticeable "male turkey" relaxation in the neck and the "jaw sagging" of the lower face are due to the non-aesthetic sagging of the skin at these sites.

Plastic surgery procedures have been developed to remove excess loose skin. These procedures generally employ long incisions that hide around anatomical boundaries, such as the ears and scalp for face lifts and the lower breast folds for breast lifts (mastopexy). There must be. However, some sites of cutis laxa lack a trade-off between aesthetic enhancement to tighter skin and visibility of the surgical incision. For this reason, skin surpluses in the upper arm, patellar knee, thigh, and buttocks are usually not removed due to the visibility of the surgical scar.

The frequency of this aesthetic malformation and its negative social impact have prompted the development of "facelift" surgical procedures. Other related plastic surgery procedures in different areas are abdominal wall plasty (abdomen), mastopexy (breast), and brachial plasty (brachial). Disadvantageous features specific to these surgical procedures are the risk of postoperative pain, scarring and surgical compliance. Extensive permanent scarring is a permanent necessity in these procedures, even though trade-offs with large surgical incisions that require aesthetic improvements in these procedures are acceptable. For this reason, plastic surgeons conceal extensive scarring around anatomical boundaries such as hairline (face lift), lower breast folds (mastopexy), and groin creases (abdominoplasty). Design these procedures. However, many of these incisions are hidden away from the area of cutis laxa and therefore have limited effect. Other cutis laxa areas, such as the suprapatellar (upper anterior) knee, are irreparable for plastic surgery resections due to poor trade-offs with more visually visible surgical scars. be.

More recently, electromagnetic medical devices that produce a reverse heat gradient have been tried with varying successes in providing tension to the skin without surgery. At this time, the electromagnetic device is optimally deployed to the patient so that the amount is appropriate for the cutis laxa. Due to the limitations of electromagnetic devices and the potential side effects of surgery, minimally invasive techniques are required to avoid surgically associated scarring and clinical fluctuations in electromagnetic heating of the skin. For many patients with age-related skin relaxation (neck and face, arms, axillae, thighs, knees, hips, abdomen, brassiere line, ptosis), partial resection of excess skin is a conventional plastic surgery procedure. There was a risk of enlarging large fragments.

More important than the aesthetic modification of the skin envelope is the surgical management of skin defects associated with burns and other trauma. Large burns are categorized by the burned whole body area and the depth of thermal destruction. First- and second-degree burns are generally managed by the application of non-surgical topical ointments and burn bandages. Deeper third-degree burns are accompanied by thermal destruction of all layers of the skin. Surgical management of these serious injuries involves the application of wound resection and split-thickness skin grafting of burned scabs.

Most often, any full-thickness skin defect resulting from burns, trauma, or excision of a malignant cutaneous tumor can be closed with either flap transfer or skin graft using current commercially available instruments. Both surgical approaches require removal from the donor site. The use of flaps is further limited by the need to include a periodic blood supply and often by the need to directly close the donor site.

The split-thickness skin graft procedure requires an autologous skin graft, i.e., removed from the patient due to immunological constraints. Typically, the donor site in a burn patient is selected in the non-burned area and a partial thickness sheet in the skin is removed from the area. The inevitability of this procedure is to create a partial thickness of skin defect at the donor site. This donor site defect is itself similar to a deep second degree burn. Healing by re-epidermal formation of this site is often very painful and can be prolonged for several days. In addition, visible donor site malformations occur that are permanently thinner and bleached than the surrounding skin. For patients with large surface area burns, extensive excision of skin grafts may also be limited by the availability of non-burned areas.

For these reasons, there is a need for aesthetic surgical skin tightening instruments and procedures in the rapidly expanding aesthetic market. In addition, there is a need for systems, instruments or devices and procedures that eliminate donor site malformations and allow repeated removal of skin grafts from the same donor site.

Each patent, patent application and / or gazette described herein is as general as each individual patent, patent application and / or gazette is specifically and individually described. Is incorporated herein.

The PAD kit placed at the target site according to the embodiment is shown. FIG. 6 is a cross-sectional view of a scalpet punch or device having a scalpet array, according to an embodiment. FIG. 6 is a partial cross-sectional view of a skull pet punch or device with a skull pet array according to an embodiment. Shown is an adhesive thin film having a backing (adhesive substrate) provided in a PAD kit according to an embodiment. Shown is an adhesive thin film (adhesive substrate) when used with a PAD kit frame and blade assembly according to an embodiment. Demonstration of skin pixel removal according to an embodiment. FIG. 6 is a side view of blade dissection and removal of incised skin pixels in a PAD kit, according to an embodiment. It is an equiangular perspective view of the blade / pixel interaction during the procedure using the PAD kit according to the embodiment. Other figures during the procedure using the PAD kit (blades excluded for simplicity), according to embodiments, are excised skin pixels or detached and captured detached plugs. And both undissected skin pixels or detached plugs prior to dissection. FIG. 6 is a side view of a portion of a pixel array showing a skull pet fixed to an operational plate according to an embodiment. FIG. 3 is a side view of a portion of a pixel array showing a skull pet fixed to an operational plate according to another embodiment. FIG. 3 is a plan view of a skull pet plate according to an embodiment. FIG. 3 is a close-up enlarged plan view of a part of a skull pet plate according to an embodiment. An embodiment of a rolling pixel drum according to an embodiment is shown. An embodiment of a rolling pixel drum assembled to a handle according to an embodiment is shown. A drum-type skin-removing sword for use in a skull pet plate according to an embodiment is shown. A drum-type skinning sword positioned on a skull pet plate according to an embodiment is shown. FIG. 6 is a view from another angle of a drum-type skinning sword positioned on a skull pet plate according to an embodiment. According to the embodiment, when the adhesive thin film is brought into contact with the drum type skin sword before rolling on the operation plate, the drum type skin sword (for example, a paget skin sword) is brought into contact with the scullpet plate. It is an equiangular perspective view to make it make. FIG. 3 is a partial side view of a drum-type skin-removing sword showing a blade position with respect to a skull pet plate according to an embodiment. FIG. 6 is a partial side view of a drum-type skinning sword showing different blade positions with respect to a skull pet plate according to an embodiment. FIG. 6 is a side view of a drum-type skinning sword having other blade positions with respect to the skull pet plate according to the embodiment. FIG. 6 is a side view of a drum-type skin-removing sword with a cutting blade clip according to an embodiment, showing that a skin pixel is cut off by a blade clip. It is a bottom view which shows the bottom part of the drum type skin picking sword together with the skull pet plate by embodiment. It is a front view which shows the front surface of the drum type skin collecting sword together with the skull pet plate by embodiment. It is a rear view which shows the back surface of the drum type skin collecting sword together with the skull pet plate by embodiment. FIG. 14A shows a combination diagram of a skin collecting sword having a pixel overlay sleeve (POS) according to an embodiment. FIG. 14B is an exploded view of a sword with a pixel overlay sleeve (POS) according to an embodiment. FIG. 14C shows a portion of a skinning sword with a pixel overlay sleeve (POS), according to an embodiment. A slip-on type PAD that slides on a padget drum type skin collecting sword according to an embodiment is shown. A combination diagram of a slip-on type PAD installed on a padget drum type skin collecting sword according to an embodiment is shown. FIG. 16A shows a padget drum type skin sword and an installed slip-on type PAD according to an embodiment. FIG. 16B shows skin pixels removed by a padget drum type skin sword and an installed slip-on type PAD according to an embodiment. An embodiment of a pixel drum type skin collecting sword according to an embodiment is shown in a state of being in contact with a target site on the skin surface. Another figure is shown which is a part of a pixel drum type skin collecting sword according to an embodiment and is in contact with a target site on the skin surface. A side perspective view of the PAD assembly according to the embodiment is shown. FIG. 6 shows a perspective view from the top surface of the scullpet device used with the PAD assembly according to the embodiment. FIG. 3 shows a perspective view from the bottom surface of a skull pet device used with a PAD assembly according to an embodiment. FIG. 6 shows a side view of a punch impact device with a vacuum component according to an embodiment. The top view of the vibrating flat sculpt array and the blade device according to the embodiment is shown. The bottom view of the vibrating flat sculpt array and the blade device according to an embodiment is shown. FIG. 3 is an enlarged view showing a flat array when the sculpt array, the blade, the adhesive thin film and the adhesive lining are combined with each other according to the embodiment. FIG. 6 is an enlarged view of a flat array of skull pets with feeder components according to an embodiment. FIG. 6 shows a cadaveric skin matrix, according to an embodiment, that is similar in size to an excised skin pixel implant and is dissected in a cylindrical shape. A drum array drug delivery device, according to an embodiment. FIG. 6 is a side view of a needle array drug delivery device according to an embodiment. FIG. 3 is an equiangular perspective view from above of the needle array drug delivery device according to the embodiment. FIG. 3 is an equiangular perspective view from below of the needle array drug delivery device according to the embodiment. Shows human skin structure. Shows the physiological cycle of hair growth. The donor hair follicle removal according to the embodiment is shown. The preparation of the transplantee site according to the embodiment is shown. The arrangement state of the removed hair plug in the transplantee's site according to an embodiment is shown. An embodiment shows a situation in which a perforated plate is placed at the occipital scalp donor site. According to the embodiment, when the skull pet is configured to penetrate the subcutaneous fat layer to capture the hair follicles, the depth of penetration of the skull pet within the skin is shown. In the embodiment, a hair plug to be removed using a perforated plate at the occipital donor site is shown. The situation of making a visible hairline according to an embodiment is shown. The embodiment illustrates the preparation of a donor site using a patterning perforated plate and a spring loaded pixelation (pixilation) device to create a homogeneous skin defect at the site to be transplanted. In the embodiment, the transplantation technique of the removed hair plug by inserting the removed hair plug into the corresponding skin defect created at the transplanted site is shown. The clinical endpoints of using pixelated sword instruments and procedures according to embodiments are shown. It is an image of the skin tattooed at the corner and the middle point of the surface area to be excised according to the embodiment. It is an image of a postoperative skin resection area according to an embodiment. It is an image which shows the excision part which made the primary healing together with the measured edge on the 11th day following the treatment by an embodiment. It is an image showing the maturation of the excision part with the primary healing and the excision area where the primary healing continues with the measured edge on the 29th day following the treatment according to the embodiment. It is an image showing the maturation of the excision part with the primary healing and the excision area where the primary healing continues with the measured lateral dimension on the 29th day following the treatment according to the embodiment. It is an image showing the maturation of the excision part where the primary healing is performed and the excision area where the primary healing is continued together with the measured lateral dimension on the 90th day after the operation according to the embodiment. It is a skull pet showing an applied rotational force and / or an impact force according to an embodiment. It is a skull pet showing an applied rotational force and / or an impact force according to an embodiment. An array with a geared skull pet and a geared skull pet according to an embodiment is shown. FIG. 3 shows a perspective view from the bottom of the excision device comprising a skull pet assembly with a geared skull pet array according to an embodiment. A detailed view of a skull pet array with gears according to an embodiment is shown. An array including a skull pet in a friction driven configuration according to an embodiment is shown. An array (outside) comprising a spiral skull pet (outside) and a spiral skull pet according to an embodiment is shown. FIG. 6 shows perspective views from both a skull pet assembly (left side) comprising a spiral skull pet array and an excision device (right side) (shown as a housing) including a skull pet assembly having a spiral skull pet array according to an embodiment. FIG. 6 shows a side view of an excision device comprising a skull pet assembly (a housing shown as transparent for clarity) with a spiral skull pet array assembly according to an embodiment. FIG. 3 shows a perspective view from the bottom of the excision device comprising a skull pet assembly (a housing shown as transparent for clarity) with a spiral skull pet array assembly according to an embodiment. FIG. 3 shows a perspective view from the top of the excision device comprising a skull pet assembly (a housing shown as transparent for clarity) with a spiral skull pet array assembly according to an embodiment. It is a push plate of a spiral skull pet array according to an embodiment. A spiral skull pet array with a push plate according to an embodiment is shown. An array comprising an inner spiral skull pet and an inner spiral skull pet according to an embodiment is shown. A spiral sculpt array with a drive plate according to an embodiment is shown. An array comprising a grooved skull pet and a grooved skull pet according to an embodiment is shown. A portion of a grooved scullpet array (eg, four (4) scullpets) with a drive rod according to an embodiment is shown. A portion of a grooved skull pet array (eg, 25 skull pets) with a drive rod according to an embodiment is shown. A vibrating pin drive assembly with a skull pet according to an embodiment is shown. The control of the variable skull pet exposure amount together with the skull pet guide plate according to the embodiment is shown. Embodiments show a sculpt assembly comprising a sculpt array (eg, a spiral) configured to be manually driven by an operator. Shows the force applied to the skull pet by contacting it with the skin. Demonstrates a stable axial force compression using a skull pet according to an embodiment. According to the embodiment, a stable single axial force compression plus kinetic impact force using a skull pet is shown. According to the embodiment, it is shown that the skull pet is moved at a speed at which the skin is impacted and penetrated. A plurality of needle tips according to an embodiment are shown. A toothless rectangular skull pet (left side) and a multi-toothed rectangular skull pet (right side) according to an embodiment are shown. A side view, a front view (or a rear view), and a side perspective view of a round skull pet having an oblique tip according to an embodiment are shown. FIG. 6 shows a round skull pet with a serrated edge according to an embodiment. FIG. 6 shows a side view of an excision device comprising a scullpet array and a scullpet assembly with extrusion pins (a housing shown as transparent for clarity), according to an embodiment. FIG. 3 shows a perspective view from a partially excised top of an excision device comprising a skull pet array and a skull pet assembly (a housing shown as transparent for clarity) with extrusion pins, according to an embodiment. FIG. 6 shows a side view and a perspective view from the top of a skull pet assembly having a skull pet array and an extrusion pin according to an embodiment. FIG. 6 is a side view of an excision device comprising a scullpet assembly having a scullpet array assembly coupled to a vibration source, according to an embodiment. The sculpt array driven by the electromechanical drive source or the sculpt array generator according to the embodiment is shown. FIG. 6 is a schematic diagram of a cutting device comprising a vacuum system according to an embodiment. 8 shows a vacuum manifold in contact with the target skin surface to remove / remove the excised skin / hair plug according to an embodiment. 8 shows a vacuum manifold with an integral wire mesh abutting on a target skin surface to remove / remove the excised skin / hair plug according to an embodiment. 8 shows a vacuum manifold with an integral wire mesh configured to suck out subcutaneous fat according to an embodiment. The stretchable docking station and the inserted skin pixels according to the embodiment are shown. The docking station is made of elastic (elastomer) material, but is not limited to this. FIG. 3 is a plan view of an extended form (left side) and a non-extended form (right side) of a docking station (for example, having elasticity) according to an embodiment. The embodiment illustrates the removal of sagging excess skin without noticeable scarring. The embodiment shows a situation in which the skin is tightened so that there is no noticeable scarring. The three-dimensional contour of the skin envelope according to the embodiment is shown. The variable partial resection density in the therapeutic surface area according to the embodiment is shown. The partial excision of fat according to the embodiment is shown. Shows the cobblestone-like condition of road pavement on the skin surface. The topographical mapping for a deeper level of partial adipose resection by embodiment is shown. The multiple treatment outline according to the embodiment is shown. The curvilinear treatment pattern according to the embodiment is shown. Shown is a digital image of a patient with a rendered digital wire mesh program, according to an embodiment. The directional closure of the partial excision area according to the embodiment is shown. A directional partial resection of the skin according to an embodiment is shown. The situation in which the incision is shortened by continuous partial excision according to the embodiment is shown. FIG. 3 is an exemplary illustration of “suture end skin deformity (dog ear)” skin surplus in breast reduction and abdominal plasty according to embodiments. According to an embodiment, it is a PAD having a single stripped skull pet having a depth control unit. PAD with a standard single skull pet, according to embodiments. A PAD with a pencil-type gear deceleration handpiece, according to an embodiment. A PAD according to an embodiment having a 3 × 3 coreless array. PAD with a cordless surgical drill for large arrays, according to embodiments. A PAD with a drill-mounted 5x5 coreless array, according to an embodiment. A PAD having a vacuum assisted pneumatic excision PAD according to an embodiment. According to the embodiment, it is a VAPR type PAD drill-connected via a DAC. The ready state (left side) and the prominent therapeutic state (right side) in the VAPR type PAD according to the embodiment are shown. The ready state (left side) and the retracted state (right side) in the SAVR type PAD according to the embodiment are shown. FIG. 3 is a cross-sectional view of a carrier having a vacuum manifold according to an embodiment. FIG. 3 is an equiangular cross-sectional view of a carrier having a vacuum manifold according to an embodiment. It is a side view of the carrier which has a vacuum manifold according to an embodiment. FIG. 3 is a three-dimensional side view of a carrier having a vacuum manifold configured to be manually controlled via an opening according to an embodiment. FIG. 3 is an equiangular perspective view of a handpiece having or configured to have or incorporate a vacuum manifold according to an embodiment. FIG. 6 is a partially cutaway perspective view of a handpiece configured to have or incorporate a vacuum manifold according to an embodiment. FIG. 5 is a side view of a partial cross section of a vacuum manifold configured to be coupled or connected to an inline vacuum component according to an embodiment. FIG. 6 is an equiangular cross-sectional view of a vacuum manifold configured to be coupled or connected to an inline vacuum component according to an embodiment. FIG. 3 is a three-dimensional side view of a vacuum manifold configured to be coupled or attached to an inline vacuum component according to an embodiment. FIG. 5 is a side view showing a partial cross section of a sculpt array used in a vacuum suction device according to an alternative embodiment. FIG. 3 is an equiangular perspective view showing a partial cross section of a skull pet array used in a vacuum suction device according to an embodiment. FIG. 5 is a side view of a scullpet array used in a vacuum aspirator according to an embodiment. FIG. 5 is a side view showing a partial cross section of a single sculpt device in contact with a target tissue site according to an embodiment. FIG. 3 is an equiangular cross-sectional view of a single skull pet device in contact with a target tissue site according to an embodiment. FIG. 5 is a side view showing a partial cross section of a multi-sculpet device in contact with a target tissue site according to an embodiment. FIG. 3 is an equiangular perspective view showing a partial cross section of the multiple sculpt device in contact with the target tissue site according to the embodiment. An exemplary skull pet with perforations or grooves, according to embodiments. An exemplary rounded microtip skull pet or cannula with perforations or grooves, according to embodiments. It is an exemplary stencil marking system according to an embodiment. It is an exemplary positive plate marking system according to an embodiment. FIG. 6 is a side perspective view of ASPMPP used as a depth guide for a single skull pet device according to an embodiment. FIG. 3 shows an equiangular perspective view from the top surface of ASPMPP used as a depth guide for a single skull pet device according to an embodiment. Partial skin resection and subdermal / partial adipose tissue resection according to the embodiment are shown. FIG. 3 shows a side view of the lower jaw as a target surface area for partial skin resection and subdermal / partial adipose tissue resection according to an embodiment. FIG. 3 shows a view of the submandibular interior (looking up) of a partial resection area as a target surface area for partial skin resection and subdermal / partial adipose tissue resection according to an embodiment. Demonstrates a horizontally aligned therapeutic surface area in the lower jaw and lateral neck for severe cutis laxa, according to embodiments. The embodiment shows a wider area of partial subcutaneous adipose tissue resection in the lower jaw for severe lipodystrophy. The face vector and neck vector directional closure according to the embodiment are shown. Shows the closed Langer line. Shown are marked target surface areas for partial cervical resection and submandibular adipose tissue resection according to embodiments. An exemplary template (stencil) according to an embodiment is shown. Illustrative directional closure vectors of the submandibular and anterior cervical regions according to embodiments are shown. Scar correction by Z-plasty and W-plasty is shown. An example of a partial depiction removal technique in scar excision according to an embodiment is shown. An example of partial scar resection in a wide range of dysgenetic scars according to an embodiment is shown. An embodiment comprising a shortening step with a lower breast incision, as applied to breast reduction and / or breast repositioning, according to embodiments. Shows an exemplary flap closure. An embodiment comprising a graft partial removal step to be applied to the donor site according to the embodiment is shown. An example is shown according to the embodiment, which comprises a partial graft neovascularization step at the site to be transplanted. An exemplary docking station with a docking tray and adjustable slides is shown.

Describes systems, instruments, and methods for minimally invasive procedures, including partial resection, adipose tissue resection, partial skin grafting, and / or one or more of partial scarring procedures. Embodiments include an instrument comprising a scalpet assembly coupled to a carrier, the scalpet assembly having a scalpet array. The scalpet array has one or more scalpets configured to perform partial resection, adipose tissue resection, partial skin grafting, and / or partial scarring. The system is equipped with vacuum components that are configured to be coupled to the scullpet assembly and to extract tissue from the site. The carrier is configured to control the rotational and / or vacuum force supply to the sculpt assembly with rotational force and / or vacuum force.

The skull pet devices described herein satisfy the expanding beauty market for instruments and procedures for aesthetic surgical skin tightening. Furthermore, embodiments of the present invention eliminate malformations of the donor site and allow repeated removal of skin grafts from the same donor site. The embodiments described herein are configured to excise excess cutis laxa without visible scarring, whereby all areas of excess cutis laxa can be excised with a pixel array skin sword. The procedure can also be performed in areas that were previously limited due to the visibility of the surgical incision. The technical effect achieved by the embodiments described herein is to obtain smooth, firm skin without visible scarring or long scarring along anatomical boundaries.

The embodiments described herein, including pixel skin grafting devices and methods, are configured to provide the ability to repeatedly remove stratified skin grafts without visible scarring of the donor site. During this procedure, a Pixel Array Dermatome (PAD) is used to remove skin grafts from selected donor sites. During the excision procedure, the pixelated skin graft is placed on a flexible semi-porous adhesive thin film. Next, the excised skin graft / thin film complex is directly abutted on the skin defect site of the transplantee. The partially resected donor site is closed by abutting an adhesive sheet or bandage (eg, Flexzan® sheet, etc.) that functions over a period of time (eg, 1 week, etc.), such as a butterfly bandage. do. Intradermal skin defects caused by PAD are closed to facilitate the primary healing process, in which the normal epidermal-dermis structure is anatomically reorganized to minimize scarring. The adhesive thin film is desquamated (peeled) with the stratum corneum of the graft, as it may occur postoperatively, after which the thin film can be removed from the graft bed without splitting the graft.

Many of the benefits achieved by pixel skin graft procedures are worthy of explanation. Because the skin grafts are pixelated, they create gaps for drainage between the components of the skin plug, which is a percentage of "takes" compared to sheet-like skin grafts. Improve. During the first week after surgery, the skin graft "roots" at the site to be transplanted by a new angiogenesis process, in which in this new angiogenesis process new blood vessels are newly transferred from the skin defect bed. Grow in. The semi-porous thin film guides the exudate to the bandage.

The flexible thin film is configured to have elastic rebound properties, which facilitate the attachment of skin plug components in the graft / thin film composite, promote primary adjacent healing of the skin graft plug, and skin graft. It transforms the pixelated appearance of a piece into a more uniform sheet-like form. In addition, the thin film aligns the microstructural components of the skin plug, thereby aligning the epidermis with the epidermis and also with the dermis, thereby promoting a primary healing process that reduces scarring.

There are many major clinical uses for the skin grafts described herein, such as partial skin resection for skin tightening, partial hair grafting for alopecia, and partial skin removal for skin transplantation. be. The embodiment of partial skin resection comprises a skin plug removal step using an adhesive thin film, but the partially incised skin plug can be extruded without removal. Incision, extrusion, and closure frameworks are the most limited use of skin tightening clinical applications. The embodiments described herein are configured to facilitate incision and extrusion to provide a larger scalpet array with more scalpets, and embodiments provide novel means of incising the skin surface. Be prepared.

Pixel array medical systems, instruments or devices, and methods describe skin graft and skin resection procedures, as well as hair graft procedures. In the following description, many specific details are introduced to provide a complete understanding and description of the embodiments herein. However, one of ordinary skill in the art will appreciate that these embodiments can be realized without one or more of these specific details, or with other components, systems, etc. In other cases, well-known structures or operations are not shown or will not be described in detail to avoid obscuring aspects of the disclosed embodiments.

The following terms are intended to have the following intent as used herein. However, these terms are not limited to the meanings described herein and may include other meanings as understood or applied by one of ordinary skill in the art.

As used herein, "First degree burn" includes superficial burns without destruction of the epidermis reaching the dermis. First-degree burns appear as erythema (redness) on the skin.

As used herein, "Second degree burn" includes relatively deep burns with destruction of the epidermis reaching the dermis, and also denatures the variable thickness of the dermis. Many second-degree burns are associated with blistering. Deep second-degree burns can usually be transformed into full-thickness third-degree burns by oxidation or infection.

As used herein, "Third degree burn" includes burns associated with full-thickness thermal destruction of the skin, including the epidermis and dermis. Third-degree burns are further associated with thermal destruction of deeper underlying tissues (subcutaneous and muscular layers).

As used herein, "ablation" includes tissue removal by tissue destruction, eg, thermal ablation by laser skin damage.
As used herein, "autograft" includes grafts taken from the same patient.
As used herein, "Backed Adherent Membrane" includes an elastic adhesive thin film that captures a detached skin plug. The lined adhesive thin film in certain embodiments is lined with an outer surface to maintain the alignment of the skin plugs during excision. After removal of the skin plug, the lining is removed from the adhesive thin film with the removed skin plug. The thin film in certain embodiments is porous that can drain when placed at the site to be implanted. The thin films of certain embodiments also have elastic recoil properties that, when removing the lining, bring the sides of the skin plug side closer to each other and promote healing at the site to be transplanted, such as a sheet-like implant.

As used herein, "Burn Scar Contraction" includes the tightening of scar tissue that occurs during the injury healing process. This process is more likely to occur with untreated third-degree burns.

As used herein, "Burn Scar Contracture" includes band-shaped scar tissue and distorts the patient's appearance, i.e., a joint or band of scar tissue such as facial burn scar contracture. Includes banded scar tissue that limits the range of movement of any of the above.

As used herein, "Dermatome" includes an instrument that cuts "skin" or removes a sheet-like stratified skin graft. Examples of drum-type skin-removing swords include paget-type and wreath-type skin-removal swords. The electric skin sword is one electric version of the Zimmer type skin sword and the Paget type skin sword.

As used herein, the "dermis" is the primary structural support and also includes a deep layer of skin that primarily contains non-cellular collagen fibers. Fibroblasts are cells in the dermis that produce collagen protein fibers.

As used herein, "Donor Site" includes the anatomical site from which the skin graft is removed.

As used herein, "Epidermis" includes the outer layer of skin consisting of living epidermal cells and a non-living stratum corneum to act as a biological barrier.

As used herein, "Excise" includes surgical removal of tissue.
As used herein, "Excisional Skin Defect" includes partial thickness defects, more typically full-thickness defects resulting from surgical removal of the skin (damaged area).

As used herein, "FTSG" includes a Full Thickness Skin Graft for removing the total thickness of the skin. Other than the instruments described herein, the donor site is closed like a surgical incision. For this reason, FTSG has a limited surface area that can be removed.

As used herein, "granulation tissue" includes highly vascularized tissue that grows in response to the absence of skin in full-thickness skin defects. Granulation tissue forms the ideal basis for the site of a skin graft.

As used herein, "Healing by primary intention" includes a wound healing process in which normal anatomy reorganizes with minimal scar tissue formation. Morphologically, scars are unlikely to be visible.

As used herein, "Healing by secondary intention" refers to a less organized wound that heals with less reorganization with normal anatomy and increased deposition of scar collagen. Includes healing process. Morphologically, scars are more likely to be visible.

As used herein, "Homograft" includes a graft taken from a different person and abutting the patient's transplant site as a temporary biological bandage. Many allografts are collected as cadaveric skin. Temporary "take" of allogeneic transplants can be achieved, in part, with immunosuppression, but if the patient remains alive, the allogeneic transplant will eventually be replaced by an autologous transplant.

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

The "Mesh Split Thickness Skin Graft" used herein is expanded in surface area by repeatedly incising a skin graft removed with an instrument called a "mesher". Includes split-thickness skin grafts. The meshed split-thickness skin graft has a higher rate of "rooting" than the sheet-like graft, which means that drainage through the graft is possible and the irregular contour of the transplanted site. Because it adapts better. However, the result is an unsightly mesh-covered appearance of the graft at the site to be transplanted.

As used herein, "PAD" includes a Pixel Array Dermatome, which is classified as an instrument for fractional skin resection.

As used herein, the "PAD kit" includes a disposable single-use treatment kit, which includes a perforated guide plate, a scalpet stamper, a guide plate frame, a lined adhesive thin film and a transection blade. To prepare for.

The "Perforated Guide Plate" as used herein includes a perforated plate, which is the entire perforated plate in which the holes in the guide plate align with the sculpt in a stamper with handle or slip-on PAD. Has a graft removal area. This plate also acts as a guard to prevent accidental lacerations on adjacent skin. The perforations in the guide plate can be of different geometries, eg, but not limited to, round, oval, square, rectangular and / or triangular.

As used herein, "Pixelated Full Thickness Skin Graft" includes full-thickness skin grafts removed with the instruments described herein without reducing visible scarring at the donor site. .. The graft also has an improved appearance similar to a sheet-like FTSG at the transplant site, but adapts better to the transplant site and also increases the proportion of "rooting" due to the drainage gap between the skin plugs. .. Another major advantage of pixelated FTSG over sheeted FTSG is the ability to implant larger surface areas, which would otherwise require STSG. This advantage is due to the ability to remove from multiple donor sites with less visible scarring.

As used herein, "Pixelated Graft Harvest" is an instrument detailed herein and includes skin graft removal from a donor site.

As used herein, "Pixelated Split Thickness Skin Graft" includes a partial thickness skin graft removed with an SRG instrument. Skin grafts share the advantages of meshed skin grafts with no unsightly donor and transplant sites.

As used herein, a "Recipient Site" includes a skin defect site to which a skin graft is abutted.
As used herein, "Resect" includes excising.
As used herein, "Scalpel" includes a single-edged knife that makes an incision in the skin and soft tissue.

As used herein, "Scalpet" includes terms that describe scalpels of small geometric shapes (eg, circles, ellipses, rectangles, squares, etc.) that make incisions in skin plugs.

As used herein, a "Scalpet Array" includes an array or array of multiple scalpets secured to a substrate (eg, base plate, stamper, stamper with handle, tip, disposable tip, etc.).

As used herein, a "Scalpet Stamper" includes a Skullpet Array instrument component with a handle in a PAD kit that incises a skin plug with a perforated guide plate.

As used herein, "Scar" is a morphological malformation that is visually apparent from the histological deposition of unorganized collagen after the wound or the histological deposition of unorganized collagen after the wound. including.

As used herein, "Sheet Full Thickness Skin Graft" includes reference to FTSG abutment at the site to be transplanted as a continuous sheet. The appearance of FTSG is superior to that of STSG, and for this reason it is mainly used for skin grafting in visible areas such as the face.

As used herein, "Sheet Split Thickness Skin Graft" is a continuous sheet and also includes a partial thickness graft associated with a typical donor site malformation.

As used herein, "Skin Defect" includes the lack of total thickness of the skin, which may also include deeper structures such as the subcutaneous fat layer and muscle. Skin defects result from a variety of causes: burns, trauma, surgical excision of malignant tumors and correction of congenital malformations.

As used herein, "Skin Pixel" includes a piece of skin consisting of a partial or total thickness of the epidermis and dermis that is cut with a skull pet, and the skin pixel is the presence or absence of a subcutaneous fat cuff. Regardless, skin appendages such as hair sac can be included, and skin plugs can also be included.

The "Skin Plug" used herein is a partial or total epidermis and dermis that is incised with a scullpet, cut with a dehiscence blade, and captured by an adhesive lining thin film. Includes a circular (or other geometrical shape) piece of skin consisting of a thickness.

As used herein, "STSG" includes a partially thickened skin graft from which a portion of the epidermis and dermis is removed with the graft.

As used herein, the "Subcutaneous Fat Layer" is just below the skin and includes a layer consisting primarily of adipocytes called liposite. This layer basically functions as an insulating layer from the environment.

As used herein, a "Transection Blade" includes a horizontally aligned single-edged blade that plugs into the frame of a perforated plate, as described in detail herein. Alternatively, the drum-type leather sword can be overhanging and attached in advance. The dissection blade dissects the base of the incised skin plug.

As used herein, "Wound Healing" refers to obligate biology resulting from any type of wound, whether thermal, kinetic, and surgical. Including the process.

As used herein, a "xenograft" is a graft taken from a different species and includes a graft that is abutted to the patient's transplant site as a temporary biological bandage.

A plurality of embodiments of a pixel array medical system, instrument or device, and usage are described in detail herein. The systems, instruments or devices and methods described herein have been relaxed without visible scarring by devices used for skin grafting and for various surgical procedures such as plastic surgery procedures. It has minimally invasive surgical techniques for skin grafting to tighten the skin and also for hair grafting. In some embodiments, the device is a single-use disposable device. The embodiments described herein avoid surgical scarring and clinical variability due to electromagnetic heating of the skin, assuming minimal invasiveness in place of large plastic surgery resection of the skin. Perform multiple small pixelated excisions on the skin. The embodiments described herein can also be further employed in hair transplants and in areas of the body that can be limiting to plastic surgery due to the visibility of surgical scars. Furthermore, this technique can perform skin transplant surgery by excision of a skin incision from the tissue site of the donor to the skin defect site of the transplantee with reduced scarring on the donor site of the patient.

Described herein for many patients with age-related skin relaxation, such as neck and face, arms, axillae, thighs, knees, buttocks, abdomen, brassiere lines, ptosis, etc. The minimally invasive pixel array medical device and method replaces scarring-unavoidable plastic surgery and performs pixelated dissection / excision of excess skin. Generally, the procedures described herein are performed in a clinic setting under local anesthesia to minimize perioperative discomfort, but are not limited to. Only a short recovery period is required compared to the prolonged healing phase from plastic surgery, preferably bandages and supporting garments worn on the treatment area are applied over a predetermined period (eg, 5 days, 7 days, etc.). Contact. This procedure is minimal or no painful.

Relatively small skin imperfections (eg, in the range of about 0.5 mm to 4.0 mm) caused by the instruments described herein are abutted and closed with an adhesive Flexan® sheet. Acting as a large butterfly bandage, the Flexan® sheet can be pulled in a direction (vector) that maximizes the aesthetic contours of the therapeutic surface area. Wear compression elastic garments on the bandage to further support the aesthetic contour. After the initial healing phase is complete, multiple small linear scars in the therapeutic area are less visible than in a larger plastic surgical incision in the same area. Additional skin tightening is likely to occur over several months due to a delayed wound healing response. Other potential applications of the embodiments described herein include hair transplantation and alopecia treatment, snoring / sleep apnea, orthopedic / rehabilitation medicine, vaginal tightening, female urinary incontinence, and gastrointestinal sphincter tightening. be.

Large burns are categorized by the area of the whole body and the depth of thermal destruction, and the method used to manage these burns is highly dependent on this classification. First- and second-degree burns are generally managed by the application of non-surgical topical ointments and burn bandages. Deeper third-degree burns are accompanied by thermal destruction of all layers of skin, resulting in full-thickness skin defects. Surgical management of this serious injury usually involves the application of wound resection and split-thickness skin grafting of the burned crust.

Most often, any full-thickness skin defect resulting from a burn, trauma, or excision of a malignant cutaneous tumor can be closed with either a flap transfer or a skin graft using conventional commercially available instruments. Both surgical approaches require removal from the donor site. The use of flaps is further limited by the need to include a periodic blood supply and often by the need to directly close the donor site.

The split-thickness skin graft procedure requires autologous skin graft removal from the patient due to immunological constraints. Typically, the donor site in a burn patient is selected in a non-burned area and a partial thickness sheet in the skin is removed from that area. The inevitability of this procedure is to create a partial thickness of skin defect at the donor site. This donor site defect is itself similar to a deep second degree burn. Healing by re-epidermal formation of this site is often very painful and can be prolonged for several days. In addition, visible donor site malformations occur that are permanently thinner and bleached than the surrounding skin. For patients with large surface area burns, extensive excision of skin grafts may also be limited by the availability of non-burned areas.

Both of the conventional surgical approaches to close skin defects (flap transfer or skin graft) not only lead to large scarring of the skin defect transplanted site, but also to scarring of the donor site from which the graft is removed. Also tied. In contrast to these conventional procedures, the embodiments described herein have a pixel skin graft procedure, also referred to as a pixel array procedure, which eliminates malformations at the donor site and is either sheet-like or sheet-like. Provided is a method of re-excising a skin graft from any pre-existing donor site, including any of the pixelated donor sites. This ability to re-extract skin grafts from pre-existing donor sites reduces the surface area requirement of donor site skin and also provides additional skin grafts in severely burned patients with limited surface area of non-burned donor skin. Provide the ability.

The pixel skin graft procedure according to the embodiment is used as a full-thickness skin graft. Many clinical applications such as facial skin grafts, manual surgery and congenital malformation repair are best performed with full-thickness skin grafts. The texture, pigment, and overall morphology of full-thickness skin grafts are more similar to the skin adjacent to the defect than the split-thickness skin grafts. For this reason, full-thickness skin grafts in the apparent area of the eye present a better appearance than split-thickness skin grafts. The main drawback of full-thickness skin grafts under conventional procedures is widespread linear scarring resulting from surgical closure of full-thickness donor site defects, which is the scarring of full-thickness skin grafts. Limit size and usefulness.

In comparison, full-thickness skin grafts of the pixel skin graft procedures described herein are less limited by size and usefulness because linear donor site scars are eliminated. Therefore, many skin defects normally covered by split-thickness skin grafts will be treated with pixelated full-thickness skin grafts instead.

Pixel skin graft procedures provide the ability to remove split-thickness and full-thickness skin grafts with minimal visible scarring at the donor site. During the procedure, skin grafts are removed from the selected donor site using a Pixel Array Dermatome (PAD) device. During the excision procedure, the pixelated skin graft is placed on an adhesive thin film. The adhesive thin film according to the embodiment includes a flexible semi-porous adhesive thin film, but the embodiment is not limited to this. Next, the excised skin graft / thin film complex is directly abutted on the skin defect site of the transplantee. The partially resected donor site is closed by abutting an adhesive Flexan® sheet that functions for a week like a butterfly bandage. Relatively small (eg, 1.5 mm) intradermal circular skin defects are closed to facilitate the primary healing process, in which the normal epidermal-dermis structure is anatomically reorganized and scarred. Minimize. The adhesive thin film is desquamated (peeled) with the stratum corneum of the graft, as it may occur about 1 week after surgery, after which the thin film can be removed from the graft bed without splitting the graft. In this way, healing of the donor site progresses rapidly with minimal discomfort and scarring.

Because the skin graft at the site of the transplant defect using the pixel skin graft procedure is pixelated, it creates a gap for drainage between the components of the skin plug, which is a sheet-like skin graft. Improves the percentage of "takes" compared to. During the first (almost) week after surgery, the skin graft "roots" at the transplant site by a new angiogenesis process, in which new blood vessels are renewed from the transplanted bed of skin defects. It grows in skin implants. The semi-porous thin film guides the exudate (fluid) to the bandage. Furthermore, the flexible thin film is designed to have elastic rebound properties, which facilitate the attachment of skin plug components in the graft / thin film composite and promote primary adjacent healing of the skin graft plug. , Transforms the pixelated appearance of skin grafts into a more uniform sheet-like morphology. In addition, the thin film aligns the microstructural components of the skin plug, thereby aligning the epidermis with the epidermis and also with the dermis, thereby promoting a primary healing process that reduces scarring. In addition, the pixelated skin grafts easily adapt to irregular transplant sites.

The embodiments described herein include a pixel skin resection procedure, also referred to as a pixel procedure. For many patients with age-related skin relaxation (neck and face, arms, axillae, thighs, knees, hips, abdomen, brassiere line, ptosis, etc.), partial excision of excess skin is inevitable for scarring. Can replace a large segment of plastic surgery. Generally, pixel procedures are performed in a clinic setting under local anesthesia. During the postoperative recovery period, the supporting garment is worn on the therapeutic surface area for a predetermined period (for example, 5 days, 7 days, etc.). This procedure is expected to be relatively painless or not accompanied at all. Small (eg, about 0.5 mm) circular skin defects are abutted and closed with an adhesive Flexan® sheet. Acting as a large butterfly bandage, the Flexan® sheet is pulled in a direction (vector) that maximizes the aesthetic contours of the therapeutic surface area. Wear compression elastic garments on the bandage to further support aesthetic contouring. After the initial healing phase is complete, multiple small linear scars in the therapeutic area are visually obscured. Furthermore, additional skin tightening subsequently occurs over several months due to the delayed wound healing response. Therefore, pixel treatment is a minimally invasive procedure that replaces widespread scarring by 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 an embodiment. The PAD kit includes a flat perforated guide plate (guide plate), a sculpt punch or scullpet device containing a scullpet array (see FIGS. 1-3), a lined adhesive thin film or adhesive substrate (see FIG. 4). And provided with, but not limited to, a skin pixel detachment blade (see FIG. 5). The skull pet punch of the embodiment is a device with a handle, but is not limited to this. The guide plate is optional in the alternative embodiment, as described in detail herein.

FIG. 2 is a perspective view showing a cross section of a skull pet punch of a PAD kit having a skull pet array according to an embodiment. The skull pet array has one or more skull pets. FIG. 3 is a partial cross-sectional view of a skull pet punch of a PAD kit having a skull pet array according to an embodiment. This partial cross-sectional view shows, but is not limited to, the overall length of the skull pet array in the skull pet array is determined by, but is not limited to, the thickness of the perforated guide plate and the depth of the incision into the skin.

FIG. 4 shows an adhesive thin film (adhesive substrate) having a backing included in the PAD kit according to the embodiment. The lower surface of the adhesive thin film abuts on the incised skin at the target site.

FIG. 5 shows an adhesive thin film when used in a PAD kit frame and blade assembly according to an embodiment. The top surface of the adhesive thin film is oriented with the adhesive side facing down in the frame and then pressed onto a perforated plate to extrude skin pixels, also referred to herein as plugs or skin plugs. Try to capture.

As described in FIG. 1, the perforated guide plate abuts the skin excision / donor site during the procedure using the PAD kit. The scullpet punch abuts at least one set of holes in the perforated guide plate so as to make an incision in the skin pixel. The skull pet punch contacts a large number of hole sets several times when the punch's skull pet array has fewer skull pets than the total number of holes in the guide plate. After one or more sequential abutments of the sculpt punch, the incised skin pixel or plug is captured by the adhesive substrate. At this time, the adhesive substrate is abutted so as to capture the skin pixel or plug from which the adhesive is extruded. As in the embodiment, the top surface of the adhesive substrate of the embodiment is oriented so that the adhesive side faces downward in the frame and then pressed onto the perforated plate to capture the extruded skin pixel or skin plug. To do. When pulling up the thin film, the captured skin pixels are dissected at the bottom by the dissociation blade.

FIG. 6 shows the removal of skin pixels by embodiment. The adhesive substrate is pulled up and moved backwards from the target site, which lifts or pulls the incised skin pixel or skin plug. As the adhesive substrate is pulled up, an incision blade is used to cut off the bottom of the incised skin pixel. FIG. 7 is a side view of the blade dissection and removal of the incised skin pixel by the PAD kit according to the embodiment. Pixel extraction is completed by dissection of the skin pixel or the bottom of the skin plug. FIG. 8 is an equiangular perspective view of the blade / pixel interaction situation during the procedure using the PAD kit according to the embodiment. FIG. 9 is another diagram using the PAD kit according to the embodiment (blades omitted for clarity), with excised and captured skin pixels or plugs, and undissected skin before dissection. Indicates both pixels or plugs. The donor site is closed by abutting the Flexan® sheet.

Guide plates and skull pet devices also cause skin defects at the site of transplantation. Skin defects are configured to receive skin pixels removed or captured at the donor site. The guide plate used at the site to be transplanted can be the same guide plate used at the donor site, or can be different to have different hole patterns or different hole configurations.

The skin pixel or plug placed on the adhesive substrate during dissection is transferred to the skin defect site (implanted site), in which case it is abutted as a pixelated skin graft at the transplanted skin defect site. To. The adhesive substrate has elastic recoil properties and allows skin pixels or plugs to be more closely aligned within the skin graft. The incised skin pixel can abut the skin defect at the site to be implanted directly from the adhesive substrate. The abutment of the incised skin pixel to the implant site is a step of aligning the incised skin pixel to the skin defect and a step of inserting the incised skin pixel into the corresponding skin defect site at the implant site. including.

The pixel array medical device of the embodiment comprises a Pixel Array Dermatome (PAD). The PAD comprises a flat array of relatively small circular skull pets that are secured to a substrate (eg, an operational plate), and the skull pet that is combined with the substrate is referred to as a skull pet array, pixel array, or skull pet plate. Will be done. FIG. 10A is a side view of a portion of a pixel array showing a skull pet fixed to an operational plate according to an embodiment. FIG. 10B is a side view of a portion of a pixel array showing a skull pet fixed to an operational plate according to another embodiment. FIG. 10C is a plan view of the skull pet plate according to the embodiment. FIG. 10D is an enlarged plan view of a part of the scullpet plate according to the embodiment. The skull pet plate comes into direct contact with the skin surface. One or more skull pets in the skull pet array have a tip surface, a needle, and a needle with multiple tips.

Pixel array medical device and method embodiments use extraction patterns instead of guide plates. The extraction pattern includes, but is not limited to, an indicator or marker on the skin surface at at least one of the donor site and the transplanted site. Markers include any compound that can be applied directly to the skin to mark areas of the skin surface. The extraction pattern is positioned at the donor site and the scullpet array of the device is aligned with or follows the extraction pattern at the donor site. Skin pixels are incised at the donor site by the sculpt array described herein. The site to be transplanted is prepared by positioning the excision pattern at the site to be transplanted. The extraction pattern used for the site to be transplanted can be the same extraction pattern used for the donor site, or can be different due to different patterns or constituent markers. As described herein, it creates a skin defect and also abuts the incised skin pixel to the site to be implanted. As an alternative, the guide plate of the embodiment is used in a state of being in contact with the extraction pattern, but the present invention is not limited to this.

In order to utilize the established medical equipment, the array of embodiments is combined with a drum-type skin sword, such as a padget-type skin sword or a wreath-type skin sword, or changed to a drum-type skin sword. use. The paget drum type skin graft referred to herein was originally developed by Dr. Earl Padgett in the 1930s and continues to be widely used by plastic surgeons around the world for skin grafts. Later, Mr. Reese's modification to the Paget-type skin graft was developed to better calibrate the thickness of the skin graft to be removed. The drum-type skin-removing sword of the embodiment is disposable for one-time use (per treatment), but is not limited thereto.

In general, FIG. 11A shows an example of a rolling pixel drum 100 according to an embodiment. FIG. 11B shows an embodiment of the rolling pixel drum 100 assembled to the handle according to the embodiment. FIG. 11C shows a drum-type skin-picking sword for use in a skull pet plate according to an embodiment.

In general, like all pixel devices described herein, the geometry of the pixel drum 100 can be of any shape, eg, circular, semi-circular, elliptical, square, flat or square. can. In some embodiments, the pixel drum 100 is supported by a core / handle assembly 102 and, for example, rotates around a drum rotating component 104 actuated by an electric motor. In some embodiments, the pixel drum 100 can be placed on a stand (not shown) when not in use, which stand is a battery charger for the working rotating component of the drum or for the working component of the syringe plunger. It can also work. In some embodiments, a vacuum (not shown) can be applied to the skin surface of the pixel drum 100 and an outrigger (not shown) can be deployed to improve tracking and stability of the pixel drum 100. Can be.

In some embodiments, the pixel drum 100 incorporates an array of skull pets 106 on the surface of the drum 100 and a plurality of small (eg, 0.5-1.5 mm) circles referred to herein as skin plugs. Make an incision. In some embodiments, the skull pet's boundary geometry (geometry) can be designed to generate skin plugs and reduce pincushion movement (“trapdoor”). The perimeter of each skin plug can be lengthened by a skull pet instead of a circular skin plug, for example, as a non-limiting example, a semi-circular, oval, square skin plug. In some embodiments, the length of the Skullpet 106 can vary based on the thickness of the skin surface area selected by the surgeon for skin grafting purposes, i.e., split layer thickness or full layer thickness.

When the drum 100 is brought into contact with the skin surface, a blade 108 placed inside the drum cuts off the bottom of each skin plug created by the sculpt array, in which case the blade 108 is the central drum center axis / handle assembly. Connect to 102 and / or connect to an outrigger attached to the central axis assembly 102. In some alternative embodiments, the internal blade 108 that dissects the bottom of the skin incision does not connect to the drum core / handle assembly 102. In some embodiments, the internal blade 108 of the pixel drum 100 can periodically vibrate manually or powered by an electric motor. Variable percentages of skin (eg, 20%, 30%, 40%, etc.) can be dissected within the excess cutis laxa area based on the density of circular skull pets on the drum.

In some embodiments, a pixel drum remover 112 is additionally placed inside the drum 100 to perform a skin graft operation, the skin graft operation performing a dissection / pixelated skin incision from the pixel donor tissue. / The plug (pixel graft) is removed and aligned with the adhesive thin film 110 lined inside the pixel drum 100. A narrow gap is created between the sculpt array 106 and the adhesive thin film 110 for the internal blade 108.

In an embodiment, the blade 108 is placed outside the drum 100 and the sculpt array 106 when the bottom of the incised circular skin plug is cut off. In another embodiment, the external blade 108 connects to the drum core assembly 102 when cutting off the bottom of the skin incision. In another embodiment, the external blade 108 does not connect to the drum core assembly 102 when cutting off the bottom of the skin incision. The adhesive thin film 110 that extrudes and aligns the dissected skin segment is later placed on the patient's skin defect site. The blade 108 (either internal or external) can be, but is not limited to, a windowed layer of blades aligned with the sculpt array 106.

The adaptable adhesive thin film 110 of the embodiment allows drainage at the skin graft defect when the thin film with aligned cut skin segments is removed from the drum and abutted as a skin graft. It can be semi-porous. The adhesive semi-porous drum-shaped thin film 110 can have an elastic rebound property that simultaneously delivers a detached / pixelated skin plug for transplantation to the site of the skin defect to be transplanted, ie, with a pixelated implant. After removing the adhesive thin film from the drum 100, the peripheral edges of each skin plug can be closer to each other as a more uniform sheet. Alternatively, the adhesive semi-porous drum thin film 110 can be expanded to cover a large surface area at the non-transplanted skin defect site. In some embodiments, the adhesive lining sheet 112 can be applied between the adhesive thin film 110 and the drum extractor 112. The drum-shaped sculpt array 106, blade 108, and adhesive thin film 110 can be assembled together as a sleeve to an existing drum 100 as described in detail herein.

The internal drum remover 112 in the pixel drum 110 of the embodiment is disposable and replaceable. Restrictions and / or control over the use of disposable components can be achieved by electronic, EPROM, mechanical, durable means, but not limited to: Electronic and / or mechanical recording and / or drum speed limits for disposable drums, and the usage time of disposable drums can be electronically or mechanically recorded, controlled and / or limited.

During the excision portion of the drum-type skin sword procedure, the PAD scullpet array is in direct contact with the skin surface. To make a circumferential incision in the skin pixel, the drum-type skin sword is positioned on the scullpet array and applies a load to the underlying skin surface. The sustained load pushes the incised skin pixels out of the holes in the scullpet array and captures them on the adhesive thin film in a drum-type sword. Cutting the skinning sword The outrigger blade (positioned on the skull pet array) cuts off the bottom of the extruded skin pixel. The thin film and the pixelated skin complex are then removed from the skin graft drum and directly abutted on the skin graft defect as a skin graft piece.

Explaining with reference to FIG. 11C, embodiments include a drum-type skinning sword for use with a scullpet plate as described herein. More specifically, FIG. 12A shows a situation in which a drum-type skin-picking sword is positioned on a skull pet plate according to an embodiment. FIG. 12B shows a situation seen from another angle in which the drum-type skin-removing sword is positioned on the skull pet plate according to the embodiment. The cutting outrigger blade of the drum-type sword is positioned at the top of the skull pet array, which dissects the extruded skin plug at the bottom.

FIG. 13A is an equiangular perspective view of a drum-type skin-collecting sword (for example, a paget-type skin-collecting sword) abutting on a skull pet plate according to an embodiment, and the adhesive thin film rolls on the operation plate. Before sticking to the drum of the sword. FIG. 13B is a side view of a part of the drum type skin collecting sword according to the embodiment, and shows the blade position with respect to the skull pet plate. FIG. 13C is a side view of a portion of the drum-type skinning sword according to the embodiment, showing different blade positions with respect to the scullpet plate. FIG. 13D is a side view of a part of the drum-type skin-picking sword according to the embodiment, showing other blade positions with respect to the scullpet plate. FIG. 13E is a side view of a drum-type skinning sword having a cutting blade clip according to an embodiment, showing a situation in which a skin pixel is cut by a blade clip. FIG. 13F shows a bottom view of a drum-type skin collecting sword together with a skull pet plate according to an embodiment. FIG. 13G shows a front view of a drum-type skin-picking sword together with a skull pet plate according to an embodiment. FIG. 13H shows a rear view of a drum-type skin collecting sword together with a skull pet plate according to an embodiment.

Based on clinical use, the disposable adhesive thin film of the drum-type skin graft can be used for depositing / discarding excised loose skin or removing / aligning pixelated skin grafts.

The embodiments described herein also include a pixel overlay sleeve (POS) for use in skinning swords, such as padgett type skinning swords and wreath type skinning swords. FIG. 14A shows an assembled view of a sword with a pixel overlay sleeve (POS) according to an embodiment. The POS has a blade incorporating a sword and an adhesive lining, an adhesive, and a sculpt array. The adhesive lining, adhesive and sculpt array are integrated as a device, but are not limited to this. FIG. 14B shows an exploded view of a sword with a pixel overlay sleeve (POS) according to an embodiment. FIG. 14C shows a portion of a sword with a pixel overlay sleeve (POS) according to an embodiment.

The POS, also referred to as the "sleeve," provides a disposable drum-type skin graft overlay for partial excision of excess loose skin and dispersed skin grafts in skin defects. The lining sleeve is used as a one-time-use disposable component in connection with Padgett and Reese swords. The POS of the embodiment is a three-sided slip-on disposable sleeve that slides into a drum-type skin-picking sword. The device has an adhesive thin film and a sculpt drum array with internal decoupling blades. The disengagement blade in the embodiment has a single-sided cut surface that is swept along the inner surface of the scullpet drum array.

In other blade embodiments, the windowed cutting layer covers the inner surface of the scullpet array. Each window with a cut surface is aligned with each individual skull pet. Instead of a sweeping motion that cuts off the bottom of the skin plug, the windowed cutting layer oscillates periodically on the skull pet drum array. A narrow gap between the adhesive thin film and the sculpt array is formed due to the displacement motion of the blade. Insertion grooves for additional adhesive thin films are provided for multiple excisions during skin graft procedures. The protective layer on the adhesive thin film is stripped in place by an elongated take-out tab that pulls from the take-out groove on the opposite side of the sleeve assembly. As in other pixel device embodiments, the adhesive thin film is semi-porous for drainage at the site of skin graft skin defects. In order to deform the pixelated skin graft into a more continuous sheet, the thin film is given elastic rebound properties, allowing the skin plugs to be more closely aligned within the skin graft.

The embodiments described herein include a slip-on PAD configured as a single-use disposable device with either a padgett or wreath sword. FIG. 15A shows a slip-on PAD attempting to slide onto a padget-type drum sword according to an embodiment. FIG. 15B shows a slip-on PAD installed on a padget-type drum skinning sword according to the embodiment.

The slip-on PAD of the embodiment is used in combination with a perforated guide plate (optionally). FIG. 16A shows a slip-on PAD installed on a padget-type drum sword according to an embodiment and also used with a perforated plate (template) or guide plate. The perforated guide plate is placed on the target skin site and held in place with an adhesive on the bottom of the apron to maintain orientation. A paddet-type skinning sword with a slip-on PAD rolls on a perforated guide plate in the skin.

FIG. 16B shows skin pixels removed by a Padgett drum skinning sword and an installed slip-on PAD according to an embodiment. For skin pixel extraction, the slip-on PAD was removed, adhesive tape was attached onto the drum of the padget-type sword, and a clip-on blade was placed on the outrigger arm of the sword, after which the blade was attached. Use to cut off the bottom of the skin pixel. The slip-on PAD of the embodiment is also used (optionally) in standard surgical instruments such as ribbon retractors to protect the skin adjacent to the donor site.

Embodiments of the pixel device described herein include a single-use disposable device or device, a pixel drum type skin sword (PD2). The PD2 has a cylinder or rolling / rotating drum connected to a handle, which cylinder has a sculpt drum array. The internal blades interconnect to the drum axle / handle assembly and / or to the outriggers attached to the central axle. Similar to the PADs and POS described herein, small multi-pixel resections of the skin are performed directly in the cutis laxa area, thereby minimizing visible scarring and improving the effect of skin tightening.

FIG. 17A shows an example of a pixel drum sword that is in contact with a target site on the skin surface according to the embodiment. FIG. 17B shows another view of a portion of a pixel drum sword abutting on a target site on the skin surface according to an embodiment.

The PD2 device is applied to a drum that rolls / rotates fully with respect to the skin surface, forming multiple small (eg, 1.5 mm) circular incisions at the target site by a "skull pet drum array". The bottom of each skin plug is then dissected by an internal blade, which interconnects with a central drum core / handle assembly and / or with an outrigger attached to the central core. The rate of skin excision can vary based on the density of circular skull pets on the drum. PD2 can excise a portion of the surface area of the skin (eg, 20%, 30%, 40%, etc.) without visible scarring in the excess cutis laxa area, but embodiments are not limited to this.

Another alternative embodiment of the pixel instrument described herein is a Pixel Drum Harvester (PDH). Similar to the pixel-drum skin graft, the added internal drum removes the pixelated excision of the skin and aligns it with an adhesive thin film that is later placed on the patient's site of the skin graft. The adaptable adhesive thin film is semi-porous, which allows drainage of the skin graft defect when the thin film with aligned excised skin segments is removed from the drum and abutted as a skin graft. The elastic rebound properties of the thin film allow the pixelated skin segments that partially transform the pixelated skin graft to be more closely approximated by the sheet-like graft at the site to be implanted.

Pixel array medical systems, instruments or devices, and methods described herein evoke or enable unavoidable cellular and / or extracellular responses to the resulting clinical outcome. With respect to the pixelated sword, the physical reduction in the surface area of the skin results from the pixelated excision of the skin, i.e. the skin plug. In addition, subsequent tightening of the skin results from a delayed wound healing response. Each pixelated resection initiates an unavoidable wound healing sequence as detailed herein.

The first phase of this sequence is the inflammatory phase in which degranulation of mast cells releases histamine into the "wound". Histamine release can evoke swelling of the capillary bed and increase vascular permeability to extracellular space. This initial wound healing reaction occurs within the first day of the wound and also appears as erythema on the surface of the skin.

The second phase (of fibrosis) begins within 3-4 days of the "wound". During this phase there is fibroblast transfer and mitotic proliferation. Wound fibroblast proliferation involves the deposition of neoplastic collagen and the contraction of myofibroblasts in the wound.

Histologically, the deposition of neoplastic collagen can be microscopically identified as consolidation and hypertrophy of the dermis. Although this is a static process, the tensile strength of the wound is significantly increased. Another feature of fibrosis is the dynamic body process that results in multidimensional contraction of the wound. This elemental feature of fibroblasts is due to active cell contraction of myofibroblasts. Morphologically, the myofibroblast contraction of the wound becomes visible as a two-dimensional tightening on the surface of the skin. Overall, the effect of fibrosis is cutaneous contracture with the deposition of statically supporting scaffolds of neoplastic collagen with a toned substructure. This clinical effect is achieved as a delayed tightening of the skin with smoothing in the texture of the skin over several months. The clinical endpoint is the skin envelope that looks younger in the therapeutic area.

The third final phase of the delayed wound healing response is maturity. During this phase there is increased strength and remodeling of the therapeutic surface area due to increased cross-linking in the collagen fibril matrix (of the dermis). This final stage begins within 6-12 months after the "wound" and can be at least 1-2 years. Small pixelated excision of the skin should preserve normal skin structure during this delayed wound healing process, and generally does not produce the prominent scarring that results from large surgical excision. Finally, there is associated stimulation and activation of the epidermis from the release of epidermal proliferative hormones. The delayed wound healing response can be evoked by scar collagen deposition in tissue (muscle or fat) with minimal existing collagen matrix.

In addition to aesthetic skin tightening, the pixel array medical systems, instruments or devices, and methods described herein may have other medical uses. In some embodiments, the pixel array device is capable of dissecting variable portions of any soft tissue structure without resorting to standard surgical excision. More specifically, the reduction of UV-damaged surface areas of the skin by pixel array devices should reduce the incidence of skin cancer. For the treatment of sleep apnea and snoring, pixelated mucosal reduction (soft palate, tongue base and pharyngeal sidewall) with pixel array devices will significantly reduce the prevalence associated with more standard surgical procedures. For childbirth damage to the vaginal fornix, pixelated skin and vaginal mucosal resection with a pixel array device will reestablish normal prepartum geometry and function without resorting to A & P resection. Related female stress incontinence could be corrected as well.

The pixel array skinning sword (PAD) of the embodiment, also referred to herein as a skull pet device assembly, is a system or kit having a control device also referred to as a punch impact handpiece and a skull pet also referred to as a chip device. Equipped with a device. The skull pet device detachably coupled to the control device has an array of skull pets positioned within the skull pet device. The removable skull pet device of the embodiment is disposable and is therefore configured for use in a single procedure, but is not limited thereto.

The PAD includes a device comprising a housing configured to include a skull pet device. The scalpet device has a substrate and a scalpet array, and the scalpet array has a plurality of scalpets arranged as components on the substrate. The substrate and the plurality of skull pets are configured to be deployed from and housed in the housing, and the plurality of skull pets are configured to produce multiple skin pixels incised in the target site when deployed. .. The base end of the control device shall be a handheld configuration. The housing is configured to be detachably connected to the receiver, which is a component of the control device. The control device has a base end that includes an actuator mechanism and an end that includes a receiver. The control device is disposable, but as an alternative, the control device is configured to perform at least one of cleaning, disinfection, and sterilization.

The sculpt array is configured to deploy in response to the actuation of the actuator mechanism. The skull pet device of the embodiment is configured such that the pet array expands from the skull pet device and is housed in the skull pet device in response to the operation of the actuator mechanism. The scalpet device of the alternative embodiment is configured to deploy from the scalpet device in response to the actuation of the actuator mechanism and to house the scalpet device in response to the release of the actuator mechanism.

FIG. 18 shows a side perspective view of the PAD assembly according to the embodiment. The PAD assembly in this embodiment has a handheld configuration and includes a control device having an actuator or a trigger and a skull pet device having a skull pet array. The control device is reusable, but other embodiments have a disposable control device. The scullpet array in the embodiment is configured to create or generate an array of small incisions (eg, 1.5 mm, 2 mm, 3 mm, etc.), as detailed herein. Skullpet Devices in Embodiments As detailed herein, there is a spring-loaded array of skullpets configured to incise the skin, but embodiments are not limited thereto.

FIG. 19A shows a perspective view of the skull pet device used in the PAD assembly according to the embodiment as viewed from the top surface side. FIG. 19b shows a perspective view of the scullpet device used in the PAD assembly according to the embodiment as viewed from the bottom surface side. The scalpet device has a housing configured to house the substrate, which substrate shall be coupled to or have a plunger. The housing is configured such that the base end of the plunger projects from the top surface of the housing. The housing is configured to be detachably connected to the control device, and the length of the plunger is configured to project from the top over a distance that allows contact with the control device and actuator when connecting the skull pet device to the control device. ..

The substrate of the skull pet device is configured to hold a large number of skull pets forming the skull pet array. The skull pet array has a predetermined number of skull pets suitable for procedures using the skull pet device assembly. The scalpet device has at least one spring mechanism configured to exert a downward force or impact force or punching force in response to the operation of the scalpet array device, which force is the incision (pixel) by the scalpet array. (Skin excision site) Supports generation. Alternatively, the spring mechanism can be configured to generate an upward or retracting force that assists in retracting the skull pet array.

The sculpt device and control device of one or more embodiments have an encryption system (eg, EPROM). Cryptographic systems are configured to prevent unauthorized use and looting of skull pet devices and / or control devices, but are not limited to this.

During the procedure, the scullpet device assembly abuts only once in the target surface area, or, as an alternative, sequentially within the designated target treatment area of cutis laxa. After this, the pixelated skin resection sites within the treatment surface area are abutted and closed with the Flexan sheet, as detailed herein, and the direct closure of these pixelated resection sites is the greatest at the treatment site. Implement in the direction of giving an aesthetic correction effect.

The PAD device in another embodiment has a vacuum component or system that extracts the incised skin pixel. FIG. 20 shows a side view of a punch impact device including a vacuum component according to an embodiment. The PAD of this embodiment includes, but is not limited to, a vacuum system or component within the control device that aspirates and extracts the incised skin pixels. The vacuum component is detachably connected to the PAD device and its use is optional. This vacuum component is connected and configured to create a low pressure zone inside or adjacent to one or more of the housing, skull pet device, skull pet array and control device. The low pressure zone is configured to extract the incised skin pixel.

Other alternative embodiments of PAD devices include radio frequency (RF) components or systems for producing skin pixels. RF components are connected and configured to supply or couple energy within or adjacent to one or more of housings, skull pet devices, skull pet arrays and control devices. The RF component is detachably connected to the PAD device and its use is optional. The energy supplied by the RF component includes one or more of thermal energy, vibrational energy, rotational energy and sound energy, to name a few.

PAD devices according to yet other alternative embodiments include vacuum components or systems and RF components or systems. The PAD of this embodiment has a vacuum system and components that aspirate the incised skin pixels into the handpiece. The vacuum component is detachably connected to the PAD device and its use is optional. Vacuum components are connected and configured to create a low pressure zone within or adjacent to one or more of the housing, skull pet device, skull pet array and control device. The low pressure zone is configured to extract the incised skin pixel. Additionally, the PAD device includes an RF component that supplies energy to or adjacent to one or more of the housing, scalpet device, scalpet array and control device. Connect and configure to combine. The RF component is detachably connected to the PAD device and its use is optional. The energy supplied by the RF component includes one or more of thermal energy, vibrational energy, rotational energy and sound energy, to name a few.

As one particular embodiment, the PAD of the embodiment has an electrosurgical generator configured to more effectively incise the donor skin or skin plug with minimal heat-induced damage to adjacent skin. For this reason, RF generators operate, for example, with relatively short duty cycles and relatively high output levels. The RF generator is configured to supply one or more of the powered impactor components, cyclic impactors, oscillating impactors, and ultrasonic transducers configured to provide additional compressive force for cutting.

The RF-equipped PAD of this embodiment further has a vacuum component as described herein. The vacuum component in this embodiment pulls the skin towards the skull pet (eg, into the lumen of the skull pet) to provide a vacuum that stabilizes and promotes an RF-mediated incision of the skin within the partial resection area. However, the present invention is not limited to this. One or more of the RF generators and vacuum devices are connected under the control of the processor running the software application. Further, the PAD of this embodiment can be used with, but is not limited to, a guide plate as detailed herein.

In addition to partial incisions at the donor site, partial skin grafting involves removal and fixation of the skin plug (eg, on an adhesive thin film, etc.) for transfer to the site to be transplanted. Like partial skin resection, duty-driven RF cutting edges in an array of scullpets are used to facilitate incision of donor skin plugs. The bottom of the incised skin plug is then dissected and removed as detailed herein.

The timing of the vacuum assist components is processor controlled to produce a specified sequence in the RF duty cycle. Software control allows for different variations and can result in an optimal sequence of RF cuts combined with vacuum support. Following the RF duty cycle, the period during the sequence of embodiments comprises the absorption and withdrawal of the incised skin plug.

Other potential control sequences for PAD include, but are not limited to, RF and vacuum assisted simultaneous duty cycles. Alternatively, the control sequence of the embodiment includes pulse generation or circulation of RF duty cycles within the sequence, and / or fluctuations in RF output or use of generators at different RF frequencies.

Another alternative control sequence is the designated RF cycle that occurs at the depth of the partial incision. Lower power and longer duration RF duty cycles on the insulated shaft and active cutting tips on the insulated shaft can produce heat-induced damage to the tissue interface of deep skin / subcutaneous fat. Deep heat damage evokes a delayed wound healing sequence that secondarily tightens the skin without burning the skin surface.

Software control can allow different variations to produce the optimum sequence of RF cutting and powered mechanical cutting in combination with vacuum support. Examples include, but are not limited to, a combination of powered mechanical cutting and vacuum support, a combination of RF cutting and power mechanical cutting and vacuum support, and a combination of RF cutting and vacuum support. Examples of combined software-controlled duty cycles include, but are not limited to, pre-cut vacuum skin stabilization periods, RF cutting duty cycle periods with vacuum skin stabilization, RF cutting duty with vacuum skin stabilization and mechanical cutting by power. Cycle period, mechanical cutting period with vacuum skin stabilization, post-cut RF duty cycle resulting in heat conduction heating in deeper skin and / or subcutaneous tissue layer, evoking wound healing response for skin tightening, and skin. There is a post-cut vacuum extraction period for tightening.

Another embodiment of the pixel array medical device described herein is a reciprocating oscillating flat array of scullpets and blades deployed either electrically or manually (without power), as described herein. Used for skin tightening as an alternative to drums / cylinders. FIG. 21A shows a perspective view of the reciprocating vibration type flat sculpt array and the blade device according to the embodiment as viewed from the top surface direction. FIG. 21A shows a perspective view of the reciprocating vibration type flat sculpt array and the blade device according to the embodiment as viewed from the bottom surface. The blade 108 can be a windowed layer of blades aligned with the skull pet array 106. The instrument handle 102 is separated from the blade handle 103, and the adhesive thin film 110 can be peeled off from the adhesive lining 111. FIG. 21C is an enlarged view of a flat array when the sculpt array 106, the blade 108, the adhesive thin film 110, and the adhesive lining 111 are combined with each other according to the embodiment. When combined, the flat array of skull pets can be instrumentally measured to result in uniform or uniform excision. In some embodiments, the scullpet flat array can further have a feeder component 115 for the adhesive extraction thin film 110 and the adhesive lining 111. FIG. 21D is an enlarged view of a flat array of skull pets with a feeder component 115 according to an embodiment.

In other skin graft embodiments, the pixel grafts are placed on an irradiated corpse skin matrix (not shown). When cultured on a skin matrix, full-thickness skin grafts are made for patients who are immunologically identical to pixel donors. In embodiments, the cadaveric skin matrix is further truncated into a cylinder similar in size to the excised skin pixel implant so that the cadaveric implant can be histologically aligned with the cadaveric skin substructure. do. FIG. 22 shows a cadaveric skin matrix, according to an embodiment, cut into a cylindrical shape similar in size to an excised skin pixel implant. In some embodiments, the rate of removal of the donor site can be partially determined by inducing normal skin histology at the site of the skin defect in the transplantee, i.e., the normal of the skin graft. Can promote (smooth) surface histology. Depending on the embodiment of either the adhesive thin film or the skin matrix, the pixel drum remover significantly reduces or eliminates visible scarring at the patient's donor site and removes a larger surface area for the graft. Including ability.

In addition to the pixel array medical devices described herein, embodiments include drug delivery devices. For many parts, parenteral administration of the drug is still done by syringe and needle injection. Percutaneous topical drug absorption with sealed patches has been developed to avoid the negative features of needle and syringe systems. However, both of these drug delivery systems have major drawbacks. Human aversion to needle injection has not been dispelled during its use for almost two centuries. Intrabody absorption of a drug injection, either subcutaneously or muscularly, may reduce the efficacy of the drug and may increase the incidence of adverse reactions to the patient. Locally abutted sealing patches based on the lipid or aqueous carrier fluid of the drug suffer from variable absorption through the epidermal barrier. Neither syringe / needle injection nor surface anesthesia is ideal for patients who require local anesthesia over a large surface area of the skin. Syringe / needle "field" injections are often painful and can inject excessive amounts of local anesthesia that can also cause systemic toxicity. Surface anesthesia rarely provides the level of anesthesia required for skin-related procedures.

FIG. 23 is a drum array drug delivery device 200 according to an embodiment. The drug delivery device 200 successfully addresses the limitations and shortcomings of other drug delivery systems. The device comprises a drum / cylinder 202 that is supported by a core / handle assembly 204 and rotates around a drum rotation component 206. The handle assembly 204 of the embodiment further comprises a reservoir 208 of the agent to be delivered and a syringe plunger 210. The surface of the drum 202 is covered by an array of needles 212 of uniform length, which inject a more controlled dose into the patient's skin with a uniform intradermal (or subcutaneous) injection depth. do. During operation, the syringe plunger 210 pushes the drug to be injected from the reservoir 208 into the sealed injection chamber 214 inside the drum 202 via a connecting tube. The agent is finally delivered into the patient's skin at a uniform depth as the array of needles 212 is pushed into the patient's skin until the surface of the drum 202 hits the skin. Unanesthetized skin areas are avoided and also result in a more uniform pattern of skin anesthesia. Rolling drum application of the drug delivery device also reduces discomfort to the patient and allows local anesthesia to be swallowed faster.

FIG. 24A is a side view of the needle array drug delivery device 300 according to the embodiment. FIG. 24B is a perspective view of the needle array drug delivery device 300 according to the embodiment as viewed from above. FIG. 24B is a perspective view of the needle array drug delivery device 300 according to the embodiment as viewed from below. The drug delivery device 300 has a flat array of uniform length microneedles 312 positioned in a manifold 310 that can be used for drug delivery. In this exemplary embodiment, a syringe 302 containing the drug to be injected is inserted into a disposable adapter 306 with a handle and a seal 308 is utilized to ensure that the syringe 302 and the disposable adapter 306 are tightly coupled to each other. .. When the syringe plunger 304 is pushed in, the drug contained in the syringe 302 is delivered from the syringe 302 to the disposable adapter 306. The agent is further sourced into the patient's skin at a uniform depth via the flat array of needles 312 as the array of needles 312 is pushed into the patient's skin until the manifold 310 hits the skin.

The use of the drug delivery device 200 has as many clinical uses as the number of pharmacological drugs requiring percutaneous injection or absorption. As a non-limiting example, some potential uses are local anesthetic injections, injections of neuromodulators (botox) such as botulinum toxin, insulin injections, injections of estrogen and corticosteroids.

In some embodiments, the syringe plunger 210 of the drug delivery device 200 can be operated by an electric motor, as a non-limiting example. In some embodiments, an IV bag and a fluid pump attached to the conduit (not shown) are connected to the infusion chamber 214 and / or the reservoir 208 to allow continuous infusion. In some embodiments, the content of the syringe plunger 210 of the drug delivery device 200 is calibrated and made programmable.

Another use for pixel skin graft removal with PAD (Pixel Array Dermatome) as detailed herein is alopecia. Alopecia is a common aesthetic illness that occurs most often in middle-aged male populations, but is also found in older baby boomer female populations. The most common form of alopecia is male-type baldness (MPB) that occurs in the anterior parietal region of the scalp. Male baldness is a sex-linked trait that is transcribed from the maternal to male offspring by the X chromosome. For men, only one gene is required for the expression of this phenotype. When the genes are recessive, feminine trichotillomania requires transcription of both genes linked to the X chromosome from both the maternal and paternal sides. Phenotypic penetrance can vary from parent to parent and is most frequently expressed in the age of onset and the amount of alopecia in the frontal / parietal / occipital region. Patient variability in MPB phenotypic expression is due to variable genotypic translation of this sex-linked trait. Based on the genotype expression of MPB, the need for hair transplantation increases. Other causes that are not related to genes include trauma, fungal infections, lupus erythematosus, radiation and chemotherapy.

A wide variety of treatment options have been proposed to the public. These options include FDA-approved topical agents such as minoxidil and finasteride, but these have limited success, which means that these agents require conversion of the dormant hair follicles to the anagen phase. Because. Other remedies include hair pieces and hair braids (weaves). Surgical hair transplantation remains as a standard technique, which involves the transfer of hair plugs, strips, and flaps from the hairy scalp to the hairless scalp. For the most part, conventional hair transplantation involves micrograph transfer of multiple single hairs from the haired scalp of the same patient to the hairless scalp. Alternatively, the donor plug is initially removed as a hair strip and then sliced into a micrograph for secondary transfer to the transplanted scalp. Nonetheless, this multi-step process is time consuming, cumbersome and expensive for the average patient to operate.

Traditional hair transplant markets have been hampered by lengthy hair transplant procedures performed in several stages. A typical hair transplant procedure involves transferring the hair plug from the donor site in the hairy scalp to the bald frontal-parietal scalp transplant site. For many procedures, each hair plug is individually transferred to the scalp to be transplanted. It is possible to implant hundreds of plugs during a procedure that can take hours to perform. The viability of "rooted" or transplanted hair plugs after treatment can vary due to factors that limit neovascularization at the site of transplantation. Exercise-induced bleeding and mechanical disruption are major factors in reducing new angioplasty and "rooting" of hair grafts. The embodiments described herein include surgical instruments configured to transfer multiple hair grafts so that several hair grafts are simultaneously fixed and aligned at the site to be transplanted on the scalp. The procedures described herein using the PAD of the embodiment reduce the boredom and time required for conventional instruments.

FIG. 25 shows the composition of human skin. The skin has two horizontally layered layers called the epidermis and the dermis, which act as a biological barrier to the external environment. The epidermis is an encapsulating layer and has a viable layer of epidermal cells that migrates upwards and "matures" into the stratum corneum, called the incapacitated layer. The stratum corneum is a lipid-keratin complex that acts as a primary biological barrier, which is constantly shed and reconstituted in a process called desquamation. The dermis is an adjacent layer that is the main structural support of the skin, and is mainly extracellular and consists of collagen fibers.

In addition to the horizontally layered epidermis and dermis, the skin contains vertically aligned elements or cellular appendages with hair follicle sebaceous gland units, which consist of hair follicles and sebaceous glands. Each hair follicle sebaceous gland unit contains a sebaceous gland and a hair follicle. The sebaceous glands are the most superficial and drain sebum (oil) into the roots of the hair follicles. The base of the hair follicle is called the hair root, and the base of the hair root has a deeply producing element called the skin (dermis) papilla. Hair follicles are generally aligned at an oblique angle to the skin surface. Hair follicles in a given area of the scalp are aligned parallel to each other. Hair follicle sebaceous units are common throughout the scalp, and the density and activity of these units within the area of the scalp are the determinants of the overall appearance of the hair.

In addition to the hair follicle sebaceous unit, sweat glands also extend perpendicular to the skin. These sweat glands provide a water-based exudate that assists in temperature regulation. Apocrine sweat glands in the axillae and groin exude more irritating sweat on the nose that causes body odor. For the rest of the body, the eccrine sweat glands excrete less pungent sweat for temperature control.

Hair follicles develop in different physiological cycles of hair growth.
FIG. 26 shows the physiological cycle of hair growth. The presence of testosterone in people who are genetically prone develops alopecia on the frontal-parietal scalp to varying degrees. Originally, hair follicles become dormant by progressing to the telogen phase without returning to the anagen phase. Male trichotillomania develops when hair is unable to return from the telogen phase to the anagen phase.

The PAD of the embodiment is configured to remove the hairy (hair-bearing) plugs all at once and transplant the haired plugs to the hairless scalp all at once, which eliminates the conventional surgical procedure in hair transplantation. be. In general, the devices, systems and / or methods of the embodiment are used to remove and align a large number of small hairy plugs in a single surgical step or process, and with this same instrument, of the hairless scalp. Used to prepare the site to be transplanted by performing multiple pixelation resections. Multiple hair plug grafts are transferred to the prepared transplant site all at once and transplanted. Therefore, with the use of time-saving procedures, hundreds of hairy plugs can be transferred from the donor site to the transplant site. Flocking using the embodiments described herein thus provides a solution to a tedious and multi-step conventional process that requires a single surgical procedure that is easy, easy and can significantly reduce time and is easy. It can be done with a single surgical procedure that is simple and can save a lot of time.

Hair transplantation using the pixel skinning sword of the embodiment facilitates an improvement over the conventional standard hair follicle unit extraction (FUT) hair transplantation approach. Generally, under the procedure of the embodiment, the hair follicles to be removed are taken from the scalp of the occipital region of the donor. In doing this, the hair at the donor site is partially shaved, the perforated plate of the embodiment is placed on the scalp, and oriented for optimal removal. FIG. 27 shows a donor hair follicle removal situation according to an embodiment. Skullpet The skullpet in the skullpet array is configured to penetrate downward towards the subcutaneous fat and later capture the hair follicles. After the hair plug is incised, the hair plug is removed into an adhesive thin film by cutting the base of the hair plug with a cutting blade as detailed herein. The original relative alignment of the hair plug at the donor site is maintained by adhering to the adhesive thin film before dissecting the base. The aligned matrix of hair plugs in the adhesive thin film is then simultaneously implanted at the transplant site in the scalp of the subject's frontal-crown.

FIG. 28 shows the preparation status of the transplanted site according to the embodiment. The site to be transplanted is prepared by excising the hairless skin plug in a topographically identical pattern to the donor site in the removed occipital scalp. The site to be transplanted is prepared for mass transplantation of hair plugs using the same instruments used at the site of donor according to the embodiment, and in doing so, a scalp defect is created at the site to be transplanted. The scalp defect created at the site to be transplanted has the same geometry (geometry) as the excised plug in the adhesive thin film.

The adhesive thin film supporting the removed hair plug abuts on the same pattern as the scalp defect portion at the transplanted site. For each row, each haired (hair-supporting) plug is inserted into the mirror-symmetrical transplant defect. FIG. 29 shows the arrangement of the removed hair plug at the transplanted site according to the embodiment. Plug-to-plug alignment is maintained so that hair growing from the transplanted hair plug is laid naturally as if it had grown at the donor site. A more uniform alignment between the native scalp and the transplanted hair also occurs.

More specifically, the hair at the donor site is partially shaved to prepare for positioning or placement of the perforated plate on the scalp. The perforated plate is positioned on the scalp of the occipital region for maximum removal. FIG. 30 shows a situation in which a perforated plate according to an embodiment is placed on the occipital scalp. Mass extraction of mass hair plugs is accomplished using a spring loaded pixelation device equipped with an impact punch handpiece with a skull pet step tip. The embodiment is configured to extract individual hair plugs using a ready-made FUE extraction device or biopsy punch, and the holes in the perforated plate are sized to accommodate the off-the-shelf technical device.

Skullpet Array Skullpets with disposable tips are configured to penetrate downward towards the subcutaneous fat and later capture the hair follicles. FIG. 31 shows the depth of scalpet penetration within the skin when the scalpet according to the embodiment is configured to penetrate the subcutaneous fat layer and capture the hair follicles. After the hair plug is incised, the hair plug is removed into an adhesive thin film by cutting off the base of the hair plug with an incision blade, but is not limited to this. FIG. 32 shows a situation in which a hair plug is removed by using a perforated plate at a donor site on the back of the head according to the embodiment. The original relative alignment of the hair plug is maintained by adhering to the adhesive thin film. The adhesive thin film is attached before, but is not limited to, the base of the excised pixel is cut off. The aligned matrix of hair plugs in the adhesive thin film is then simultaneously implanted at the site of implantation in the frontal-parietal scalp.

The additional single hair plug can be removed with a perforated plate, for example, for use in creating a visible hairline. FIG. 33 shows a situation that creates a visible hairline according to an embodiment. Visible hairline is determined and deployed by manual FUT technology. Massive transplantation of the visible hairline and crown can be performed simultaneously or at individual stages. When performing visible hairline and mass transplantation at the same time, the site to be transplanted starts from the visible hairline and develops.

Transplantation of the removed hair plug has a site preparation step prepared by excising the hairless skin plug in a topographically identical pattern to the donor site in the removed occipital scalp. FIG. 34 shows a situation in which a donor site is prepared using a patterned perforated plate and a spring loaded pixelation device to create the same skin defect site at the site to be transplanted according to the embodiment. The site to be transplanted of the embodiment prepares for mass transplantation of hair plugs using the same perforated plate and spring loaded pixelation device used at the donor site. Scalp defects are created at the site to be transplanted. These scalp defects have the same geometry as the excised plug in the adhesive thin film.

The adhesive thin film supporting the removed hair plug abuts on the same pattern as the scalp defect portion at the transplanted site. For each row, each hair follicle-supported or hairy (hair-supported) plug is inserted into the mirror-symmetrical implant defect. FIG. 35 shows a situation in which the removed plug is transplanted by inserting the removed hair plug into the corresponding skin defect portion created at the transplanted site according to the embodiment. Plug-to-plug alignment is maintained so that hair growing from the transplanted hair plug is laid naturally as if it had grown at the donor site. A more uniform alignment between the native scalp and the transplanted hair also occurs.

Although clinical endpoints vary from patient to patient, it is expected that hair plugs will "root" at a higher rate as a result of improved neoangiogenesis. FIG. 36 shows a clinical endpoint using a pixel sword instrument and procedure according to an embodiment. With a combination of better "rooting", shorter treatment times and more natural-looking outcomes, pixelated sword instruments and treatments according to embodiments can overcome the shortcomings of traditional hair transplant approaches.

Embodiments of pixelated skin grafts for skin defects and pixelated skin resections for cutis laxa are described in detail herein. These embodiments remove areas of skin pixels in the surface areas of loose skin where skin tightening is desired. The skin defects caused by this procedure (eg, diameter in the range of about 1.5-3 mm) are small enough for primary healing without visible scarring, and wound closure of multiple skin defects It is carried out with directivity so as to produce the desired contour effect. Experiments with live animals with pixel excision procedures have yielded excellent results.

The pixel treatment of the embodiment is performed in a clinic setting under local anesthesia, but is not limited to this. The surgeon uses the instruments of the embodiment to quickly excise an array of skin pixels (eg, circles, ovals, squares, etc.). This procedure is relatively painless. Intracutaneous skin defects produced during this procedure are abutted and closed with an adhesive Flexan® sheet, but the embodiments are not limited to this. Acting as a large butterfly bandage, the Flexan sheet is pulled in a direction (vector) that maximizes the aesthetic contours of the therapeutic surface area. Wear compression elastic garments on the bandage to further support aesthetic contouring. During the recovery period, the patient wears a supporting garment on the therapeutic surface for a period of time (eg, 5 days, etc.). After initial healing, multiple small linear scars in the therapeutic area are not visually apparent. Additional skin tightening subsequently occurs over several months from a delayed wound healing reaction. Therefore, the pixel procedure is a minimally invasive skin tightening procedure that avoids widespread scarring from conventional aesthetic plastic surgery and replaces conventional procedures.

Pixel treatment evokes unavoidable cellular and / or extracellular responses to the resulting clinical outcome. The physical reduction in the surface area of the skin results from a partial excision of the skin that physically removes a portion of the skin directly in the relaxed surface area. In addition, subsequent tightening of the skin results from a delayed wound healing reaction. Each pixelated resection initiates an unavoidable wound healing sequence. The healing response achieved in the embodiment has three phases, as detailed herein above.

The first phase of this sequence is the inflammatory phase in which degranulation of mast cells releases histamine into the "wound". Histamine release evokes swelling of the capillary bed and enhances vascular permeability to extracellular space. This initial wound healing reaction occurs within the first day of the wound and also appears as erythema on the surface of the skin.

Within a few days of the "wound", the second phase of healing, i.e., fibrosis begins. During fibroblast proliferation, there is fibroblast metastasis and mitotic proliferation. Fibrosis has two important features: the deposition of neoplastic collagen and the contraction of muscle fibers in the wound. Histologically, the deposition of neoplastic collagen can be microscopically identified as consolidation and hypertrophy of the dermis. Although this is a static process, the tensile strength of the skin is significantly increased. Muscle fiber contraction is a dynamic body process that results in a two-dimensional tightening of the skin surface. This process results from active cell contraction of myofibroblasts and deposition of contractile proteins in the extracellular matrix. Overall, the effect of fibrosis is cutaneous contracture and the deposition of statically supporting scaffolds of neoplastic collagen with a toned substructure. This clinical effect is achieved as a delayed tightening of the skin with smoothing in the texture of the skin over several months. The clinical endpoint is the skin envelope that looks younger in the therapeutic area.

The third final phase of the delayed wound healing response is maturity. During maturation, there is increased strength and remodeling of the therapeutic surface area due to increased cross-linking in the collagen fibril matrix (of the dermis). This final stage begins within 6-12 months after the "wound" and can be at least 1-2 years. Small pixelated excisions of the skin should preserve normal skin structure during maturation and generally do not produce the prominent scarring that results from large surgical excisions. Finally, there is associated stimulation and activation of the epidermis from the release of epidermal proliferative hormones.

Figures 37-42 show images obtained as a result of pixel treatment performed on live animals according to embodiments. The embodiments described herein have been used in proof-of-concept studies in animal models to verify that pixel treatment resulted in aesthetic skin tightening without visible scarring. The study used a live pig model anesthetized for treatment. FIG. 37 is an image of the skin tattooed at the corners and midpoints of the surface area to be excised, according to the embodiment. The margin of the excision area is defined with tattoos for postoperative evaluation, but the embodiments are not limited to this. The procedure was performed using a perforated plate (eg, a 10x10 pixel array) to specify a surface area for partial excision. Partial excision was performed using a biopsy punch (eg, 1.5 mm diameter). FIG. 38 is an image of a postoperative skin resection area according to an embodiment. Following the pixel excision, the pixelized excision defect was closed (horizontally) with a Flexan thin film.

On the 11th day following the procedure, all excisions were primary healed in the area specified by the tattoo, and photographic and dimensional measurements were taken. FIG. 39 is an image according to the embodiment on the 11th day after the operation, and shows the excision portion that has been primarily healed together with the measured peripheral edge. Photographic and dimensional measurements were subsequently performed for 29 days postoperatively. FIG. 40 is an image of the 29th postoperative day according to the embodiment, showing the maturation of the excised part that has been primary healed and the excised area where the primary healing continues together with the measured peripheral edge. FIG. 41 is an image of the 29th postoperative day according to the embodiment, showing the maturation of the primary healed excision and the excision area where the primary healing continues, along with the measured lateral dimensions. The photographic measurement and the dimensional measurement were repeated for 90 days after the operation, and the skin in the test surface area was completely smooth to the touch. FIG. 42 is an image according to the embodiment on the 90th day after surgery, showing the maturation of the excised part that has been primary healed and the excised area where the primary healing continues together with the measured lateral dimensions.

The partial resection described herein was performed intradermally or over the entire thickness of the dermis. The ability of the skin incision by the skull pet (eg, round, square, oval, etc.) is enhanced by adding additional force. This additional force is the force applied to the scalpet or scalpet array, for example, the force includes one or more of rotational force, kinetic impact force, vibration force, all of which. The force of the force is described in detail herein with respect to partial cutaneous resection.

The skull pet device of the embodiment generally comprises a skull pet assembly and a housing. The skull pet assembly has a skull pet array, and these skull pet arrays have a large number of skull pets and a force applying component or a driving component. The scullpet assembly is one or the other configured to accurately hold and position the scullpet according to the form of the scullpet array and to transfer force from the operator to the target tissue to be excised (z-axis direction). It has the above alignment plate. The scullpet assembly has, but is not limited to, a spacer configured to hold the alignment plate coaxially and separated from the sculpt array by a fixed distance.

The shell is configured to hold spacers and alignment plates and also has mounting points for the housing and drive shaft. Alignment plates and / or spacers are attached or connected in place on the shell (eg, snap connections, welds (ultrasonic, laser, etc.), seizure, etc.), thereby resulting in rigid assembly and skulls. Discourage the misuse of pet arrays or their willingness to reuse them for other purposes. In addition, the shell protects the drive mechanism or gearing and scullpet from contamination during use and allows lubrication (if necessary) to be applied to reduce torque requirements and extend the life of the gearing.

As an example of applying force using the embodiments described herein, the ability to incise the skin with a circular skull pet may be enhanced by the addition of rotational torque. The downward axial force used to make an incision in the skin is significantly reduced when applied in combination with a rotational force. This improved ability is similar to that of a surgeon incising the skin with a standard scalpel when the surgeon uses a combination of simultaneous compression (axial force) and movement across the skin to cut the skin surface more effectively. be.

Since it punctures the skin, the amount of skin compression required is significantly reduced when vertical kinetic forces are applied at the same time. For example, darts throwing techniques for injection have previously been used by health care providers to puncture the skin. The "impactor" motion applied to the skin by the circular skull pet of the embodiment enhances the cutting ability of this modality by simultaneously adopting an axial compression force and an axial kinetic force. The axial compression force used to incise the skin surface is significantly reduced when applied in combination with kinetic forces.

Traditional biopsy punches are intended for single-use use in tissue removal, which is generally achieved by pushing the punch directly into the tissue along the central axis. Similarly, partial excision according to the embodiment uses a circular skull pet. The Skullpet of the embodiment can be used in a stand-alone manner, and the alternative embodiment includes, but is not limited to, a Skullpet array that bundles each other as an array of various sizes so that the Skullpet can extract multiple areas of skin. do not have. The force used to puncture the skin with a partially excised skull pet is a function of the number of skull pets in the array, and as the array size increases, so does the force used to puncture the skin.

The ability to incise the skin with a circular skull pet is greatly improved, along with a reduction in the force required for skin puncture introduced by the rotational movement around the central axis and / or the addition of impact force along the central axis. FIG. 43 is a skull pet showing the applied rotational force and / or impact force according to the embodiment. This improved rotational morphology has an effect similar to that of a surgeon incising the skin with a standard skull pet, in which case the surgeon has a movement across the skin (dynamic energy) and simultaneous compression (axial force). The combination is used to cut the skin surface more effectively. Impact force is similar to the use of a staple gun or the rapid movement of a subcutaneous injection needle prior to impacting the skin.

A consideration in the scalpet rotation mode is the amount of torque used to drive multiple scalpets at a preferred speed, that is, the physical size of the system used to drive the scalpet array and This is because the power increases as the required torque increases. To reduce the incision force required for the scalpet array, the rows or columns or segments of the array can be driven individually or sequentially during array abutment. The approach of rotating the sculpt includes, but is not limited to, a gear type, an outer spiral type, a groove type, an inner spiral type, a pin drive type, and a friction (elastic) type.

Scalpet arrays configured for partial excision using a combination of rotational and axial incisions use one or more devices for rotation. For example, the device's sculpt array uses a rotary or reciprocating vibration mechanism of one or more of gear, outer spiral, grooved, inner spiral, pin driven, and friction (elastic) types. It is configured to rotate, but is not limited to this. Each of the rotation mechanisms used in the various embodiments will be described in detail herein.

FIG. 44 shows an array with a geared (geared) skull pet and a geared skull pet according to an embodiment. FIG. 45 is a perspective view from the bottom of an excision device comprising a skull pet assembly with a geared skull pet according to an embodiment. The device comprises a housing (shown as transparent for clarity) configured to have a geared sculpt array for applying rotational torque to rotate the sculpt. FIG. 46 is a perspective view from the bottom of a skull pet assembly (housing not shown) having a geared skull pet array according to an embodiment. FIG. 47 is an enlarged detailed view of the gear type scullpet array according to the embodiment.

A geared (geared) scullpet array has an appropriate number of sculpets for excision procedures using the array, with gears coupled or coupled to each sculpt. For example, the gear fits on or around the skull pet, but embodiments are not limited to this. Geared skull pets are configured as units or arrays such that each skull pet rotates with an adjacent skull pet. For example, after mating, the geared skull pets should be placed together on the alignment plate so that each skull pet engages with four adjacent skull pets and rotates together, thereby keeping them in a precise alignment state. Install. The geared scullpet array is driven by, but is not limited to, by at least one external rotating shaft carrying a gear at the end. The rotating shaft is configured to supply or transmit an axial force, which compresses the array's skull pet into the skin during the incision. Alternatively, an axial force can be applied to the plate holding the skull pet.

In another embodiment, friction drive is used to drive or rotate the skull pet of the array. FIG. 48 shows an array with a friction driven form of skull pet according to an embodiment. The friction drive mode has elastic rings around each skull pet, similar to the gear arrangement in the gear type embodiment, and the frictional force in the compressed state between the rings of the adjacent skull pets results in the skull as well as the gear type array. Causes pet rotation.

The excision device comprises a spiral sculpt array, including, but not limited to, outer and inner spiral sculpt arrays. FIG. 49 shows an array with a spiral skull pet (outside) and a spiral skull pet (outside), according to an embodiment. FIG. 50 is a side perspective view (left side) of a scalpet assembly having a spiral scalpet array and a side view of a resection device with a scalpet assembly having a spiral scalpet array, according to an embodiment. The perspective view (right side) (showing the housing) seen from the side is shown. FIG. 51 is a side view of an excision device comprising a scalpet assembly (a housing shown as transparent for clarity) with a spiral scalpet array assembly according to an embodiment. FIG. 52 is a perspective view from the bottom of an excision device comprising a sculpt assembly (a housing shown as transparent for clarity) with a spiral sculpt array assembly according to an embodiment. FIG. 53 is a perspective view from the top of an excision device comprising a sculpt assembly (a housing shown as transparent for clarity) with a spiral sculpt array assembly according to an embodiment.

The spiral sculpt form has a sleeve configured to fit onto the end region of the sculpt, the outer region of the sleeve having one or more spiral threads. After attaching the sleeve to each skull pet, the sleeved skull pet is configured as a unit or array such that each skull pet rotates with the adjacent skull pet. Alternatively, a spiral thread is formed on or as a component of each skull pet.

The spiral sculpt array is configured to be driven by a push plate that reciprocates up and down along the region of the central axis of the sculpt array. FIG. 54 is a push plate of a spiral skull pet array according to an embodiment. This push plate has a number of alignment holes corresponding to the number of skull pets in the array. Each alignment hole has a notch configured to match the spiral (outer) thread in the skull pet sleeve. When driving the push plate, it causes the rotation of each skull pet in the array. FIG. 55 shows, according to an embodiment, a spiral sculpt array with a push plate.

The excision device further comprises an inner spiral sculpt array. The device comprises a housing configured to have a spiral sculpt array assembly for applying rotational torque for sculpt rotation. FIG. 56 shows an array with an inner spiral skull pet and an inner spiral skull pet according to an embodiment. The inner spiral skull has a twisted square rod (eg, solid, hollow, etc.) or insert that fits within the open end of the skull pet. As an alternative, the skull pet is configured to have a spiral region. The twisted insert is held in place by binding a portion of the scullpet around the insert (eg, crimping, binding, brazing, welding, gluing, etc.). Alternatively, the insert is held in place with an adhesive bond. At this time, the inner spiral skull pet is configured so that each skull pet rotates together with the adjacent skull pet, and is configured as a unit or an array. The spiral sculpt array is configured to be driven by a drive plate that moves or reciprocates up and down along the spiral region of each sculpt in the sculpt array. The drive plate has a number of square alignment holes corresponding to the number of skull pets in the array. When the drive plate is driven, it causes rotation of each skull pet in the array. FIG. 57 shows a spiral sculpt array according to an embodiment with a drive plate.

FIG. 58 shows an array with a grooved skull pet and a grooved skull pet according to an embodiment. The grooved skull pet form has a sleeve configured to fit over the end region of the skull pet, the sleeve having one or more spiral grooves. Alternatively, each skull pet has a spiral groove without the use of a sleeve. The sleeved skull pet is configured as a unit or array such that the groove top regions of each skull pet are aligned with the adjacent top regions. The external drive rod is aligned and fitted horizontally along the top of the groove. Driving the drive rod downwards results in rotation of the sculpt array. FIG. 59 shows a portion of a grooved scullpet array (eg, four (4) scullpets) according to an embodiment with a drive rod. FIG. 60 shows a drive rod with an exemplary grooved skull pet array (eg, 25 skull pets) according to an embodiment.

FIG. 61 shows a reciprocating vibration pin drive assembly according to an embodiment. The assembly has a lower or intermediate plate configured to hold or connect to the skull pet to hold the skull pet. The top plate or drive plate is positioned in the area above the sculpt and intermediate plate and also has drive groove holes or groove holes. The pin is coupled or connected to the top of the skull pet, and the top region of the pin projects beyond the top of the skull pet. The groove is configured to accommodate and loosely hold the pin. The groove is positioned relative to the pin so that the rotation or reciprocating vibration of the top plate causes the skull pet to rotate or reciprocate by following the pin within the groove.

One or more components of the scalpet device include adjusting means configured to control the amount (eg, depth) of scalpet exposure during deployment of the scalpet array at the target site. For example, the adjusting means of the embodiment is configured to collectively control the deployment length of the skull pet in the skull pet array. The adjusting means of another embodiment is configured to collectively control the unfolded length of a portion or set of skull pets in the skull pet array. In another embodiment, the adjusting means is configured to individually control the deployment length of each individual skull pet in the skull pet set in the skull pet array. The skull pet depth control means has many mechanisms configured to control the skull pet depth in an adjustable manner.

The depth control means of the embodiment has an adjustable collar or sleeve on each skull pet. The collar should be configured to move along the length of the skull pet (eg, slidable, etc.) to prevent the skull pet from penetrating into the target tissue beyond the depth controlled by the position of the collar. Configure. The position of the collar is adjusted by the user of the Skullpet device prior to use in the procedure, in which case the adjustments include, for example, manual adjustment, automatic adjustment, electronic adjustment, pneumatic adjustment, and adjustment under software control. There is.

As a depth control means in another embodiment, there is an adjustable plate configured to move along the skull pet length of the skull pet array. The plate is configured to prevent the scalpets of the scalpet array from penetrating into the target tissue beyond the depth controlled by the position of the plate. In this way, the scullpet array is deployed in the target tissue to a depth equal to the length of the scullpet protruding beyond the plate. The position of the plate is adjusted by the user of the Skullpet device prior to use in the procedure, in which case the adjustments include, for example, manual adjustment, automatic adjustment, electronic adjustment, pneumatic adjustment, and adjustment under software control. There is.

As an example of depth control adjustment using a plate, the variable length skullpet exposure is controlled by, but is not limited to, the adjustment of the skullpet guide plate of the skullpet assembly. FIG. 62 shows variable skull pet exposure control according to an embodiment together with a skull pet guide plate. Other embodiments control the amount of Skullpet exposure from within the Skullpet Array handpiece and / or under one or more of software, hardware, and mechanical controls.

Embodiments include a mechanical sculpt array in which axial and rotational forces are manually applied by compression forces from the device operator. FIG. 63 shows, according to an embodiment, a scalpet assembly having a scalpet array (spiral) configured to be manually driven by an operator.

Embodiments include, and / or are coupled to, a rotational source configured to produce optimum rotational (eg RPM) and rotational torque to incise the skin in combination with an axial force. Optimal rotation of the skull pet is configured to follow the best balance between rotational speed and increased cutting efficiency vs. increased friction loss. Optimal rotation of each scalpet array form is, to name a few examples, array size (number of scalpets), scalpet cutting surface geometry, scalpet and alignment plate material selection, gear materials, lubricant usage, and skin. Based on the mechanical properties of.

With respect to the forces to be considered in the form of skull pets and skull pet arrays described herein, FIG. 64 shows the forces exerted on the skull pet by contacting the skin. The parameters considered when determining the applicable force according to the embodiment are as follows, that is,
Average skull pet radius: r
Skull pet rotation speed: ω
Skullpet Axial force: F _n (Skullpet abuts perpendicular to the skin)
Skin friction coefficient: μ
Friction force: F _f
Skull pet torque: τ
Motor output: _Php
Is.

The torque used to rotate the scalpet during initial abutment is a function of the axial force (applied perpendicular to the skin surface) and the coefficient of friction between the scalpet and the skin. The frictional force initially acts on the cut surface of the skull pet. The initial contact of the skull pet with the skin is as follows, ie =
F _f = μ · F _n
τ = F _f・ r
P _hp = τ ・ ω / 630.25
Is.

The initial force that a skullpet penetrates into the skin is a function of the skullpet's sharpness, axial force, skin tensile strength, and the coefficient of friction between the skin and the skullpet. After penetrating the skull pet into the skin, the frictional force increases due to the presence of additional frictional forces acting on the sidewalls of the skull pet.

The excision device of the embodiment includes a kinetic impact incision device and a non-rotating puncture method of the skin. Approaches that directly compress the scalpet into the skin include, but are not limited to, axial force compression, single axial force compression plus kinetic impact force, and moving the scalpet at high speed to impact and puncture the skin. Includes letting. FIG. 65 shows a stable axial force compression using a skull pet according to an embodiment. Stable axial force compression places the skull pet in direct contact with the skin. After being placed in place, a continuous, stable axial force is applied to the skull pet until it punctures the skin and progresses from the dermis to the subcutaneous fat layer.

FIG. 66 shows a situation of stable single axial force compression plus kinetic impact force application using a skull pet according to an embodiment. Stable single axial force compression plus kinetic impact force places the scullpet in direct contact with the skin. Axial forces are applied to maintain contact. The end of the sculpt is then struck by another object that provides additional kinetic energy along the central axis. These forces cause the skull pet to puncture the skin and also progress from the dermis to the subcutaneous fat layer.

FIG. 67 shows a situation in which the skull pet is moved at a speed of puncturing the skin by giving an impact to the skin according to the embodiment. The skull pet is positioned a short distance from the target surface area of the skin. A kinetic force is applied to the skull pet to obtain the desired speed for puncturing the skin. This kinetic force causes the skull pet to puncture the skin and also progress from the dermis to the subcutaneous fat layer.

The skull pet of the embodiment has a large number of cut surfaces or blade geometries suitable for the incision method of the procedure involving the skull pet. Scalpet blade geometries include, but are not limited to, linear edges (eg, cylindrical), slanted, multi-needle tips (eg, sawtooth, etc.) sinusoidal. As an example, FIG. 68 shows a plurality of needle-shaped tips according to an embodiment.

Skull pets include, for example, one or more types of square skull pets. The square skull pet includes, but is not limited to, a square skull pet having a plurality of sharp tips or teeth, and a square skull pet having a plurality of sharp tips or teeth. FIG. 69 shows a toothless square skull pet (left side) and a toothless square skull pet (right side) according to an embodiment.

The partial excision device of the embodiment comprises a square scullpet assembled into a scullpet array with multiple sharp tips that facilitates skin incision by direct non-rotational kinetic impact force. The square geometry of the skin plug to be removed results in a side-side and point-point approximation of the skin plug combined with an adhesive thin film. A closer approximation of the skin plug gives a more uniform appearance of the skin graft at the site to be transplanted. In addition, each skin plug that is an excised component has an additional surface area (eg, 20-25%).

Further, the skull pet includes one or more types of elliptical or round skull pets. Round skull pets include, but are not limited to, round skull pets with diagonal tips, round skull pets without multiple sharp tips or teeth, and round skull pets with multiple sharp tips or teeth. FIG. 70 shows a plurality of views of a round skull pet with an oblique tip, i.e., a side view, a front (or back) view, and a side perspective view, according to an embodiment. FIG. 71 shows a round skull pet with serrated edges, according to an embodiment.

The excision device of the embodiment is configured to include an extrusion pin corresponding to the skull pet. FIG. 72 shows a side view of an excision device (the housing is shown as transparent for clarity), comprising a sculpt array and a scullpet assembly with extrusion pins, according to an embodiment. FIG. 73 shows a perspective view from the top of an excision device (the housing is shown as transparent for clarity), comprising a sculpt array and a scullpet assembly with extrusion pins, according to an embodiment. FIG. 74 shows a side view and a top-view perspective of the scalpet assembly including the scalpet array and the extrusion pins according to the embodiment.

The extrusion pin of the embodiment is configured to eject the held skin plug. Extruded pins of other embodiments are configured to be driven into a partially defective portion at the site to be implanted. Extruded pins of other embodiments are configured to inject a skin plug into a pixel canister at a docking station for partial skin grafting.

The embodiments described herein include the use of a vibrating component or system that uses vibration to facilitate a skin incision with rotational torque / axial force and also to facilitate a skin incision with a direct impact without rotation. FIG. 75 is a side view of an excision device comprising a scullpet assembly having a scullpet array assembly coupled to a vibration source, according to an embodiment.

The embodiments described herein have an electrical-mechanical sculpt array generator. FIG. 76 shows a scalpet array driven by an electrical-mechanical power source or scalpet array generator according to an embodiment. The function of the generator is not electronically controlled and is powered by power, but the embodiments are not limited to this. The platform of the embodiment includes control software.

Embodiments include and include auxiliary energy or auxiliary forces configured to reduce the axial force used to incise the skin (or other tissue surface such as mucous membranes) by the skull pet in the skull pet array. / Or combine or concatenate. Auxiliary energy or force includes, but is not limited to, at least one of rotational torque, kinetic rotational energy (RPM), vibration, ultrasonic, and electromagnetic energy (eg, RF, etc.). ..

The embodiments described herein include a sculpt array generator with and / or connected to an electromagnetic radiation source. Electromagnetic radiation sources include, for example, one or more of radio frequency (RF) sources, laser sources, and ultrasonic sources. Electromagnetic radiation is provided to support cutting by the skull pet.

The embodiment is a skull configured like a "sewing machine" type skull pet or skull pet array in which the skull pet repeatedly retracts and deploys under at least one of manual, electromechanical, and electronic controls. Has a pet mechanism. This embodiment has a movable skull pet or skull pet array that incises the site row by row. This incision can take the form of a stamping motion approach in which the scullpet or scullpet array moves, for example, or the array rolls on a surface to be treated so that the scullpet array achieves the desired excision density. The excision can be performed by moving a predetermined distance.

The partial excision described herein is configured to perform excision and transplantation in which the excision of the partial incision skin pixel is performed in vacuum to anchor the plug in the lumen of each sculpt shaft. The skin plug is then inserted into the separate docking station described herein by a proximal pin array that pushes the skin plug out of the skull pet's shaft.

FIG. 77 is a schematic representation of a cutting device, including a vacuum system, according to an embodiment. This vacuum system has a vacuum tube and a vacuum port on / in the device housing and is configured to create a vacuum in the housing by evacuating air from the housing. The vacuum of the embodiment is configured to result in skin placement / fixation for a skull pet incision, thereby improving depth control and cutting efficiency.

The vacuum of the other embodiment is configured to evacuate or remove the skin plug and / or the hair plug into one or more of the sculpt lumen and the array manifold housing. FIG. 78 shows a vacuum manifold in contact with the target skin to retract / remove the cut skin / hair plug according to the embodiment. A vacuum manifold configured to abut directly on the skin surface is coupled or connected to a vacuum source. FIG. 79 shows, according to an embodiment, a vacuum manifold having an integrated wire mesh that abuts on the skin surface to retract / remove the cut skin / hair plug.

In addition, the external vacuum manifold is used in an absorption-assisted adipose tissue excision machine that percutaneously removes superficial subcutaneous fat from partially excised skin defects in areas created partially for cellulite treatment. FIG. 80 shows a vacuum manifold with an integrated wire mesh configured to vacuum-suck subcutaneous fat, according to an embodiment.

The external vacuum manifold also has a docking station (as described herein) incorporated to remove the skin plug for implantation and can also be configured to deploy. The docking station can be in the form of one or more of static, extendable, and / or stretchable.

The partial excision device described herein comprises a separate docking station configured as a platform for aggregating partially excised skin plugs onto a more uniform skin sheet for skin grafting. The docking station has a perforated grid matrix with the same pattern and pore density as the skull pets in the skull pet array. A retention canister positioned at the bottom of each hole is configured to retain and align the removed skin plug. In embodiments, the epidermal surface faces upward at the level of the pores. In another embodiment, the docking station is partially stretchable to bring the docked skin plug closer to it before it is captured by the adhesive thin film. Partial skin grafts captured on the adhesive thin film are then defat with either an incorporated or non-incorporated decoupling blade. In another alternative embodiment, the adhesive thin film itself has elastic recoil properties that feed or position the captured skin plugs for closer alignment. Regardless of the embodiment, the contracted partial skin graft / adhesive thin film composite is then directly abutted at the site of the defect to be transplanted.

The embodiment has a stretchable docking station or tray configured to accept and orient the skin and / or hair plug removed from the skull pet by an extrusion pin and / or removed after being ejected. FIG. 81 shows a stretchable docking station and inserted skin pixels according to an embodiment. The docking station is made of, but is not limited to, an elastic material. The docking station is configured to extend from the first shape to a second shape aligned with the pixel receiver with the sculpt array in the handpiece. FIG. 82 is a plan view showing a stretched state (left side) and a non-stretched state (right side) of the docking station (for example, elasticity).

Pixels are ejected from the sculpt array into the docking station until the docking station is full, after which the docking station relaxes into a pre-stretched shape that has the effect of bringing the pixels closer together. The flexible, sticky, semi-permeable thin film is then stretched and placed on the docking station (sticky side down). After the pixels attach to the thin film, lift the thin film from the docking station. The thin film is then restored to its normal non-stretched state, which also has the effect of attracting the pixels to each other. The thin film is then placed on the site of the defect to be transplanted.

The excision device described herein comprises delivering a therapeutic agent to the excision defect created by the excision device described herein. In this way, the excision site is configured to be used as an injection site applied topically for delivery or application of a therapeutic agent for adipocyte depletion (lipolysis) during or after the excision procedure.

The embodiments described herein are for vacuum removal of the intrascalp hair plug at the donor site and for transplanting a large amount of the removed hair plug into the partially excised defect at the site to be transplanted (without a separate collection reservoir). Configure for. Under this embodiment, the donor skull pet array deployed on the occipital scalp is a skull pet having a diameter relatively larger than the constituent skull pets of the skull pet array deployed to create defects at the site to be implanted. Has. Following the removal of the hair plug at the donor site, the hair plug is implanted at the defect site created at the transplant site using the removed hair plug transferred by the skull pet array.

Due to the elastic retraction of the incised dermis, the elastic retraction diameter of the hair plug removed from the occipital scalp is similar to the elastic retraction diameter of the partial excision defect of the transplanted site in the frontal-parietal-occipital scalp. In an embodiment, the hair plug removed into the donor skull pet array is extruded by a proximal pin in the lumen of the skull pet in the same pattern as the partially defective portion created by the transplant site skull pet array. Skullpets of the Skullpet Array deployed at the donor site (including the donor hair plug) align (visually) in the same pattern as the partially resected area of the defect at the site of the transplanted scalp. During alignment, the proximal pin in the shaft of each scalpet advances below the shaft of the scalpet, pushing out the hair plug into the partial excision defect of the implant site, thereby simultaneously delivering multiple plugs to the implant site. To transplant. Partial excision of the skin plug This mass flocking into the transplanted site (eg, bald scalp) is more likely to maintain root alignment with other mass transplanted hair plugs at the transplanted scalp site. Directional closure in the donor site area is performed with, but is not limited to, the most clinically effective vector.

The partial excision device described herein is configured for tattoo removal. Later in life, many patients want to remove pigmented tattoos for a variety of reasons. In general, tattoo removal involves the removal of pigments impregnated in the dermis. Traditional tattoo removal approaches range from heat ablation of pigments to direct surgical excision. Thermal cauterization with a laser results in decolorization or partial surface scarring. Surgical excision of tattoos inevitably results in unavoidable linear scarring due to surgical procedures. For many patients, the trade-off between tattoo removal and post-procedure scars can be minimal.

The use of partial excision for tattoo removal allows partial removal of the majority of the pigment in the dermis with minimal visible scarring. Partial excision extends beyond the boundaries of the tattoo and fuses the excision with non-excised tattoo-free skin. De-delineation of tattoo patterns can occur even if all residual pigments are not or cannot be removed. In embodiments, initial partial resection is performed on a scalpet array and subsequent partial resection is performed by scalpet resection alone for residual dermal pigment. As with other uses described herein, directional closure is performed with the most clinically effective vector.

The partial resection device described herein is configured for cellulite treatment. This aesthetic malformation has resisted effective treatment for decades due to the multifactorial pathological mechanism of action. Cellulite is a combination of cutis laxa with age or weight loss and the growth and enhancement of superficial fat-encapsulated bodies. The invisible paving stone appearance of the skin is common to the buttocks and lateral thighs. Effective treatment should address each contributor to malformations.

The partial excision device described herein is configured to perform partial excision of the skin in order to tighten the affected skin and at the same time reduce the prominent fat encapsulation involved in paving stone surface morphology. .. The same partial excision defect created for skin tightening uses a locally applied vacuum to percutaneously aspirate the superficial fat encapsulation. In embodiments, a clear manifold suction cannula is directly abutted against the partially excised skin surface. The proper vacuum pressure used for the aspiration assisted adipose tissue ablation (SAL) unit is determined by visually determining that an appropriate amount of subcutaneous fat has been aspirated. The proper duration of contact with the manifold is also a monitoring factor for treatment. When used in combination with partial skin tightening, only a relatively small amount of fat is aspirated to produce a smoother surface morphology. As with other uses described herein, the partial resection area is closed with directional closure.

The partial resection device described herein is configured for correction of abdominal streaks and scarring. Obvious scarring is a malformation that requires clear removal of scar depiction from adjacent normal skin. Scar depiction is caused by changes in texture in pigments and contours. In order to make scars less visible to the eye, these three elements of scarring must be addressed in terms of scar repair, which significantly reduces the visual impact. Some scars, called contractures around the joint, can also limit the range of movement. For the most part, scar repair is performed surgically, in which case the scar is cut in an oval shape and carefully closed by careful joining of the cut margins in the unscarred skin. However, any surgical modification will lead the scar again and will replace the existing scar with an unavoidable surgical scar that can be delineated or partially delineated by Z or W plasty.

Scarring is diagnostically divided into hypertrophic and dysgenetic types. Hypertrophic scars generally have raised contours, irregular textures, and deeper pigmentation. In contrast, dysgenetic scars have a more depressed contour than the level of skin without adjacent normal scarring. In addition, the color is more whitish (bleached) and the texture is smoother than normal adjacent skin. Histologically, hypertrophic scars are rich in tissue-disordered skin scar collagen due to overactive melanocytes. Dysgenetic scars are deficient in skin collagen with few or no melanocytes.

The partial resection device described herein is configured for partial scar repair that does not reintroduce additional surgical scarring and significantly eliminates the depiction of visually impactful malformations. Instead of surgically induced linear scars, partial excision of the scar results in an invaluable reduction in coloring, texture and contour elements. Partial correction is performed along the linear dimensions of the scar and extends beyond the scar's boundaries to normal skin. Partial repair of scars involves a direct partial excision of scar tissue, where residual scars and unscarred normal skin are finely interlaced. Basically, micro W plasty is performed along the entire scar area. As in other applications, the partial excision area is closed by directional closure. An example of using partial modification is dysgenetic postpartum abdominal streak modification. The micro-intersection of the recessed scar epidermis and dermis in the streaks with the adjacent normal skin significantly reduces the depressed, linear bleached appearance in this malformation.

The partial resection device described herein is configured to repair postpartum vaginal relaxation and prolapse. Full-term fetal delivery by the vagina is partially accompanied by excessive extension of the vaginal entrance and vaginal canal. Elongation of the longitudinal aspect of the vaginal canal during labor occurs with dilation of the labia, vaginal entrance and vaginal fornix in the cross-sectional direction. For many patients, childbirth trauma results in permanent extension of the vaginal canal along the longitudinal and cross-sectional aspects. Vaginal repair of vaginal prolapse is generally performed as anterior-posterior resection of the vaginal mucosa with prosthetic insertion. For patients with severe vaginal prolapse, this procedure, which is needed as additional support for the anterior and posterior vaginal walls, is required. However, many patients with postpartum vaginal relaxation desire less invasive treatment.

The partial excision device described herein is configured to partially excise the vaginal mucosa to narrow the dilated vaginal canal at the labia and vaginal entrance in the circumferential direction. The pattern of partial resection can also be performed longitudinally when the vaginal canal is elongated. Directional closure of the partially resected area can be assisted by a vacuum thrombus that shapes the partially resected vaginal canal into a prepartum form as a stent.

The partial resection devices described herein are configured for the treatment of snoring and sleep apnea. Snoring has some health effects, but it has an acoustically disturbing effect on relationships with sleeping partners. For the most part, snoring results from unpleasant vibrations of the soft tissue structures of the mouth and pharynx in the oral cavity, pharynx, and nasal cavity during breathing. More specifically, vibrations of the palate, turbinates, pharyngeal sidewalls, and base of the tongue are the main anatomical structures that cause snoring. Many surgical procedures and medical devices have limited their success in improving their conditions. Surgical reduction of the soft palate is often complicated by prolonged recovery and pain due to bacterial contamination of the incision site.

The partial resection devices described herein can reduce mucosal excess (and relaxation) of soft tissues in the mouth and pharynx due to aging, and can be complicated by prolonged recovery and pain due to bacterial contamination of the incision site. Constructed for partial resection of the oropharyngeal mucosa so as not. The reduction in size and relaxation of these structures reduces the vibrations generated by the passage of air. Directional to the anterior and posterior dimensions of the soft palate using a perforated (with a hole for spraying local anesthesia into the partially resected area) oral tooth fixative (fixed to the tooth and covering the posterior aspect of the soft palate) Close the door. A more severe condition, referred to as sleep apnea, has serious health consequences due to hypoxia caused by upper airway obstruction during sleep. Although CPAP has become the standard for sleep apnea treatment, selective partial resection of the tongue base and pharyngeal sidewall can significantly reduce sleep-related upper airway obstruction.

The partial excision device described herein is configured for partial skin culture / expansion, also referred to as "culture spansion". The ability to grow the skin in an organ form would be a great achievement for patients with major skin defects such as burns and trauma, and large congenital skin abnormalities such as Portwine nevus and sea swimsuit nevus. Conventional capabilities, although some reports show that wound healing occurred in organ-type skin culture specimens, have limitations in achieving long survival of excised skin. Improved culture results have been reported to result from better substrates, culture media, and more effective filtration of metabolic by-products. Gene expression proteinology is also promising for growth hormone and wound healing stimulation. However, at present, there are no reports of organ-type growth of the skin.

Partial excision of autologous donor skin for skin grafting, according to embodiments, provides an opportunity for organ-type culture of skin that did not previously exist. Fixing the partially excised skin grafts to the stretchable docking station provided by the embodiments described herein allows the skin plugs to be placed apposition to each other. Induction of primary wound healing can convert partial skin grafts into solid sheets by known or upcoming organ-type culture techniques. In addition, the use of mechanical skin dilation can also significantly increase the surface of organ-type preserved / grown skin. Extracorporeal substrate device repeats include, but are not limited to, expandable docking stations with partially excised skin plugs, and individual substrates that can be controlled to result in gradual and continuous expansion of full-thickness organ-type cultured skin (eg, curvature, Flat, etc.) There is an expander. In addition, the use of organ-type skin dilation results in continuous and synergistic wound healing stimuli for organ-type growth. Progressive and continuous dilation makes the epidermis less likely to detach from the dermis. In addition, organ-type skin dilation helps avoid the surgical risks and pain associated with internal dilation.

The partial excision device described herein enables an organ-type dilation method of the skin. This method comprises the step of autologous partial removal of skin from the patient's donor site. For example, a square skull pet array is used for side-side and tip-tip junction transfer of partially excised skin plugs. This method comprises the step of transferring the partial skin plug to a stretchable docking station, which maintains the directivity of the skin plug and also imparts an apposition. The docked skin plug is trapped on a porous adhesive thin film, which maintains orientation and apposition. The semi-elastic recoil properties of the adhesive thin film result in additional contact and apposition of the skin plug. The method comprises transferring the sticky thin film / partial graft complex to a culture bay containing a medium that retains substrate and viability and promotes organ-type wound healing and growth. After healing of the skin plug margin, place the entire substrate in a culture bath with a mechanically expandable substrate. After this, organ-type expansion is initiated progressively and continuously. The dilated full-thickness skin is autologously transplanted into the patient's site defect.

Organ-type skin dilation can be performed as organ-type dilation for non-partial skin grafts, or more typically any other tissue structure. The use of mechanical stimuli that evoke a wound healing response for organ-type cultures can also be an effective aid.

The embodiments described herein are used and / or used as components in one or more of the devices and methods described in the relevant applications described and referenced herein. To. In addition, the embodiments described herein can be used for devices and methods associated with partial excision of skin and fat.

The embodiment is a novel minimally invasive surgical norm that has broader advantages over conventional plastic surgery procedures. Partial skin resection is applied as a new stand-alone procedure in an anatomical off-limits area for conventional plastic surgery due to the poor trade-off between scar visibility and the amount of improvement obtained by incision. Partial skin resection is also applied as an adjunct to established plastic surgery procedures such as liposuction and is also used to significantly reduce the incision length required for special applications. Shortening the incision has applications in both the aesthetic and reconstructive fields of plastic surgery. The procedure of partial resection and the development of the device are described in detail below, without limitation.

The embodiments described herein are configured to remove multiple small skin sections without scarring, instead of conventional linear skin resection. Removal of multiple small skin sections involves removal of over-relaxed skin without obvious scarring to the eye. As in the examples, FIG. 83 shows a relaxed excess skin removal situation without scarring according to an embodiment. Removal of a plurality of small skin sections also includes skin tightening without scarring, for example, FIG. 84 shows a skin tightening situation without scarring according to an embodiment. Removal of multiple small skin sections further includes partial skin tightening resulting in clinical endpoints resulting in three-dimensional contouring of the skin envelope. FIG. 85 shows a three-dimensional contouring of the skin envelope according to an embodiment.

The clinical efficacy of any surgical procedure requires a complete understanding of the basic processes that lead to a reliable clinical endpoint. For partial skin tightening and contouring, a number of mechanisms of action are described below. The basic mechanism of action recognized is the conversion of two-dimensional partial skin tightening to three-dimensional aesthetic contouring (see, eg, FIG. 3). Contribution to its basic clinical endpoint is a coordinated secondary mechanism of action. The mechanism of action that contributes is described below according to, but not limited to, the ability to achieve clinical endpoints.

The density of partial excision within the outlined partial area is a primary determinant of two-dimensional skin tightening that contributes to three-dimensional contouring. In general, density is, but is not limited to, the percentage of partially excised skin within a partial area. FIG. 86 shows the variable partial resection density within the therapeutic surface area according to the embodiment. The partial excision density (“partial density”) may be variable to provide a more selected skin tightening and contouring as well as a smoother transition into the non-partially excised surface area. can. Thus, for example, the transition into a non-partially excised surface area includes, but is not limited to, partial density reduction.

Another mechanism of action associated with partial skin resection is partial resection of fat. FIG. 87 shows partial fat resection according to an embodiment. Immediately adjacent to the underlying layer of skin is the dermis or subcutaneous fat layer, which has anatomical continuity with the excised skin plug and partially contains a variable amount of fat. Can be excised. A variable amount of partially excised fat, and thus the amount of skin tightening and contouring, is controlled in the embodiment, and this control is one or more of the excision depth and the amount of fat excised at the target site. Is done by controlling. Thus, partial excision density (“partial density”) is a more selected skin tightening and contouring by controlling one or more of the partial density, excision depth, and amount of fat excised. Can be variable to provide a smoother transition into the uncut surface area. Thus, for example, the transition into a non-partially excised surface area includes, but is not limited to, a decrease in a combination of partial density, excision depth, and excised fat mass.

Another modality of partial fat resection is percutaneous vacuum fat resection (PVR) from a direct partial defect in the skin. Numerous clinical uses of partial adipose resection are expected in the embodiments described herein. The most important aesthetic use of partial fat resection is cellulite reduction. The combined continued use of partial skin and lipectomy directly addresses the pathology of this aesthetic malformation. Cutis laxa and protruding encapsulation due to fat that give rise to a visible surface paving stone appearance of skin morphology are eliminated by the coordinated application of this minimally invasive excision capacity, respectively. FIG. 88 shows paving stones on the surface of the skin.

In addition, another versatile application is the ability to alter three-dimensional contour anomalies with a combined continuous approach of partial skin tightening from partial adipose resection and inward contouring. Preoperative topographic contour mapping in a partial area helps to deliver more predictable clinical outcomes. Basically, the topographical mapping of two-dimensional partial skin resection is combined with variable marking for adipose resection. FIG. 89 shows a topographic mapping for a deeper level of partial adipose resection by embodiment. The mapping further includes feathering or transition zones to uncut surface areas where partial density is reduced. Based on the patient's preoperative topographic marking, a variable amount of fat is partially resected to be continuous with the partial skin resection.

Areas to be corrected with convex contours undergo deeper partial adipose resection. Concave (recessed) surface areas to be corrected are corrected using partial skin resection. The unmultiplied result within the mapped partial area is the overall smoothness of the 3D contour, as well as the 2D tightening of the skin.

The use of combined partial resection is best manifested by the reduction in length required for conventional plastic surgery incisions and the elimination of iatrogenic incision skin surplus (“suture end skin deformity (dog ear)”). Standard resection of skin lesions does not result in additional scarring due to an elliptical incision, but there is a significant reduction in the linear dimensions required for closure of the excised lesion (see Figure 94).

Another mechanism of action associated with partial skin resection is the overall size of the outline pattern of the partial resection area. The total amount of partially excised skin depends on the size of the partially excised area. The larger the area, the more skin tightening occurs at a particular density of partial excision. FIG. 90 shows a multi-treatment outline according to an embodiment.

The mechanism of action of the patterned outline includes each particular anatomical selectivity curve patterning for each particular patient. Topographic analysis of digitally acquired images of patients, including rendered (and re-rendered to improved contours) digital wire mesh programs, is a selected anatomical region and patient size and curvilinear outline. Supports formatting. Standard cosmetic plastic surgery cut patterns for specific anatomical areas also aid in the formatting of partial resection patterns. FIG. 91 shows a curvilinear treatment pattern according to an embodiment. FIG. 92 shows a digital image of a patient with a rendered digital wire mesh program, according to an embodiment.

Directional closure of the partial excision area according to the embodiment provides selective skin tightening ability to achieve improved aesthetic contouring. For many applications, the closure is performed at an angle perpendicular to the Langer's line, but can also be done in different directions to achieve maximum aesthetic contours, such as closure based on the remaining skin tension line. FIG. 93 shows the directional closure of the partial excision area according to the embodiment. Directional closure can also follow known vectors used in conventional plastic surgery procedures (eg, the face lift of the face / submandibular component of the face lift is upward (horizontally oriented in the partial area). Corresponds to the closure), and the neck component below the cervical mandibular angle is more inclined posterior (corresponding to the more vertical orientation of the partial area)). Multiple vectors of directional closure can also be used for more complex topographic areas such as the face and neck.

Embodiments include directional partial resection of the skin that enhances the effectiveness of the procedure. This process is performed by pre-stretching the skin at an angle orthogonal to the direction suitable for maximum skin resection. FIG. 94 shows a directional partial resection of the skin according to an embodiment.

Embodiments include aesthetic contouring as a result of mechanical pulling (or vector) resulting from a partial area adjacent to the targeted contour. This effect on partial areas is based on plastic surgery procedures that direct at some distance from the target contour. In addition, it provides variable topographical transition of excision density within the area and along the patterned outline, which provides selective contouring to the unexcised surface area and smoother transition. In addition, variable topographic transitions by sculpt size excision within the patterned outline (and at different sculpt sizes within the array) provide selective two-dimensional skin tightening and three-dimensional contouring. ..

The embodiments described herein evoke a selective wound healing sequence, along with accelerated primary healing during the immediate postoperative period and delayed secondary contraction of the skin during the collagen proliferation phase. The promotion of accurate junctions at the skin margin is unique to multiple (partial) resections of small segments of the skin, i.e., the skin margin is more closed than the larger linear resection common to standard plastic surgery incisions. Align more closely to the front. Subsequent wound contraction is also unique to the partial resection area, and the elongation of the partial resection pattern results in a directional wound healing response along the longitudinal dimension of the partial resection pattern.

Clinical methods of partial skin resection include directional closure methods. Based on the anatomical plane area, the directional closure of the cut skin defect within the partial excision area is by following the Langer line, the remaining skin line, and / or the direction to achieve the maximum aesthetic contouring. obtain. The direction in which closure is most easily achieved can also use the most effective vector of directional closure as a guide. For many applications, the Langer line is used as a guide for maximum aesthetic tightening. Following Dr. Langer's original work, the partial excision defect extends the direction of Langer's line. Directional closure is performed at an angle orthogonal to the Langer's line in the anatomical region where the skin margins of each partial resection defect are closest.

In a continuous partial procedure adjacent to or continuously deployed in a plastic surgery incision, the greatest ability gained by the embodiments described herein is the ability to shorten the incision. The need to cut skin cancer in an elliptical shape is reduced both in this technique scope and incision length. Therefore, the need to cut a lateral extent in cancer resection is avoided by partial resection in its colateral aspect. FIG. 95 shows a situation in which the incision is shortened in a continuous partial treatment according to an embodiment.

The result without multiplication is a significant reduction in scar length due to excision, as when the partial area under the embodiment heals without visible scarring. Another use within this category is shortening in conventional plastic surgical incisions used in breast reduction, mastopexy and abdominal wall plasty. The lateral extent of these incisions can be shortened without creating a "sutured end skin deformity (dog ear)" skin surplus, which would otherwise result in an incision of the same length. FIG. 96 is an exemplary illustration of “suture end skin deformity” skin surplus in breast reduction and abdominal plasty. For example, an incision area beyond the lower fold of the breast for breast reduction or beyond the iliac crest for abdominal plasty is no longer needed. Postoperative "sutured end skin deformity" partial correction of skin surplus can also be performed without pre-existing incision coverage expansion.

Embodiments include a combination procedure that results in aesthetic enhancement at both the site of partial resection and the site of implantation. The most obvious use of this method is to use partial removal of the beard for hair transplantation on the scalp of the frontal region and the crown. The double benefit arises from the procedure in which aesthetic contouring is produced along the anterior cervical region and in the restoration of the hairy scalp.

Embodiments are individual partial procedures in the anatomical plane that are not currently addressed by plastic surgery due to the poor trade-off between visible surgical incisions and aesthetic enhancements. including. There are several examples in this partial treatment category, such as the knee above the patella, the upper arm, the elbow, the skin of the brassiere wearing area, the excess part of the back, the medial and lateral surfaces of the thigh, and the lower buttock fold.

Embodiments include ancillary partial procedures that are discontinuously deployed in a conventional plastic surgical incision. This category includes suction-assisted adipose tissue resection, which removes subcutaneous fat by suction in areas of lipodystrophy, such as the lateral surface of the buttocks and thighs. However, many patients have pre-existing cutis laxa exacerbated by aspirated adipose tissue resection. Tightening of the skin envelope by partial resection over these areas brings several benefits to these patients. Many patients with skin relaxation and lipodystrophy were considered unfit for liposuction procedures Many patients with skin relaxation and lipodystrophy are candidates for liposuction. For patients with no existing cutis laxa but with more severe lipodystrophy, greater contour reduction can be performed without iatrogenic cutis laxa. This procedure can be developed as a combinational procedure for smaller partial resections or as a stepwise procedure.

Directional closure of the subregion is performed without suturing and is achieved by abutment of the adhesive stent thin film as detailed herein. The partial area is closed with an adhesive thin film using many methods. The exemplary method comprises the step of anchoring the thin film on the outer periphery of the subregion. At this time, tension is applied to the opposite end of the adhesive thin film. At this time, the main body of the adhesive thin film is brought into contact with the partial area line by line with respect to the remaining skin in the area. The application direction follows the selected vector of directional closure. The occasional application direction is, but is not limited to, an angle orthogonal to the Langer's line, and any application direction can be selected to obtain the maximum aesthetic contouring.

Another method uses the elastic properties of the adhesive stent encapsulant to selectively confine the partial area. In this way, the ends of the adhesive stent encapsulant are stretched or preloaded and the stent encapsulant is abutted into this posterior segment. Upon release of the thin film end, the elastic recoil of the stent encapsulant closes the partial defect in the direction orthogonal to the elastic recoil.

The embodiments detailed herein include a skin Pixel Array Dermatome, also referred to herein as "sPAD". This sPAD is an interlocking multiple scalpel array with a plurality of individual circular scalpels. The circular form can apply rotational torque to the skin to facilitate the incision. The coupling or linking mechanism of the scalpet to the electromechanical power source is carried out by a series of gears between each scalpet and the drive shaft, as described herein. In addition, a vacuum is created in the housing to retain stability during the incision. This same vacuum capacity can also be applied as pneumatic support to apply additional axial (Z-axis) directional forces during the duty cycle of the incision. Another vacuum application is the extraction of an incised skin plug in a partial area.

The sPAD comes in many forms as detailed herein. FIG. 97 is an sPAD comprising a stripped single skull pet with depth control, according to an embodiment. FIG. 98 is an sPAD comprising a standard single skull pet according to an embodiment. FIG. 99 is an sPAD including a pencil-type gear deceleration handpiece according to an embodiment. FIG. 100 is an sPAD comprising a 3x3 coreless array according to an embodiment.

An instrument with a surgical drill is provided for use in sPAD. FIG. 101 is an sPAD comprising a cordless surgical drill for a large array, according to an embodiment. FIG. 102 is an sPAD with a drill equipped with a 5x5 coreless array according to an embodiment.

Embodiments include a vacuum assisted pneumatic avalanche (VAPR) array sPAD, also referred to herein as "VAPR sPAD". FIG. 103 is an sPAD comprising a vacuum assisted pneumatic excision sPAD according to an embodiment. The VAPR sPAD uses a vacuum pressure configured to drive the skull pet from the sPAD into the treatment area. The VAPR sPAD is coupled or coupled to the drill via a drill array coupling (DAC). FIG. 104 is a VAPR sPAD coupled to a drill via a DAC, according to an embodiment. The DAC secures the housing of the VAPR sPAD to the drill and the hexagonal tube material allows the drive shaft of the VAPR sPAD to slide up and down during treatment. An externally supplied vacuum (not shown) is coupled or connected to the VAPR sPAD via a vacuum port.

FIG. 105 shows the VAPR sPAD in the preparatory state (left side) and the extension treatment state (right side) according to the embodiment. By vacuum and drill operation, a single treatment cycle comprises placing a VAPR sPAD relative to the treatment site and creating a seal between the housing and the treatment site. After this seal is established, the vacuum, along with the rotating gear, pulls the piston into the treatment area. After reaching the desired cutting depth, the sPAD is pulled away from the treatment site. This breaks the seal and forces the spring in the sPAD to return to the ready state.

Embodiments include a spring-assisted vacuum ablation (SAVR) sPAD that behaves similarly to a VAPR sPAD. FIG. 106 shows the SAVR sPAD in the ready state (left side) and the retracted state (right side) according to the embodiment. The SAVR sPAD is coupled or connected to the drill via the DAC. Vacuum ports are attached to separate vacuum sources. The drive shaft slides back and forth in a tube attached to the drill.

In SAVR sPAD, the positioning of springs and vacuum is totally reversed from VAPR sPAD. Both the spring and the vacuum port are located on the base end side of the piston, but are not limited to this. The vacuum assists in extracting the skin pixels from the skull pet and also pulling them away from the treatment area. The spring drives the rotating skull pet into the treatment area and also applies an axial force to make an incision in the skin. The skull pet is extended from the housing ready for the array.

The treatment cycle begins with placing the skull pet on the desired treatment site. A vacuum is applied, a drill is applied downwards, and the piston and sculpt are forcibly pulled up into the housing (retracted state). Activate the drill and rotate the skull pet. The spring force combined with the rotation of the scalpet results in excision. The vacuum pulls the pixels produced by excision into the housing and subsequently withdraws from the housing. After the desired cutting depth is achieved, the SAVR sPAD can be lifted from the treatment site and the cycle repeated.

Embodiments include instruments and procedures for aesthetic surgery skin tightening, such as, but not limited to, devices or devices and procedures capable of repeatedly removing skin grafts from the same donor site and eliminating donor site malformations. Describe as having. The embodiments described herein include a device configured for partial excision and a corresponding method or procedure, comprising a platform for a single sculpt and a multi-sculpet array using a vacuum manifold. Other disclosures relating to the corresponding devices configured for partial excision and the corresponding methods or procedures are found in the relevant applications, each of which is incorporated herein by reference in its entirety. In connection with the use of vacuum in the partial excision area, the vacuum manifold is configured to apply vacuum into the scalpet (or in the multiple scalpet array) via the lumen. Alternatively, the vacuum manifold is configured to apply vacuum via the outside of the lumen, such as either a component of a sculpt assembly or an individual manifold device that applies directly to the skin of a subregion.

Applications of the vacuum capacity of the scalpet assembly include suction removal of partially incised skin plugs (see, eg, FIGS. 108, 112, and 113). In addition, an application of the vacuum capacity of the scullpet assembly is vacuum stabilization of the skin surface during partial excision (see, eg, FIGS. 109 and 114). Another use of the vacuum capacity of the Skullpet assembly is partial vacuum assisted adipose tissue resection of the subcutaneous or subdermal fat layer (see, eg, FIG. 114).

FIG. 107A is a side view showing a partial cross section of the carrier 1071 having the vacuum manifold 1072 according to the embodiment. FIG. 107B is an equiangular perspective view showing a partial cross section of the carrier 1071 having the vacuum manifold 1072 according to the embodiment. FIG. 107C is a side view showing a partial cross section of the carrier 1071 having the vacuum manifold 1072 according to the embodiment. The vacuum manifold 1072 is configured to be coupled or attached to the terminal region of the carrier 1071 and the scalpet assembly / scalpet array 1073. The vacuum manifold 1072 of the embodiment has a "slip-on" or overlay encasement configured to be detachably coupled to the end of the carrier 1071. This embodiment has, but is not limited to, a skull pet array 1073 with a single skull pet.

The vacuum manifold 1072 has a vacuum port 1074 configured to connect to a vacuum source (not shown). The vacuum manifold 1072 of the embodiment further includes, but is not limited to, a suction device (not shown). The vacuum manifold 1072 is configured to connect to, for example, a perforation (eg, end side, proximal side, side surface, etc.) and / or the lumen of the scalpet 1073 and direct a vacuum force directly to the target site via the lumen. do. Alternatively, the vacuum manifold 1072 is configured to direct a vacuum force directly to the target site via the outside of the lumen (not shown).

The vacuum feeding of the device of the embodiment is controlled by a perforation component configured to be handled and operated by the device operator. FIG. 108 is a three-dimensional side view of a carrier 1071 having a vacuum manifold 1072 configured to be manually controlled via an opening 1075, according to an embodiment. Alternatively, the vacuum component is electronically controlled. For example, the on / off of the cycle operation of the vacuum source is at least partially computer controlled (eg, computer controlled duty cycle, etc.). An electronic controller is used to cycle through changes to the rotation (RPM) component of the sculpt assembly. The length of the sculpt can also be one or more of manual or computer control.

The vacuum manifold 1072 of the embodiment extends end-to-end on the skull pet to act as a depth guide 1076, and the end of the vacuum manifold 1072 is configured to control the penetration depth of the skull pet array 1073 into the tissue. do. Various depth guide-dependent vacuum manifolds address variable skin depth in different clinical applications and different anatomical sites. In embodiments, the plastic manifold is formed as a one-time-use disposable with a separate vacuum port incorporated into the manifold, but is not limited thereto.

In other embodiments, the vacuum capacity is in the form of an "in-line" or "in-series" form in the carrier or handpiece where the vacuum is supplied internally, as well as the length of the lumen and scalpet. It can be fed down or to a separate side opening of the skull pet. FIG. 109A is an equiangular perspective view of a handpiece configured to include or incorporate a vacuum, according to an embodiment. FIG. 109B is a partially cutaway equiangular perspective view of a handpiece configured to contain or incorporate a vacuum, according to an embodiment.

FIG. 110A is a side view showing a partial cross section of the vacuum manifold 1101 configured to be coupled or connected to the inline vacuum component 1102 according to the embodiment. FIG. 110B is an equiangular perspective view of a partial cross section of the vacuum manifold 1101 configured to be coupled or connected to the inline vacuum component 1102 according to the embodiment. FIG. 110C is a three-dimensional side view of the vacuum manifold 1101 configured to be coupled or connected to the inline vacuum component 1102 according to the embodiment.

FIG. 111A is a side view showing a partial cross section of the sculpt array used in the vacuum suction device according to the embodiment. The device of this embodiment has a skull pet assembly 111 including a skull pet array 112 with multiple skull pets. FIG. 111B is an equiangular perspective view showing a partial cross section of the sculpt array used in the vacuum suction device according to the embodiment. FIG. 111C is a side view showing a partial cross section of the sculpt array used in the vacuum suction device according to the embodiment. The vacuum suction device is coupled or connected to the scullpet assembly and is specifically adapted for partial resection, as well as conventional surgical suction devices or suction assisted adipose tissue resection (SAL). Configure as one or more of the devices. In embodiments, the intraluminal vacuum scullpet or scullpet array has, but is not limited to, a rotating component that enhances both skin incision and liposuction curettage capabilities.

FIG. 112 is a side view showing a partial cross section of a single sculpt device in contact with a target site according to an embodiment. This exemplary motion embodiment shows tissue extracted by vacuum force from a partial excision site through a lumen and lateral perforation of a skull pet. FIG. 113 is an equiangular perspective view showing a partial cross section of a single sculpt device in contact with a target site according to an embodiment.

FIG. 114A is a side view showing a partial cross section of the multiple sculpt device in contact with the target site according to the embodiment. FIG. 114B is an equiangular perspective view showing a partial cross section of the multiple sculpt device in contact with the target site according to the embodiment. This exemplary embodiment illustrates a situation in which partially excised tissue is removed from a target site using vacuum suction.

The skull pet devices of various embodiments have one or more skull pets. The skull pet type of the embodiment includes one or more of a grooved skull pet and a grooved blunt head microchip cannula. The skull pet or skull pet device of the embodiment has one or more openings or orifices located axially in the skull pet adjacent to the lumen inside the skull pet, but is limited thereto. It's not a thing. FIG. 115 is an exemplary skull pet 1150 with perforations or groove holes 1151 according to an embodiment. FIG. 116 is an exemplary blunt-headed microchip scullpet 1160 with perforations or groove holes 1161 according to an embodiment.

The ability to partially aspirate subdermal / subcutaneous fat according to the embodiments described herein has several uses based on the targeted anatomical region. These uses include, but are not limited to, flattening of convex three-dimensional contours and inward contouring of anatomical areas that restore aesthetic features such as submandibular and cervical-mandibular horns. For these uses, side grooved perforated skull pets and blunt tip side grooved perforated partial cannulas are described below. The blunt tip cannula is configured for use in the anatomical region where the major vessel or neural structure is just below the partial adipose tissue resection area. Regardless of the type of skull pet / cannula, the combination of rotational function and vacuum capacity of the system provides a more effective means of suction curettage of the subdermal / subcutaneous fat layer.

Embodiments include, but are not limited to, a partial marking system configured as a guide to ensure an appropriate partial excision density. The guides include, for example, a template (stencil) configured for use as a guide for partial excision and / or an adhesive translucent perforated plastic thin film guide (ASPMPP). The template marking system comprises a template (eg, for ink, etc.) having a grid pattern of circles or dots that is temporarily abutted at the target site prior to surgery. The circles or dots are at least one of a grid pattern stencil and a template, and the ink material is configured to be biocompatible and free of stains or deterioration during patient preparation or treatment. FIG. 117 is an example of a stencil marking system according to an embodiment. FIG. 118 is an example of a positive plate marking system according to an embodiment.

The ASPMPM marking system includes an adhesive translucent perforated plastic thin film. FIG. 119A is a side perspective view of the ASPMPP used as a depth guide with a single skull pet device according to an embodiment. FIG. 119B is an equiangular perspective view from the top surface of ASPMPP used as a depth guide with a single skull pet device according to an embodiment. The perforated plastic thin film is further configured to act as a depth guide to ensure that the specified depth of partial excision is not exceeded.

Clinical applications for single and multiple skull pet array platforms include, but are not limited to, the most effective aesthetic contouring produced by the combination of skin tightening and inward contouring according to embodiments. .. The ability to partially remove skin and fat during the procedure provides greater ability than conventional electromagnetic devices and cosmetic plastic surgery procedures, which means that partial excision does not result in visible scarring of the skin (cutis laxa surface). This is because it involves directly removing (in the region). The enhanced ability of the embodiment to partially excise the skin is combined with subepithelial / subcutaneous partial adipose tissue excision to regain a more youthful aesthetic contour.

FIG. 120 shows partial skin resection and subdermal / partial adipose tissue resection according to embodiments. Examples of partial skin resection and subdermal / partial adipose tissue resection include, but are not limited to, submandibular (under the chin) treatment. FIG. 121 shows a side view of the lower jaw as a target surface area for partial skin resection and subdermal / partial adipose tissue resection according to an embodiment. FIG. 122 shows a view of the submandibular interior (looking up) of a partial resection area as a target surface area for partial skin resection and subdermal / subcutaneous partial adipose tissue resection according to an embodiment. The presence of cutis laxa and the bulge of the submandibular fat pad are the main components of aesthetic malformations. Each patient has a variable amount of each soft tissue element that requires selective modification tailored or configured for each particular patient. More specifically, the submandibular convex contour is mainly caused by lipodystrophy of the submandibular fat pad, and the loss of the cervical-mandibular horn is mainly due to skin relaxation.

Patients generally exhibit variable amounts of submandibular cutis laxa and lipodystrophy, so embodiments use patient planning and marking for specific treatments. The combined ability of the assembly of the embodiment strongly correlates with the need to modify the particular soft tissue element of the aesthetic malformation. For patients with more severe cutis laxa, a wider horizontally aligned therapeutic surface area in the submandibular and lateral necks is marked for partial skin resection. FIG. 123 shows a horizontally aligned therapeutic surface area in the lower jaw and lateral neck for severe cutis laxa, according to embodiments.

For patients with more severe lipodystrophy, wider partial adipose tissue resection is marked within the therapeutic area. The depth of partial adipose tissue resection can also be selectively altered to address the topographical features of this convex contour malformation. FIG. 124 shows a wider area of partial subcutaneous adipose tissue resection in the lower jaw for severe lipodystrophy according to an embodiment.

Clinical applications for single and multiple skull pet array platforms include directional closed specifications. Accurate closure of the incision is the basic principle adopted in plastic surgery to promote early healing (primary healing), which reduces scarring. However, the direction of closure is also important for aesthetic contouring. Appropriate vectors of skin tightening consider anatomical structures that should be aesthetically enhanced. For more complex aesthetic contours such as the face and neck, multiple vectors of skin tightening are employed during the procedure.

FIG. 125 shows the face vector and neck vector directional closure according to the embodiment. In addition to the skin tightening vector, various closure lines also limit tension during closure. The closing line has been described by Karl Langer, and FIG. 126 shows the closing Langer line. Closure of the skin incision, indicated by the Langer line, reduces the tension of the closure and thus promotes primary healing. When there is a match between the skin tightening vector and the Langer line, the resulting aesthetic contouring and primary healing work in concert with each other to provide optimal clinical outcomes.

An embodiment described herein includes a stepwise procedural algorithm configured to more uniformly mitigate practices that produce predictable clinical outcomes. Many of the procedural steps (and step sequences) described herein are unique advances in partial resection procedures. A procedural algorithm, but not limited to, is included for submandibular resection.

According to the treatment procedure of the embodiment, the patient is marked in a sitting position preoperatively. For patients with a relatively large amount of cutis laxa, the area outlined for partial resection is wider and extends to the lateral neck. For patients with relatively little or no cutis laxa, the outlined partial excision surface area is restricted to the area where lipodystrophy of the submandibular fat pad is producing convex contour malformations. For patients with both cutis laxa and lipodystrophy, both areas are individually outlined as components of a single complex therapeutic outline. FIG. 127 shows the marked target surface areas for partial neck resection and submandibular adipose tissue resection according to embodiments.

Peripheral infiltration local anesthesia is applied to the submandibular / cervical demarcation plane area to avoid a decrease in partial area density. The dots / stencil are then abutted to ensure the appropriateness of the partial cut density as detailed herein. FIG. 128 shows an exemplary marking template according to an embodiment. These procedure steps can also be reversed, in which case stencil printing is performed prior to local anesthesia infusion. Stenciled skin dilation can be compensated for in a larger outlined therapeutic area. After this, a partial skin resection is performed within the entire demarcated surface area.

Partial adipose tissue resection is limited to the topographically outlined area of lipodystrophy (see, eg, FIG. 127) and is performed during or as a treatment step during or after partial skin resection. Transitional or freehand feathering across the demarcated outline is performed to delineate the partial excision boundary. Directional closure of partial defect separation is performed by an absorbent adhesive elastic bandage stretched (preloaded) in the preferred vector direction of closure / skin tightening.

Bandages (eg, Flexzan, etc.) can be preloaded by first attaching one end of the bandage to a lateral fixation point that crosses a subregion. After fixing, this load is applied to the opposite end of the bandage. This load is maintained during adhesion. An alternative loading technique applies loads facing each other to each lateral range of the elastic bandage, i.e., the bandage is first stretched along the longitudinal axis of the material prior to attachment. With the load maintained, the elastic bandage is then fully adhered to the partial area. When the load is released, elastic recoil occurs and closes the defect in the sub-area along the designated vector. Under the jaw where cutis laxa of the anterior neck is present, bidirectional closure by the two vectors continues, but the embodiments are not limited to this.

FIG. 129 shows exemplary directional closure vectors for the submandibular and anterior cervical regions according to embodiments. The anterior cervical (lower submandibular) vector is more lateral and is used to emphasize the cervical-mandibular angle. With respect to the submandibular gland, the closure vector (as indicated by the Langer line) is vertical. After this, a sterile bandage is worn to complete this procedure. In addition, compression garments are also worn to provide compression and vectorized support during the postoperative phase.

An embodiment is partial scar repair. The reduction of the visible impact of existing scar malformations has been a major focus in plastic surgery from the beginning of this surgical discipline. Different surgical techniques have been adopted based on the type of scar malformation. A commonly adopted technique is oval cutting with layered closure. Other techniques such as Z-plasty and W-plasty were tried to reduce scar linearity. FIG. 130 shows scar repair by Z-plasty and W-plasty. However, these conventional techniques prolong scar malformations. Partial scar repair is configured to reduce the visible impact of scars without lengthening the scars.

For linear scar malformations, embodiments include partial depiction removal techniques that perform partial excision that alternates along each periphery of the scar. To maximize depiction removal, directional closure of the subregion is performed at an angle orthogonal to the linear scar. FIG. 131 shows an example of a partial depiction removal technique in scar resection according to an embodiment.

Additional depiction removal is performed under embodiments by freehand partial excision across the periphery of the scar. Embodiments include partial techniques for a wide range of dysgenetic scars resulting from biopsy excision by scraping off skin lesions. Partial scar excision is performed within the periphery of the scar to reduce the width of the scar malformation. Directional closure is performed as described in detail below. FIG. 132 shows an example of partial scar resection in a wide range of dysgenetic scars according to an embodiment. Another alternative embodiment is a combination of both partial scar repair techniques, in which the combination modification is performed as a single procedure or as a planned sequence of procedures, but is not limited to this. do not have.

Another embodiment has the use of partial resection to shorten the incision required for lesion excision. This new capability can also be applied to shorten long plastic surgery incisions used for surplus skin resection. If the lateral aspect of each incision is partially resected using the devices and methods described herein, the oval area of the incision (to avoid "suture end skin deformity (dog ear)" skin surplus) , No longer needed.

The partial procedure can be performed at the same time as the primary excision procedure or as a planned subsequent resection. The partial excision of the embodiment can also be used for the existing sutured end skin deformity surplus after excision. An example is shortening by a lower breast incision required for breast reduction and / or breast repositioning. FIG. 133 shows an example comprising a shortening step with a lower breast incision, as applied to breast reduction and / or breast repositioning, according to embodiments. The incision does not extend beyond the lower fold of the breast, making the incision less visible.

An embodiment described herein is a partial skin graft. This includes closure in full-thickness skin defects, which was also the primary eye of plastic surgeons. Large defects that cannot be closed by direct closure require a more complex approach. Two conventional approaches developed by plastic surgery are flap closure and skin grafting. FIG. 134 shows exemplary flap closure. Closure with a near or distant flap requires a blood source of an endogenous or pedunculated flap removed with the flap at the donor site. Flip closure at the skin defect is also complicated by the formation of additional scarring at the donor site.

Skin grafting (either split-thickness or full-thickness) is another approach used to close large full-thickness skin defects. When using a skin graft approach, a skin graft donor site is required, which is associated with large scarring and morbidity.

Decades after adopting these two plastic surgery approaches, a novel third approach is now described in embodiments herein. Partial skin grafts can avoid the side effects inherent in sheet skin grafts, because partial skin grafts have the unique ability to avoid donor site malformations inherent in sheet skin grafts. Partial skin grafts also provide the additional ability to subsequently harvest skin grafts from the same donor site. FIG. 135 shows an example of an embodiment comprising a graft partial removal step to be applied to the donor site.

Partial skin grafts are of particular importance to patients with burns over large surface areas where availability of donor sites is extremely limited. Sequential removal at the same donor site is also important for patients with skin defects in the lower extremities caused by diminished circulatory function. Patients with venous stasis, ischemic and diabetic ulcers are at particular risk of loss of limbs if skin coverage in ulcers due to vascular injury is not immediately available. Many of these patients must undergo a series of skin grafts after the skin graft is obtained. The prevalence associated with long-term skin grafting processes involving multiple donor sites can be particularly annoying in patients who also have other severe systemic symptoms. Partial skin grafts described herein allow for these patients specifically the absence of a single visible donor site malformation associated with the ability to continuously remove skin grafts from the same donor site. Provide treatment options. Compared to segmented skin graft donor sites, directional closure of partial donor sites results in faster healing and dramatically reduces donor site morbidity and scarring.

When the partial skin graft of the embodiment is full layer, the durability of the skin graft is also improved over the partial skin graft. For wound healing at the wounded site, abutting of the partial skin graft can be performed without forming partial skin segments (pixels) on a more uniform sheet. In this clinical setting, "lateral neovascularization" occurs between the individual partial skin segments and the bed to be transplanted. FIG. 136 shows an embodiment comprising a partial graft neovascularization step at the site to be transplanted, according to an embodiment. The site to be transplanted serves as a biological docking station that organizes the partial skin segment into a lateral orientation with respect to the bed to be transplanted.

For other unwounded and more visible skin imperfections, an embodiment has the option of first forming a partially excised skin segment as a more uniform implant at a mechanical docking station. FIG. 137 shows an exemplary docking station with a docking tray and adjustable slides, according to embodiments. In this clinical setting, "bottom-up neoangiogenesis" occurs from the transplanted bed within the deep aspect of the dermis (see, eg, FIG. 136). In each clinical setting, compression stent bandages provide additional support and immobilization that promotes neovascularization or "rooting" of skin grafts.

In an embodiment, there is a system including a carrier. The system is configured to bind to a carrier and comprises a skull pet assembly with a skull pet array. The scalpet array has at least one scalpet configured for at least one of partial or partial adipose tissue resection at the subject's target site. The carrier is configured to control the application of rotational force to at least one sculpt during partial and partial adipose tissue resection. The system comprises a vacuum component that connects to a sculpt assembly and is configured to use vacuum force to pull tissue out of the target site.

An embodiment is a scalpet assembly configured to bind to the carrier and having a scalpet array, wherein the scalpet array is a partial excision of tissue at a subject's target site, partial adipose tissue. It has at least one skull pet configured for at least one of the excisions, said carrier is configured to control the application of rotational force to the at least one skull pet during partial excision and partial adipose tissue excision. , A system comprising the skull pet assembly and a vacuum component connected to the skull pet assembly and configured to pull tissue out of a target site using vacuum force.

The tissue includes a skin plug that is incised to form a partial area during the partial resection and fat that is removed from the partial area during partial adipose tissue resection.

The at least one skull pet has a lumen that at least partially extends from the end to the proximal end of the at least one skull pet.

The vacuum component has a vacuum manifold configured to connect to the end of the carrier, and the vacuum manifold has a vacuum port configured to connect to a vacuum source.

The vacuum manifold is configured to connect to the lumen and to direct the vacuum force through the lumen to the target site via the lumen.

The vacuum manifold is configured to direct the vacuum force to the target site via the outside of the lumen.

The end of the vacuum manifold is configured as a depth guide that controls the penetration depth of the sculpt array into the tissue.
The end of the vacuum manifold is configured to be used with a depth guide.
The vacuum manifold has an overlay engagement.
The vacuum manifold is detachably connected to the end of the carrier.
The vacuum manifold is configured to manually deliver the vacuum force to the target site.

The system comprises a controller configured to automatically control at least one of the rotational forces to the at least one sculpt and the vacuum forces to the target site.

The vacuum component has a vacuum suction device.
The vacuum force is configured to stabilize the target site in vacuum during the partial excision.
The vacuum component is configured to be placed in series with the carrier and the scalpet assembly.

The vacuum component has a carrier lumen within the internal region of the carrier, the carrier lumen is connected to the lumen of the at least one skull pet, and the carrier lumen is the at least one skull. It is configured to direct a vacuum force to the target site through the lumen of the pet.

The at least one skull pet has a cylindrical skull pet, and the terminal region close to the terminal portion is configured to excise and receive tissue.
The terminal region has a cut surface.

The cut surface has at least one sharp edge, at least one tip, and at least one serrated edge.
The cut surface has a blunt edge.
The lumen and the proximal end are configured to allow tissue from the target site to pass through.

The at least one skull pet has at least one opening adjacent to the lumen and positioned axially with the skull pet.
The at least one skull pet has a plurality of openings adjacent to the lumen and positioned axially with the skull pet.
The at least one opening is configured to allow tissue from the target site to pass through.
The at least one perforation has at least one cut surface.
The at least one opening is configured to divert the received tissue in at least one of the radial outwards from the lumen and the radial inward towards the lumen.

The system comprises a partial marking system configured to display the partial excision density of a partial area.

The partial marking system has a template containing a grid pattern of markers.
The template has an ink template.
The template includes at least one of a positive template and a negative template.
The marker comprises at least one of a circular marker and a dot marker configured to mark the target site.

The marker has at least one notch marking at least one corner of the subarea.
The partial marking system has a thin film with holes.
The thin film is configured as a depth guide that controls the penetration depth of the sculpt array into the tissue.

The thin film is composed of a material containing at least one of a plastic, a polymer, and a composite material, and the thin film is translucent.
The thin film is configured to adhere to the target site.
The lumen of the skull pet connects to a reservoir configured to hold the received tissue.
The reservoir has a canister.
The carrier is configured to be handheld.

The system comprises a motor that is coupled to the skull pet assembly and configured to drive the at least one skull pet.
The skull pet array has a plurality of skull pets.
Each skull pet is configured to rotate about the central axis of the skull pet.

The scalpet assembly has a drive assembly connected to each scalpet, the drive assembly is configured to apply a rotational force to a proximal region of each scalpet, and the rotational force applies each scalpet. Rotate around the central axis.

The drive assembly has at least one of a gear drive system and a friction drive system.
The system includes a depth guide that controls the penetration depth of the sculpt array into the tissue.
The system has a terminal region connected to a vacuum component and comprises a housing configured to form a vacuum seal when contacting adjacent tissue adjacent to the target site.

The sculpt assembly has a spring device configured to control the position of the scullpet array with respect to the target site.
The vacuum force is configured to control the position of the sculpt array with respect to the target site.
The scalpet assembly has a spring device configured to control the position of the scalpet array with respect to the target site in coordination with the vacuum force.

In an embodiment, there is a device comprising a scullpet assembly configured to be coupled to a carrier. The scalpet assembly has a scalpet array configured for at least one of partial or partial adipose tissue resection at the subject's target site. The carrier is configured to control the rotational force application of the scalpet array to the scalpet during partial resection and partial adipose tissue resection. The device comprises a manifold configured to be detachably coupled to the scullpet assembly. The manifold has a depth control device configured to control the penetration depth of the skull pet into the tissue in the skull pet array. The manifold is configured to control the vacuum force applied to pull tissue out of the target site. The tissue includes a skin plug that is incised to form a partial area during the partial resection and fat that is removed from the partial area during partial adipose tissue resection.

An embodiment is a scalpet assembly configured to bind to a carrier and having a scalpet array, wherein the scalpet is at least one of partial or partial adipose tissue resection at the subject's target site. The scalpet assembly is configured to control the application of rotational force to the scalpet in the scalpet array during partial excision and partial adipose tissue excision. , And a manifold configured to be detachably coupled to the skull pet assembly, wherein the manifold is configured to control the penetration depth of the skull pet into the tissue in the skull pet array. Having a device, the manifold is also configured to control the vacuum force applied to pull tissue from the target site, where the tissue is a skin plug that is incised to form a partial area during the partial excision. And, there is a device comprising the manifold, which assumes that there is fat removed from the partial area during partial adipose tissue excision.

In an embodiment, there is a device including a carrier having a proximal region and a distal region. The proximal region is configured as a handheld type. The device comprises a sculpt assembly configured to connect to the terminal region. The scalpet assembly has at least one scalpet array configured for at least one of partial or partial adipose tissue resection at the target site of an elephant. The skull pet array comprises a skull pet, each skull pet consisting of a tube having a hollow region and a sharp end configured to penetrate tissue at the subject's target site. The device comprises a manifold configured to connect to the terminal region. The manifold is configured to control the vacuum force applied to pull tissue out of the target site. The tissue shall include a skin plug that is incised to form a partial area during the partial resection and fat that is removed from the partial area during partial adipose tissue resection.

In an embodiment, a carrier having a proximal region and a distal region, wherein the proximal region is configured as a handheld type, the carrier and a scullpet configured to be connected to the distal region. The scalpet assembly comprises at least one scalpet array configured for at least one of partial or partial adipose tissue resection at the target site of the elephant. The array has skull pets, each of which consists of a tube having a hollow region and a sharp end configured to penetrate tissue at the subject's target site, said sculpt assembly and said end. A manifold configured to connect to a lateral region, said manifold being configured to control the vacuum force applied to pull tissue from the target site, the tissue being a partial area during the partial excision. There is a device comprising a skin plug that is incised to form a, and a manifold, wherein there is fat removed from the partial area during partial adipose tissue excision.

In an embodiment, it is a step of constructing a carrier, and the carrier is connected to a scalpet assembly having a scalpet array so that at least one of partial excision of tissue and partial adipose tissue excision at a target site of a subject is performed. There is a method of providing a step of constructing a carrier to do so. The method comprises steps constituting the carrier to control rotational force application to the sculpt array and to control vacuum force application by a vacuum component connected to the sculpt assembly. The rotational force is configured to incise the tissue at the target site. The vacuum force is configured to pull the tissue out of the target site. The tissue comprises a skin plug that is incised to form a partial area during the partial resection and at least one of the fats removed from the partial area during partial adipose tissue resection.

In an embodiment, the carrier is linked to a scalpet assembly having a scalpet array so as to perform at least one of partial excision and partial adipose tissue excision at the target site of the subject, which is a step of constructing the carrier. By doing so, in the step of forming the carrier and in the step of forming the carrier so as to control the application of rotational force to the scalpet array and to control the application of vacuum force by the vacuum component connected to the scalpet assembly. The rotational force is configured to incise the tissue at the target site, the vacuum force is configured to pull the tissue out of the target site, and the tissue forms a partial area during the partial excision. There is a method comprising a skin plug that is incised to do so, and a step that constitutes the carrier, comprising at least one of the fats that are removed from the partial area during partial adipose tissue resection.

The method comprises marking the target site of the subject.
The marking has a marking step on the periphery of the target site of the subject.
The marking uses a template containing a grid pattern of markers.
The marker comprises at least one of a circular marker and a dot marker configured to mark the target site.

The template has at least one notch for marking at least one corner of the partial area.
The marking includes marking at least one of a first region and a second region at the target site.
The first region exhibits cutis laxa.
The second region exhibits lipodystrophy.
The second region exhibits the lipodystrophy of the submandibular fat pad.

The method comprises marking a plurality of partial excision sites within at least one of the first and second regions.
The marking step of the plurality of partial excision sites includes a step of contacting the partial marking system with at least one of the first region and the second region.

The method comprises performing a partial excision in at least one of the first and second regions.
The method comprises performing a partial adipose tissue resection in the second region.
The method comprises performing the partial adipose tissue resection in the second region following the partial resection.
The method comprises performing the partial resection in the second region following the partial adipose tissue resection.
The method comprises performing the partial adipose tissue resection during the partial resection.
The method comprises the step of removing the depiction of the boundary of the first region by feathering across the boundary.
The method comprises a closure step of closing a partial area of the partial excision, wherein the closure comprises a directional closure.

The directional closure includes at least one of closure in a substantially first direction, closure in multiple directions, closure in a nearly horizontal direction, and closure in a nearly vertical direction.
The directional closure uses the Langer line.
The directional closure uses the remaining skin tension lines.
The directional closure uses the closure vector of the surgical skin resection procedure.
The directional closure has at least one of a bandage and an adhesive thin film instead of a suture.
The method comprises the step of wearing a bandage on the target site.

The vacuum component has a vacuum manifold configured to connect to the end of the carrier.
The vacuum manifold has a vacuum port configured to connect to a vacuum source.
The vacuum manifold is connected to the lumen of at least one skull pet in the skull pet array and is configured to direct the vacuum force to the target site through the lumen and through the lumen.
The vacuum manifold is configured to direct the vacuum force to the target site via the outside of the lumen.
The vacuum component has a vacuum suction device.
The vacuum force is configured to stabilize the target site in vacuum during the partial excision.

The method comprises a controller configured to automatically control at least one of the rotational force applied to the at least one skull pet and the vacuum force delivered to the target site.

The scalpet array comprises at least one scalpet consisting of a cylindrical scalpet having a lumen that at least partially extends from the end to the proximal end of the scalpet. The distal region in close proximity to the section is configured to incise and accept the tissue.

The terminal region has a cut surface.
The cut surface has at least one of a sharp edge, at least one tip, a serrated edge, and a blunt edge.
The lumen and proximal end are configured to allow tissue from the target site to pass through.
The at least one skull pet has at least one opening positioned axially adjacent to the hollow region.

The at least one opening is configured to divert the received tissue at least one of the radial outwards from the lumen of the scalpet and the radial inward towards the lumen of the scalpet. ..

The skull pet array has a plurality of skull pets.
Each skull pet is configured to rotate around the central axis of the skull pet.

The scalpet array has at least one scalpet, the scalpet assembly has a drive assembly coupled to each of the scalpets, and the drive assembly applies a rotational force to the proximal region of each scalpet. The rotational force is configured to apply, and the rotational force is configured to rotate each skull pet around its central axis.

The carrier configuration is configured to use the carrier with a depth guide, which controls the penetration depth of the sculpt array into the tissue.

In an embodiment, a step of constructing the carrier is performed so as to perform at least one of partial excision and partial adipose tissue excision at the target site of the subject by connecting the carrier to the skull pet assembly having the skull pet array. There is a way to prepare. The method comprises the steps of configuring the carrier to control the rotational force supply to the at least one sculpt and to control the vacuum force supply by the vacuum component connected to the sculpt assembly. The vacuum force is configured to pull tissue out of the target site. The tissue comprises a skin plug that is incised to form a partial area during the partial resection and at least one of the fats removed from the partial area during partial adipose tissue resection.

In an embodiment, the carrier is linked to a scalpet assembly having a scalpet array so as to perform at least one of partial excision and partial adipose tissue excision at a target site of a subject, which is a step of constructing a carrier. By In a step, the vacuum force is configured to pull the tissue out of the target site, the tissue being incised to form a partial area during the partial excision, and during partial adipose tissue excision. There is a method comprising a step constituting the carrier, which comprises at least one of the fats removed from the subregion.

An embodiment is a method comprising the steps of creating a protocol that uses patient data. The protocol comprises at least one target site and a topographic map of partial skin resection configured to apply to the at least one target site. The method comprises positioning a carrier with a sculpt assembly comprising at least one sculpt and a depth control device at the target site. The at least one skull pet has a lumen and an end configured to penetrate the tissue at the at least one target site. The method involves partial excision by using the scullpet assembly to make a circumferential incision in the skin pixel at the at least one target site and controlling the penetration depth of the incision using the depth control device. And a step of performing at least one of partial adipose tissue resections. The method comprises the step of removing the skin pixel and the adipose tissue underneath at least a portion of the at least one target site via an orifice in the at least one skull pet.

An embodiment is a protocol creation step of creating a protocol that uses patient data, wherein the protocol is a topo of at least one target site and a partial skin resection configured to apply to the at least one target site. A positioning step of positioning a carrier having a skull pet assembly including at least one skull pet and a depth control device at the target site, comprising the graphic map and the protocol creation step, said at least one skull. The pet has a lumen and an end configured to penetrate the tissue at the at least one target site, the positioning step and the skin at the at least one target site using the skull pet assembly. A resection step in which at least one of partial resection and partial adipose tissue resection is performed by making a circumferential incision in the pixel and controlling the penetration depth of the incision using the depth control device, and at least said. There is a method comprising the step of removing the skin pixel and the adipose tissue underneath at least a portion of the at least one target site via an orifice in one skull pet.

In an embodiment, a partial excision and partial adipose tissue excision of tissue is performed by connecting the carrier to a scullpet assembly having a sculpt array containing at least one sculppet and a vacuum component, which is a step of constructing a carrier. There is a method of providing a step of forming the carrier so as to perform aesthetic contouring by. The method comprises a step of marking the target site of the subject. The method comprises creating a partial area at the target site by partially excising the tissue according to the marking. The partial excision comprises making a circumferential incision by application of the scullpet assembly and also removing at least one skin plug. The method comprises the step of removing adipose tissue from the partial area using the scullpet assembly, wherein the adipose tissue is below at least a portion of the target site.

In an embodiment, the carrier is coupled to a scalpet assembly with a scalpet array containing at least one scalpet and a vacuum component to perform aesthetic contouring by partial tissue resection and partial adipose tissue resection. A step of marking a target site of a subject, a step of creating a partial area in the target site by partially excising the tissue according to the marking, and the partial excision. The application of the scalpet assembly involves making a circumferential incision and removing at least one skin plug, the subregion creation step, and using the scalpet assembly to remove adipose tissue from the subregion. There is a method comprising the adipose tissue removing step, wherein the adipose tissue is below at least a portion of the target site.

The marking step includes applying and marking the skull pet array.
The marking step includes marking the periphery of the target site of the subject.
The marking step includes marking at least one of a first region and a second region of the target site.
The first region exhibits cutis laxa.
The second region exhibits lipodystrophy.
The second region exhibits the lipodystrophy of the submandibular fat pad.

The surface area of the first region is larger than the surface area of the second region.
The area of the second region is determined based on the severity of lipodystrophy.
The first region includes at least a portion of the subject's lower jaw.
The first region includes at least a part of the lateral neck surface region of the subject.
The marking step includes marking a plurality of partial excision sites within at least one of the first and second regions.

The step of marking the plurality of partial excision sites includes a step of contacting the partial marking system with at least one of the first region and the second region.

The method comprises performing a partial excision in at least one of the first and second regions.
The method comprises performing a partial adipose tissue resection in the second region.

The depth of the partial adipose tissue resection is variable.
The depth of the partial adipose tissue resection is selectively controlled based on the topographical features of the convex contour malformation in the second region.

The method comprises performing the partial adipose tissue resection in the second region following the partial resection.
The method comprises performing the partial resection in the second region following the partial adipose tissue resection.
The method comprises performing the partial adipose tissue resection during the partial resection.
The method comprises the step of removing the depiction of the boundary of the first region by feathering across the boundary.
The method comprises a closure step of closing a partial area of the partial excision, wherein the closure comprises a directional closure.

The directional closure includes at least one of closure in a substantially first direction, closure in multiple directions, closure in a nearly horizontal direction, and closure in a nearly vertical direction.
The directional closure is a closure step approximately along the first and second vectors, wherein the first vector corresponds to the region of the face and the second vector corresponds to the region of the subject's neck. It has the closure step of the same.
The directional closure involves the use of Langer's wire.
The directional closure involves the use of the remaining skin tension lines.
The directional closure involves the use of a closure vector for surgical skin resection procedures.
The directional closure involves the use of at least one of a bandage and an adhesive thin film instead of suturing.
The method comprises the step of wearing a bandage on the target site.

The steps constituting the carrier include connecting the vacuum component to the sculpt assembly, the vacuum component being configured to use vacuum force to remove tissue and adipose tissue.

The vacuum component has a vacuum manifold configured to connect to the end of the carrier, the vacuum manifold having a vacuum port configured to connect to a vacuum source.
The vacuum manifold is connected to the lumen of at least one skull pet and is configured to direct the vacuum force to the target site through the lumen and through the lumen.
The vacuum manifold is configured to direct the vacuum force to the target site via the outside of the lumen.
The vacuum component has a vacuum suction device.
The vacuum force is configured to stabilize the target site in vacuum during the partial excision.

The method comprises a controller configured to automatically control at least one of the rotational force applied to the at least one skull pet and the vacuum force delivered to the target site.

The at least one skull pet has a cylindrical skull pet with a lumen that at least partially extends from the end to the proximal end of the at least one skull pet and is in close proximity to the end. The distal region is configured to incise and accept the tissue.

The terminal region has a cut surface.
The cut surface has at least one of a sharp edge, at least one tip, a serrated edge, and a blunt edge.
The lumen and proximal end are configured to allow tissue from the target site to pass through.
The at least one skull pet has at least one opening positioned axially adjacent to the hollow region.

The at least one opening is configured to divert the received tissue at least one of the radial outwards from the internal region of the scalpet and the radial inward towards the internal region of the scalpet.
The skull pet array has a plurality of skull pets.
Each skull pet is configured to rotate around the central axis of the skull pet.

The scalpet assembly has a drive assembly coupled to each scalpet, the drive assembly being configured to apply a rotational force to the proximal region of each scalpet, the rotational force having each scalpet thereof. It is configured to rotate around the central axis.

The carrier configuration is configured to use the carrier with a depth guide, which controls the penetration depth of the sculpt array into the tissue.

In an embodiment, a partial excision and partial adipose tissue excision of tissue is performed by connecting the carrier to a scullpet assembly having a sculpt array containing at least one sculppet and a vacuum component, which is a step of constructing a carrier. There is a method of providing a step of forming the carrier so as to perform aesthetic contouring by. The method comprises the step of creating a partial area at the target site by partial excision of the tissue. The partial excision involves making a circumferential incision and removing the at least one skin plug by application of the scullpet assembly. The method comprises the step of removing adipose tissue from the partial area using the skull pet assembly. The adipose tissue shall be below at least a portion of the target site.

In an embodiment, the carrier is coupled to a scalpet assembly with a scalpet array containing at least one scalpet and a vacuum component to perform aesthetic contouring by partial tissue resection and partial adipose tissue resection. And a partial area creation step of creating a partial area at the target site by partial excision of the tissue, wherein the partial excision is a circumferential incision by application of the sculpt assembly and at least. A subregional creation step comprising removing one skin plug and an adipose tissue removal step of removing adipose tissue from the subregion using the scullpet assembly, wherein the adipose tissue is the target. There is a method comprising the adipose tissue removal step, which shall be below at least a portion of the site.

In an embodiment, the carrier is configured to perform partial scar repair by connecting the carrier to a scalpet array comprising at least one scalpet and a scalpet assembly having a vacuum component. There is a way to provide steps to configure. The method comprises identifying at least one surface area adjacent to the scar malformation as the target site of the subject. The method comprises the step of creating a partial area by partially excising the tissue in the vicinity of the at least one surface area adjacent to the scar malformation. The partial excision comprises making a circumferential incision by application of the scullpet assembly and also removing at least one skin plug.

In an embodiment, the carrier is configured to perform partial scar repair by connecting the carrier to a scalpet array comprising at least one scalpet and a scalpet assembly having a vacuum component. A step of identifying at least one surface area adjacent to the scar malformation as a target site of the subject, and a partial excision of the tissue in the vicinity of the at least one surface area adjacent to the scar malformation. A partial area creation step thereby creating a partial area, wherein the partial excision involves making a circumferential incision by applying the sculpt assembly and removing at least one skin plug. There are steps and ways to prepare.

The scar malformation includes a linear scar malformation.
Partial excision of the tissue comprises partial excision of the tissue along each periphery of the scar malformation.
The method comprises forming incision regions that alternately fit around each periphery of the scar malformation.
The method comprises the steps of delineating and removing the boundaries of the incision region by partially excising the tissue beyond each of the perimeters.
Partial excision of the tissue comprises partial excision of the tissue at one or more ends of the scar malformation.
The scar malformation includes a wide range of scar malformations, and partial excision of the tissue comprises partially incising the tissue within the periphery of the scar malformation.

Partial excision of the tissue comprises partial excision of the tissue along each perimeter of the scar malformation and partial incision of the tissue within the perimeter of the scar malformation.

The method comprises forming incision regions that alternately fit around each periphery of the scar malformation.
The method comprises the steps of delineating and removing the boundaries of the incision region by partially excising the tissue beyond each of the perimeters.
The method comprises a marking step of marking the target site, wherein the marking marks a plurality of partial excision sites in at least one surface area adjacent to the scar malformation. ..

Marking of the plurality of partial excision sites comprises contacting the partial marking system with at least one surface area adjacent to the scar malformation.
The method comprises a closing step of closing the partial area of the partial excision, wherein the closing comprises a directional closure.

The directional closure includes a directional closure in a direction substantially orthogonal to the direction of the scar malformation.
The directional closure involves the use of Langer's wire.
The directional closure involves the use of the remaining skin tension lines.
The directional closure involves the use of at least one of a bandage and an adhesive thin film instead of suturing.
The method comprises the step of wearing a bandage on the target site.

The steps constituting the carrier include connecting the vacuum component to the sculpt assembly, the vacuum component being configured to use vacuum force to remove tissue.

The vacuum component has a vacuum manifold configured to connect to the end of the carrier, and the vacuum manifold has a vacuum port configured to connect to a vacuum source.
The vacuum manifold is connected to the lumen of at least one skull pet and is configured to direct the vacuum force to the target site through the lumen and through the lumen.
The vacuum manifold is configured to direct the vacuum force to the target site via the outside of the lumen.
The vacuum component has a vacuum suction device.
The vacuum force is configured to stabilize the target site in vacuum during the partial excision.

The method comprises a controller configured to automatically control at least one of the rotational force applied to the at least one skull pet and the vacuum force delivered to the target site.

The at least one skull pet has a cylindrical skull pet with a lumen that at least partially extends from the end to the proximal end of the at least one skull pet and is in close proximity to the end. The distal region is configured to incise and accept the tissue.

The terminal region has a cut surface.
The cut surface has at least one of a sharp edge, at least one tip, a serrated edge, and a blunt edge.
The lumen and proximal end are configured to allow tissue from the target site to pass through.
The at least one skull pet has at least one opening positioned axially adjacent to the hollow region.

The at least one opening is configured to divert the received tissue at least one of the radial outwards from the internal region of the scalpet and the radial inward towards the internal region of the scalpet.

The skull pet array has a plurality of skull pets.
Each skull pet is configured to rotate around the central axis of the skull pet.
The scalpet assembly has a drive assembly coupled to each scalpet, the drive assembly being configured to apply a rotational force to the proximal region of each scalpet, the rotational force having each scalpet thereof. It is configured to rotate around the central axis.
The carrier configuration is configured to use the carrier with a depth guide, which controls the penetration depth of the sculpt array into the tissue.

In an embodiment, a partial skin graft comprising partial excision of tissue by connecting the carrier to a scalpet array comprising at least one scalpet and a scalpet assembly having a vacuum component, which is a step of constructing the carrier. There is a method including a step of forming the carrier so as to perform the above. The method comprises a step of marking the target site of the subject. The target site includes a donor site. The method comprises creating a partial area at the target site by partially excising the tissue according to the marking. The partial excision involves making and removing a plurality of skin plugs in the circumferential direction by at least one application of the scullpet assembly. The skin graft comprises the plurality of skin plugs. The method comprises the steps of transferring and placing the skin graft to the site to be transplanted.

In an embodiment, a partial skin graft comprising partial excision of tissue by connecting the carrier to a scalpet array comprising at least one scalpet and a scalpet assembly having a vacuum component, which is a step constituting the carrier. A step of constructing the carrier and a marking step for marking the target site of the subject, wherein the target site includes a donor site, the marking step and partial excision of the tissue according to the marking. A partial area creation step of creating a partial area at the target site, wherein the partial excision involves circumferentially incising and removing multiple skin plugs by at least one application of the sculpt assembly. There is a method comprising the subregion creation step, wherein the skin graft comprises the plurality of skin plugs, and a step of transferring and placing the skin graft to the site to be grafted.

Removal of the plurality of skin plugs involves introduction of the skin plugs into a collecting canister.
The transfer of the skin graft includes the heterogeneous transfer of the plurality of skin plugs.
The non-uniform transfer of the plurality of skin plugs includes a free-form transfer.
The transfer of the skin graft includes the uniform transfer of the plurality of skin plugs.
The uniform transfer of the plurality of skin plugs comprises a transfer in a docking tray having a plurality of receptors, the docking tray receiving the plurality of skin plugs taken from the donor site.

The docking tray maintains the orientation of the plurality of skin plugs removed from the donor site.
The docking tray is made of an elastomer material.
The uniform transfer is a transfer on an adhesive substrate that captures the plurality of skin plugs from the docking tray.
The adhesive substrate maintains the relative positioning of the plurality of skin plugs during transfer and abutment to the implant site.
The adhesive substrate brings the skin pixel into contact with the transplanted site.
The adhesive substrate aligns the skin pixels with the transplanted site.

The placement of the skin graft at the transplant site comprises the spread of the plurality of skin plugs over the surface area of the transplant site.
The spread comprises an arrangement in which the plurality of skin plugs are in contact with the transplanted site in a laterally oriented state.

The plurality of skin plugs evoke lateral neovascularization at the transplanted site.
The spread comprises an arrangement in which the plurality of skin plugs are in contact with the transplanted site in a horizontally oriented state.
The plurality of skin plugs evoke lateral end neovascularization at the transplanted site.
The plurality of skin plugs evoke a wound healing reaction at the transplanted site.
The vacant spaces created by the removal of the plurality of skin plugs evoke a wound healing reaction at the donor site.

The marking includes marking of a plurality of partially resected sites at the target site.

The marking of the plurality of partial excision sites comprises contacting the target site of the partial marking system.
The contact of the partial marking system to the target site includes contact of the sculpt array to the target site.
Contact of the scalpet array with the target site results in proper partial density extraction at the target site.

The marking includes marking of a plurality of second partial resection sites at the target site.

The method comprises the step of creating a second partial area at the plurality of second partial excision sites using the second partial excision of the tissue according to the marking.

The second partial excision comprises a circumferential incision and removal of a plurality of second skin plugs by at least one application of the scullpet array, and the second skin graft comprises the plurality of second skin plugs.

The method comprises the steps of transferring and placing the second skin graft with respect to the site to be transplanted.
The method comprises an identification step of identifying a second target site of the subject, wherein the second target site comprises a second donor site.

The method comprises the step of creating a second partial area at the second target site using a second partial excision of the tissue according to the second marking.

The second partial excision comprises a circumferential incision and removal of a plurality of second skin plugs by at least one application of the scullpet array, and the second skin graft comprises the plurality of second skin plugs.

The method comprises the steps of transferring and placing the second skin graft with respect to the site to be transplanted.

The vacuum component is configured to use vacuum force to remove the tissue.
The vacuum component has a vacuum manifold configured to connect to the end of the carrier, and the vacuum manifold has a vacuum port configured to connect to a vacuum source.
The vacuum manifold is connected to the lumen of at least one skull pet and is configured to direct the vacuum force to the target site through the lumen and through the lumen.
The vacuum manifold is configured to direct the vacuum force to the target site via the outside of the lumen.
The vacuum component has a vacuum suction device.
The vacuum force is configured to stabilize the target site in vacuum during the partial excision.

The method comprises a controller configured to automatically control at least one of the rotational force applied to the at least one skull pet and the vacuum force delivered to the target site.

The at least one skull pet has a cylindrical skull pet with a lumen that at least partially extends from the end to the proximal end of the at least one skull pet and is in close proximity to the end. The distal region is configured to incise and accept the tissue.

The terminal region has a cut surface.
The cut surface has at least one of a sharp edge, at least one tip, a serrated edge, and a blunt edge.

The lumen and proximal end are configured to allow tissue from the target site to pass through.
The at least one skull pet has at least one opening positioned axially adjacent to the hollow region.

The at least one opening is configured to divert the received tissue at least one of the radial outwards from the internal region of the scalpet and the radial inward towards the internal region of the scalpet.

The skull pet array has a plurality of skull pets.
Each skull pet is configured to rotate around the central axis of the skull pet.

The scalpet assembly has a drive assembly coupled to each scalpet, the drive assembly being configured to apply a rotational force to the proximal region of each scalpet, the rotational force having each scalpet thereof. It is configured to rotate around the central axis.

The carrier configuration is configured to use the carrier with a depth guide, which controls the penetration depth of the sculpt array into the tissue.

Throughout this specification, the terms "comprise", "comprising", etc. have a comprehensive meaning that is contrary to exclusive or absolute meaning, unless the context explicitly states that it is otherwise required. It should be understood in, that is, it should be interpreted as meaning "including, but not limited to". Terms that use the singular or the plural also include the plural or the plural, respectively. In addition, the terms "herein", "hereunder", "above", "below", and similar terms are used herein. When, it refers to the entire application and not to any special part of the application. When the term "or" is used to refer to two or more item enumerations, the term is used in subsequent commentary on the term, any item in the enumeration, all items in the enumeration, and in the enumeration. Covers all of any combination of items.

The above description of embodiments is not intended to be devoted to or limited to the exact embodiments disclosed in the system and method. Although particular embodiments or embodiments of medical devices and methods have been described herein for purposes of illustration, various equivalent modifications are also within the scope of the system and method, as will be appreciated by those of skill in the art. obtain. The teachings of medical devices and methods made herein can be applied not only to the systems and methods described above, but also to other systems and methods.

The elements and actions of the various embodiments described above can be combined into other embodiments. These and other modifications can be made in light of the previously detailed description of medical devices and methods.

In general, the terms used in the claims should not be construed as limiting medical devices and methods as well as corresponding systems and methods to the special embodiments disclosed herein and in the claims. It should be understood to include all systems operating under the claims. Accordingly, medical devices and methods and corresponding systems and methods are not limited by the disclosures described herein, but their scope is entirely determined by the claims.

Some aspects of medical devices and methods and corresponding systems and methods are described in some claims, and we add other claims after filing, such as this. We reserve the right to prosecute additional claims against other aspects of medical devices and methods as well as corresponding systems and methods.

Claims (29)

With the carrier
A scalpet assembly configured to bind to the carrier and also having a scalpet array, the scalpet array for at least one of partial or partial adipose tissue resection at the subject's target site. With the scalpet assembly having at least one configured scalpet, the carrier is configured to control the application of rotational force to the at least one scalpet during the partial resection and partial adipose tissue resection. ,
A vacuum component that is connected to the sculpt assembly and configured to pull the tissue out of the target site using vacuum force.
Equipped with
The end of the vacuum manifold is used in conjunction with a depth guide to control the penetration depth of the sculpt array into the tissue . In the system of claim 1, the tissue includes a skin plug that is incised to form a partial area during the partial resection and fat that is removed from the partial area during the partial adipose tissue resection. .. In the system of claim 1, the at least one skull pet has a lumen that at least partially extends from the end to the proximal end of the at least one skull pet. In the system of claim 3, the vacuum component has a vacuum manifold configured to connect to the end of the carrier, and the vacuum manifold has a vacuum port configured to connect to a vacuum source. .. In the system of claim 4, the vacuum manifold is configured to connect to the lumen and to direct the vacuum force through the lumen to the target site. system. In the system of claim 4, the end of the vacuum manifold is configured as a depth guide to control the penetration depth of the scalpet array into the tissue. In the system of claim 4, the vacuum manifold is configured to overlay the terminal region of the carrier . In the system of claim 4, the vacuum manifold is detachably connected to the end of the carrier. In the system of claim 4, the vacuum manifold is configured to manually deliver the vacuum force to the target site. The system according to claim 4, further comprising a controller configured to automatically control at least one of the rotational force to the at least one sculpt and the vacuum force to the target site. In the system of claim 3, the at least one skull pet has a cylindrical skull pet, and the terminal region close to the terminal portion is configured to excise and receive tissue.
The terminal region has a cut surface and
The system, wherein the cut surface has at least one of a sharp edge, at least one tip, a serrated edge and a blunt edge. In the system of claim 11 , the lumen and the proximal end are configured to pass tissue from the target site. In the system of claim 11 , said at least one skull pet has at least one opening adjacent to the lumen and positioned axially with the skull pet. In the system of claim 13 , the at least one opening is configured to allow tissue from the target site to pass through. The system of claim 13 , wherein the at least one perforation has at least one cut surface. In the system of claim 13 , the at least one opening is configured to divert the received tissue to at least one of the radial outwards from the lumen and the radial inward towards the lumen. ,system. The system according to claim 3, comprising a partial marking system configured to display the partial excision density of the partial area. In the system of claim 17 , the partial marking system comprises a template comprising a grid pattern of markers. In the system according to claim 17 , the partial marking system has a thin film with holes. In the system of claim 19 , the thin film is configured as a depth guide that controls the penetration depth of the sculpt array into the tissue. In the system of claim 19 , the thin film is configured to adhere to the target site. In the system of claim 3, the lumen of the skull pet is connected to a reservoir configured to hold the received tissue. The system according to claim 3, comprising a motor coupled to the scalpet assembly and configured to drive the at least one scalpet. In the system according to claim 3, the scalpet array has a plurality of scalpets. In the system according to claim 24 , each skull pet is configured to rotate around the central axis of the skull pet. In the system according to claim 3, the scalpet assembly has a drive assembly connected to each scalpet, and the drive assembly is configured to apply a rotational force to a proximal region of each scalpet. The rotational force is a system that rotates each skull pet around the central axis. In the system of claim 26 , the drive assembly comprises at least one of a gear drive system and a friction drive system. The system according to claim 3, further comprising a depth guide that controls the penetration depth of the scalpet array into the tissue. A scalpet assembly configured to bind to a carrier and having a scalpet array, said scalpet assembly for at least one of partial or partial adipose tissue resection at a subject's target site. The scalpet assembly and the carrier are configured to control the application of rotational force to the scalpet in the scalpet array during the partial excision and partial adipose tissue excision.
A manifold configured to be detachably coupled to the scalpet assembly, wherein the manifold is a depth control device configured to control the penetration depth of the scalpet into the tissue in the scalpet array. The manifold is also configured to control the vacuum force applied to pull the tissue out of the target site, the tissue being a skin plug that is incised to form a partial area during the partial excision. , And the manifold, which shall have fat removed from the partial area during partial adipose tissue resection.
A device equipped with.

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