title: Comparison of Neurovascular Characteristics of Facial Skin in Patients After Primary and Revision Rhytidectomies.
abstract: OBJECTIVE
  Wound healing influences both the cosmetic and functional outcomes of facial surgery. Study of cutaneous innervation may afford insight into patients' preoperative wound healing potential and aid in their selection of appropriate surgical procedures.
  
  
  OBJECTIVE
  To present the quantitative and qualitative differences of epidermal nerve fibers (ENFs), neurotransmitters, vasculature, and mast cells in facial skin among patients after primary and revision rhytidectomies.
  
  
  METHODS
  This pilot study collected cutaneous specimens from 8 female patients aged 42 to 66 years who underwent primary rhytidectomy (n = 5) and revision rhytidectomy (n = 3) at Centennial Lakes Surgery Center, Edina, Minnesota, from July 2010 to March 2014. Tissue was processed for confocal/epifluorescence microscopy and indirect immunofluorescent localization of several neural and tissue antigens as well as basement membrane and mast cell markers.
  
  
  METHODS
  Primary rhytidectomy vs revision rhytidectomy with selection of a small area of redundant, otherwise disposed of tissue anterior to the tragus for ENF study.
  
  
  METHODS
  Demographic characteristics included smoking status; 10-point rating scales for facial sensation, pain, and paresthesias; and confocal/epifluorescence microscopy to quantify ENFs, neurotransmitters, vasculature, and mast cells.
  
  
  RESULTS
  Patients in the primary rhytidectomy group had a mean (SD) of 54.4 (31.6) ENFs/mm (range, 14.2-99.2 ENFs/mm), and those in the revision rhytidectomy group had a mean (SD) of 18.6 (5.8) ENFs/mm (range, 13.8-25.0 ENFs/mm). A patient in the primary rhytidectomy group was a 25-pack-year smoker and had 14.2 ENFs/mm, the lowest in both groups. In addition to these structural neural changes, functional neural changes in revision rhytidectomy samples included qualitative changes in normal neural antigen prevalence (substance P, calcitonin gene-related peptide, and vasoactive intestinal peptide). Capillary loops appeared less robust and were less common in dermal papilla among samples from both the primary and revision groups, and mast cells were more degranulated. No differences were found in subjective, self-reported postoperative facial sensation.
  
  
  CONCLUSIONS
  Previous skin elevation was associated with decreased epidermal nerve fiber density and qualitative changes in dermal nerves, capillaries, and mast cells in a clinical sample of patients undergoing rhytidectomy. Future research is needed to determine whether histological findings predict wound healing and to better understand the effects of surgery on regenerative capacity of epidermal nerve fibers.
  
  
  METHODS
  NA.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle.
authors.forename: Farhad
authors.initials: F
authors.lastname: Ardeshirpour
authors.affiliation: Department of Dermatology, University of Minnesota Medical Center, Minneapolis.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Hurliman
authors.affiliation: Department of Neurology, University of Minnesota Medical Center, Minneapolis.
authors.forename: Gwen
authors.initials: G
authors.lastname: Wendelschafer-Crabb
authors.affiliation: Department of Neurology, University of Minnesota Medical Center, Minneapolis.
authors.forename: Brian
authors.initials: B
authors.lastname: McAdams
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Minnesota Medical Center, Minneapolis.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Hilger
authors.affiliation: Department of Neurology, University of Minnesota Medical Center, Minneapolis.
authors.forename: William R
authors.initials: WR
authors.lastname: Kennedy
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Minnesota Medical Center, Minneapolis.|Department of Otolaryngology-Head and Neck Surgery, Hennepin County Medical Center, Minneapolis, Minnesota.
authors.forename: Amy Anne D
authors.initials: AAD
authors.lastname: Lassig
authors.affiliation: Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Brenner
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D002196:Capillaries / Q000378:metabolism / Q000473:pathology*; D004817:Epidermis / Q000294:innervation / Q000473:pathology* / Q000502:physiology* / Q000601:surgery; D005260:Female; D019085:Fluorescent Antibody Technique, Direct; D006801:Humans; D008407:Mast Cells / Q000378:metabolism; D018613:Microscopy, Confocal; D008875:Middle Aged; D009412:Nerve Fibers / Q000378:metabolism / Q000473:pathology*; D018377:Neurotransmitter Agents / Q000378:metabolism; D010865:Pilot Projects; D012086:Reoperation; D015361:Rhytidoplasty; D014945:Wound Healing
chemical_list: D015415:Biomarkers; D018377:Neurotransmitter Agents