JP2019506235A - Pixel array medical system, device and method - Google Patents

Abstract

Embodiments include devices and methods configured to partially ablate skin and / or fat. Partial resection is applied as a stand-alone procedure in anatomical areas that exceed the limits of conventional orthopedic surgery due to the small trade-off between the visibility of the incision scar and the amount of improvement obtained. Also, applying partial resection as an add-on to established orthopedic procedures such as liposuction and using partial resection significantly reduces the incision length required for a particular application. Shortening the incision has applicability in both the aesthetic and reconstructive aspects of orthopedics.
[Selection] Figure 100

Description

This application enjoys the benefit of priority of US Patent Application No. 62 / 294,136, filed February 11, 2016.
This application is a continuation-in-part of US patent application Ser. No. 15 / 016,954 filed Feb. 5, 2016.
This application is a continuation-in-part of US patent application Ser. No. 15 / 017,007 filed Feb. 5, 2016.
This application is a continuation-in-part of US patent application Ser. No. 14 / 840,274, filed Aug. 31, 2015.
This application is a continuation-in-part of US patent application Ser. No. 14 / 840,284, filed Aug. 31, 2015.
This application is a continuation-in-part of US patent application Ser. No. 14 / 840,267, filed Aug. 31, 2015.
This application is a continuation-in-part of US patent application Ser. No. 14 / 840,290, filed Aug. 31, 2015.
This application is a continuation-in-part of US patent application Ser. No. 14 / 840,307 filed Aug. 31, 2015.
This application is a continuation-in-part of US patent application Ser. No. 14 / 505,090 filed Oct. 2, 2014.
This application is a continuation-in-part of US patent application Ser. No. 14 / 505,183, filed Oct. 2, 2014.
This application is a continuation-in-part of US patent application Ser. No. 14 / 099,380 filed Dec. 6, 2013.
This application is a continuation-in-part of US patent application Ser. No. 14 / 556,648, filed Dec. 1, 2014. US patent application Ser. No. 14 / 556,648 is a continuation of US patent application Ser. No. 12 / 972,013 (currently US Pat. No. 8,900,181) filed Dec. 17, 2010.
This application is related to US Patent Application No. 62 / 456,775, filed February 9, 2017.

  Embodiments herein relate to medical systems, devices or devices, and methods, and more particularly to medical devices and methods applied to partial excision of skin and fat.

  The aging process is most visually represented by the progression of dependent skin relaxation. This lifelong process begins as early as the 30s and then gradually worsens over decades. Previous studies have shown that part of the cause of skin-dependent elongation and aging-related relaxation is progressive dermal atrophy associated with reduced skin tension. When combined with the downward force of gravity, aging-related dermal atrophy will cause a two-dimensional stretch of the skin envelope. The clinical finding of this physical-tissue process is excessive skin relaxation. The most affected areas are the head, neck, upper arm, thigh, chest, lower abdomen, and knees. The most visible of all these areas is the head and neck. In this area, there is a pronounced “turkey gobbler” relaxation in the neck and “jowls” in the lower face, the cause of which is the dependence that undermines the skin aesthetic in these areas.

  Plastic surgery techniques have been developed to remove excess loose skin. These procedures must use long incisions. Often long incisions are hidden around the anatomical boundary. Such a boundary is, for example, between the ear and the scalp if wrinkles on the face, and below the breast if it is a chest uplift (breast fixation). However, in some areas of skin laxation, the tradeoff between improved aesthetics and more visible surgical incision is worse. For this reason, the surplus skin on the upper arm, patella, thigh, and buttocks is generally not removed due to the visibility of surgical scars.

  Due to the frequency of this aesthetic distortion and negative social impact, the development of “face lift” surgery has been underway. Other related plastic surgical techniques in different areas are abdominal surgery (abdomen), breast fixation (chest), and sagging upper arm (upper arm). The inherent adverse effects of these surgeries are the risk of postoperative pain and scars and surgical complications. Even though the aesthetic enhancement of these techniques is an acceptable tradeoff for the significant surgical incision required, considerable permanent scarring is always a part of these techniques. For this reason, plastic surgeons design these techniques to hide considerable scars around anatomical boundaries such as the hairline (face lift), lower breast (breast fixation) and inguinal groove (abdominal surgery) . However, many of these incisions are hidden away from the area of skin relaxation, thus limiting their effectiveness. Other areas of skin relaxation, such as above the patella (upper anterior), are not amenable to plastic surgical resection due to a bad tradeoff with more visible surgical scars.

  Recently, electromagnetic medical devices that generate an inverse thermal gradient (ie, Thermage) have attempted to tighten the skin without surgery and may or may not have been successful. At present, these electromagnetic devices are best used for patients with moderate amounts of skin relaxation. Due to the limitations of electromagnetic devices and the potential side effects of surgery, minimally invasive techniques are needed to avoid medical variability of surgically related scars and electromagnetic heating of the skin. For many patients with aging-related skin relaxation (neck and face, arms, armpits, thighs, knees, buttocks, abdomen, braline, chest droop), partial resection of excess skin is a significant part of conventional plastic surgery Can strengthen the segment.

  Even more prominent than aesthetic changes in the skin envelope is the surgical management of burns and other trauma-related skin defects. Severe burns are classified by the total amount of burnt body surface and the depth of thermal destruction.

  First and second degree burns are generally managed in a non-surgical manner with topical cream application and burn bandages. Deeper third-degree burns involve thermal destruction of the entire skin thickness. Surgical management of these severe injuries includes removal of burned scab tissue and application of split-skin grafts.

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

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

  Typically, a burn patient's donor site is selected from a non-burn area and a sheet of partial skin thickness is taken from that area. Around this approach is the creation of a partial thickness skin defect at the donor site. This defect in the donor site itself is similar to a deep second degree burn. Healing by re-epithelialization at this site is often painful and can take several days. In addition, a visible alteration of the donor site is produced that appears to be permanently thinner and bleached than the surrounding skin. For patients with burns over a significant surface area, skin graft incorporation may be limited by the availability of non-burn areas.

  For these reasons, there is a need for instruments and techniques for aesthetic surgical skin tightening in the rapidly expanding aesthetic market. There is a need for a system, device, device or technique that can repeatedly incorporate skin grafts from the same donor site while removing the alteration of the donor site.

INCORPORATION BY REFERENCE Each patent, each patent application, and / or each publication mentioned herein is hereby incorporated by reference in its entirety. The extent is the same as if each individual patent, patent application and / or publication was specifically and individually indicated to be incorporated by reference.

Fig. 3 shows a PAD kit placed at a target site under an embodiment. 2 is a cross-section of a scalp punch or device including a scalp array, under an embodiment. FIG. 3 is a partial cross-section of a scalp punch or device including a scalp array, under an embodiment. The adhesive film with the backing (adhesive substrate) contained in the PAD kit is shown under the embodiment. FIG. 2 shows an adhesive film (adhesive substrate) when used with a PAD kit frame and blade assembly under an embodiment. FIG. 4 illustrates skin pixel removal under an embodiment. FIG. 4 is a side view showing removing an incision skin pixel across a blade with a PAD kit, under an embodiment. FIG. 3 is an isometric view showing blade / pixel interaction during an approach using a PAD kit, under an embodiment. FIG. 3B is another view of the procedure using a PAD kit (excluding blades for clarity), according to an embodiment, with the cut-out and acquired skin pixels or plugs and non-resection prior to resection FIG. 5 shows both skin pixels or plugs. FIG. 2 is a side view of a portion of a pixel array, showing a sculpture held on an investing plate, under an embodiment. FIG. 6 is a side view of a portion of a pixel array under an alternative embodiment showing a sculpture held on an investing plate. It is a top view of a sculpture plate based on an embodiment. FIG. 3 is an enlarged view of a part of a sculpture plate under the embodiment. An example of a rotating pixel drum is shown under the embodiment. 1 illustrates an example of a rotating pixel drum assembled to a handle under an embodiment. Figure 3 shows a drum dermatome for use with a sculpture plate under an embodiment. Fig. 3 shows a drum dermatome placed on a sculpture plate under an embodiment. FIG. 4 is another view of a drum dermatome placed on a skull pet plate, under an embodiment. FIG. 3 is an isometric view of application of a drum dermatome (e.g., paget dermatome) to a sculpture plate, according to an embodiment, wherein the adhesive film is applied to the drum of the dermatome before rolling the drum over the investing plate. Applies to FIG. 3 is a side view of a portion of a drum dermatome, showing the position of the blade relative to the sculpture plate, under an embodiment. FIG. 3 is a side view of a portion of a drum dermatome, showing different positions of the blades relative to the sculpture plate, under embodiments. FIG. 5 is a side view of a drum dermatome with other positions of the blades relative to the sculpture plate, under embodiments. FIG. 3 is a side view of a drum dermatome with a cross-cutting blade clip, according to an embodiment, showing the crossing of skin pixels by the blade clip. It is a bottom view of the drum dermatome along a sculpture plate under an embodiment. 1 is a front view of a drum dermatome along a sculpture plate, under an embodiment. FIG. It is a rear view of the drum dermatome along a sculpture plate based on Embodiment. FIG. 3 shows an assembly diagram of a dermatome with a pixel-on-lay sleeve (POS) according to an embodiment. FIG. 3 shows an exploded view of a dermatome with a pixel-on-lay sleeve (POS), according to an embodiment. FIG. 3 shows a portion of a dermatome with a pixel-on-lay sleeve (POS) under an embodiment. FIG. 3 shows a slip-on PAD that slides on a paget drum dermatome under an embodiment. FIG. 3 shows an assembly view of a slip-on PAD installed on a paget drum dermatome, under an embodiment. FIG. 4 shows a slip-on PAD installed on a paget drum dermatome and used with a perforated template or guide plate, under an embodiment. Fig. 4 shows skin pixel uptake by a Paget Drum Dermatome and an installed slip-on PAD, under an embodiment. An example of a pixel drum dermatome applied to a target site on the skin surface under an embodiment is shown. FIG. 5 shows another view of a portion of a pixel drum dermatome being applied to a target site on the skin surface under an embodiment. FIG. 3 shows a side perspective view of a PAD assembly, under an embodiment. FIG. 3 shows a top perspective view of a scalpel device used with a PAD assembly, under an embodiment. FIG. 3 shows a bottom perspective view of a scalpel device used with a PAD assembly, under an embodiment. FIG. 3 shows a side view of a punch impact device including a vacuum component, under an embodiment. FIG. 3 shows a top view of an oscillating flat sculpture array and blade device, under an embodiment. FIG. 3 shows a bottom view of a vibrating flat sculpture array and blade device, under an embodiment. It is an enlarged view of a flat array when a sculpture array, a blade, an adhesive film, and an adhesive backer are assembled under the embodiment. FIG. 3 is an enlarged view of a flat array of scalpets with a feeder component, under an embodiment. FIG. 3 shows a cylindrically cut cadaveric dermal matrix that resembles a size-captured skin pixel implant under embodiments. Under embodiments, a drum array drug delivery device. 1 is a side view of a needle array drug delivery device, under an embodiment. FIG. FIG. 3 is an upper isometric view of a needle array drug delivery device, under an embodiment. FIG. 3 is a lower isometric view of a needle array drug delivery device, under an embodiment. The composition of human skin is shown. 2 shows the physiological cycle of hair growth. Under embodiments, uptake of donor hair follicles is shown. The preparation of the recipient site is shown under the embodiment. Fig. 4 shows the arrangement of incorporated hair plugs at a recipient site under an embodiment. FIG. 4 shows the arrangement of a perforated plate at the donor site of the occipital scalp under the embodiment. FIG. 6 shows the penetration depth of the skull pet into the skin when the skull pet is configured to penetrate the subcutaneous fat layer to obtain a hair follicle. Under embodiments, hair plug uptake using a perforated plate at the occipital donor site is shown. FIG. 6 shows the generation of a visible hairline under the embodiment. FIG. 4 illustrates the preparation of a donor site for generating identical skin defects at a recipient site using a patterned perforated plate and a spring-loaded pixelation device under an embodiment. FIG. 4 illustrates implantation of an incorporated plug by inserting the incorporated plug into a corresponding skin defect created at the recipient site, under an embodiment. FIG. 3 illustrates a clinical endpoint using a pixel dermatome instrument and technique, under embodiments. It is the image of the skin by which engraving was performed to the corner | angular part and intermediate | middle point of the area | region of excision under embodiment. FIG. 6 is an image of a postoperative skin resection field under an embodiment. FIG. FIG. 6 is an image after 11 days from surgery, showing the primary healing with a measured margin, under the embodiment. FIG. 6 is an image after 29 days from surgery, showing the primary healing of the ablation and the primary maturation of the ablation field continuing, along with the measured margin, under an embodiment. FIG. 9 is an image after 29 days from surgery, showing the ablation is primarily cured and the primary maturation of the ablation field continues, along with the measured lateral dimensions, under an embodiment. FIG. 4 is an image after 90 days post-operatively, with the measured lateral dimension showing that the ablation is primarily cured and the primary maturation of the ablation field continues, according to an embodiment. FIG. 2 is a sculpture showing an applied rotational force and / or impact force under an embodiment. FIG. 3 shows a gear sculpture and an array including gear sculptures under embodiments. FIG. 3 is a lower perspective view of an ablation device including a scalp assembly with a gear sculpture array, under an embodiment. FIG. 3 is a bottom perspective view of a sculpture assembly (housing not shown) with a gear sculpture array, according to an embodiment. It is detail drawing of a gear sculpture array based on embodiment. FIG. 4 shows an array including a scalpet in a friction drive configuration, under an embodiment. FIG. 3 shows an array comprising a helical sculpture (outward) and a helical sculpture (outward) under an embodiment. Under embodiments, a side perspective view (left) of a skullpet assembly including a helical scalpet array and a side perspective view (right) of a cutting device including a skullpet assembly with a helical skullpet array (right) ( The housing is shown). FIG. 3 is a side view of an ablation device (with the housing depicted as transparent for clarity of details) including a skullpet assembly with a helical skullpet array assembly, according to an embodiment. 1 is a lower perspective view of an ablation device (housing is shown as transparent for clarity of clarity) including a scalp assembly with a helical scalp array assembly, under embodiments. FIG. 1 is a top perspective view of an ablation device (housing is depicted as transparent for clarity of clarity) including a scalpel assembly with a helical scalpel array assembly, under embodiments. FIG. FIG. 3 is a push plate of a spiral sculpture array under an embodiment. FIG. 2 shows a helical sculpture array with a push plate under an embodiment. FIG. 3 shows an array comprising an inner helical sculpture and an inner helical sculpture under an embodiment. FIG. 3 shows a helical sculpture array with a drive plate under an embodiment. FIG. 2 shows a slot sculpture and an array including slot sculptures under an embodiment. FIG. 4 shows a portion of a slot sculpture array (eg, four (4) sculptures) with a drive rod, under an embodiment. FIG. 3 shows an exemplary slot sculpture array (eg, 25 sculptures) with a drive rod, under embodiments. FIG. 3 shows a vibrating pin drive assembly with a scalpet, according to an embodiment. FIG. 6 illustrates variable scalpet exposure control with a scalp guide plate under an embodiment. FIG. 3 illustrates a sculpture assembly that includes a sculpture array (eg, spiral) configured to be manually driven by an operator, under embodiments. It shows the force exerted on the sculpture through application to the skin. Under the embodiment, it represents compression by a steady axial force using a sculpture. FIG. 4 shows compression plus motion impact force due to a steady single axial force using a sculpture under the embodiment. In the embodiment, the sculpture is moved at a certain speed and applied to the skin to penetrate. In the embodiment, the tip of a plurality of needles is represented. Under the embodiment, a square sculpture without teeth (left) and a square sculpture with multiple teeth (right) are shown. FIG. 3 shows a side view, a front view (or rear view) and a side perspective view of a round skullpet with an oblique tip under an embodiment. Figure 2 shows a round sculpture with a serrated edge, according to an embodiment. FIG. 2 shows a side view of an ablation device (housing is depicted as transparent for clarity of clarity) including a scalpel array and a scalpel assembly with push pins, under embodiments. FIG. 5 shows a top perspective cross-sectional view of an ablation device (housing is depicted as transparent for clarity of clarity) comprising a scalpel assembly with a scalpel array and push pin, under embodiments. FIG. 3 shows a side view and a top perspective view of a scalpet assembly including a scalpel array and push pins, under embodiments. FIG. 3 is a side view of an ablation device including a sculpture assembly with a sculpture array assembly connected to a vibration source, according to an embodiment. Fig. 2 shows a sculpture array driven by an electrodynamic source or sculpture array generator under an embodiment. FIG. 3 is an illustration of an ablation device including a vacuum system, under an embodiment. FIG. 3 shows a vacuum manifold applied to a target skin surface for removing / incorporating a cut skin / hair plug under embodiments. FIG. 4 shows a vacuum manifold with an integrated wire mesh applied to a target skin surface for removing / incorporating a cut skin / hair plug under embodiments. FIG. 3 illustrates a vacuum manifold with an integrated wire mesh configured to vacuum remove subcutaneous fat under an embodiment. Under embodiments, represents a retractable docking station and inserted skin pixels. The docking station is formed from an elastic material, but is not limited thereto. FIG. 4 is a top view of an extended configuration (left) and a non-extended configuration (right) of a docking station (eg, elastic), according to an embodiment. Under embodiments, it is shown that loose excess skin is removed without obvious wounds. Under embodiments, it shows tightening the skin without an obvious wound. Figure 3 shows a three-dimensional contouring of the skin envelope, under an embodiment. FIG. 3 shows a variable partial ablation density in the treatment area under the embodiment. FIG. 3 shows partial excision of fat under an embodiment. Shows cobblestones on the skin surface. FIG. 3 shows a deeper level topographic mapping of partial lipotomy under an embodiment. A plurality of treatment contours are shown under the embodiment. Under the embodiment, a curvilinear treatment pattern is shown. FIG. 3 shows a digital image of a patient with a rendered digital wire mesh program, under an embodiment. FIG. 3 shows a directional occlusion of a partially ablated field, according to an embodiment. FIG. 3 shows a directional partial resection of the skin under the embodiment. FIG. 6 illustrates shortening of the incision through a continuous partial procedure, under an embodiment. FIG. 6 is an exemplary illustration of a “dog ear” skin surplus in chest reduction and abdominal surgery. 1 is a skull pet device including a single shaved skull pet with depth control, under embodiments. Under embodiments, a scalpel device that includes a standard single scalpet. 1 is a skull pet device including a pen-style gear reduction carrier under embodiments. Under embodiments, a scalpet device including a multi-scalpet (eg, 3 × 3) array. 1 illustrates a skull pet device including a cordless surgical drill carrier, according to an embodiment. FIG. 4 illustrates an exemplary sculpture device comprising a 5 × 5 centerless array for use with a surgical drill carrier, under embodiments. 1 is a sculpture device including a vacuum-assisted pneumatic ablation device. FIG. 3 is a detailed view of the distal region of a VAPR sculpture device including a sculpture assembly coupled to a carrier drill using a CAC, under an embodiment. FIG. 2 shows a VAPR scalpet assembly in a ready state (left) and that in a stretched treatment state (right), according to an embodiment. Fig. 3 shows a SAVR device in a ready state (left) and a retracted state (right) under an embodiment.

  Embodiments include devices and methods configured to partially ablate skin and / or fat. Partial resection is applied as a stand-alone procedure in anatomical areas that exceed the limits of conventional orthopedic surgery due to the small trade-off between the visibility of the incision scar and the amount of improvement obtained. Also, applying partial resection as an add-on to established orthopedic procedures such as liposuction and using partial resection significantly reduces the incision length required for a particular application. Shortening the incision has applicability in both the aesthetic and reconstructive aspects of orthopedics.

  Embodiments include a device comprising a carrier and a chuck connected to a distal region of the carrier. The device includes a skull pet assembly that includes at least one skull pet and a depth control device. The skull pet assembly includes a shank configured for retention with the chuck. The at least one sculpture includes a tube that includes a hollow region and a pointed distal end configured to penetrate tissue at a target site. The depth control device is configured to control the depth of penetration of the at least one scalpet into the tissue.

  Embodiments include a device comprising a carrier having a proximal region and a distal region. The proximal end is configured to be held by hand. The device includes a skull pet assembly that includes a plurality of skull pets. The sculpture assembly includes a drive assembly configured to rotate each sculppet about a central axis by applying a rotational force to the plurality of sculptes. Each sculpture includes a sculpture shaft that includes a proximal end and a distal end configured to penetrate tissue at a target site. The skull pet shaft includes a hollow region adjacent to the distal end and configured to pass tissue received through the distal end. The sculpture shaft includes an orifice connected to the hollow region and configured to pass the received tissue from the sculpture shaft.

  Embodiments include a method that includes configuring an ablation device to include a sculpture assembly comprising a sculpture array and a depth control device. The sculpture array includes a plurality of sculptures, each sculpture including a tube that includes a hollow region and a pointed distal end configured to penetrate tissue at a target site. The distal end includes at least one of a pointed region and a blunt region. The depth control device is configured to control the depth of penetration of the skull pet array into the tissue. The method includes configuring the ablation device at the target site to operate according to a protocol that includes a map of partial ablation. The method includes setting the ablation device to perform the partial ablation by incising a skin pixel at the target site. The method includes setting the ablation device to remove at least one of the partially ablated skin pixels and fat from the target site.

  Systems, apparatus, and methods are described that include a housing in which a scalp device is configured to include a scalp assembly. The skull pet assembly includes a skull pet array and one or more guide plates. The skull pet array includes a collection of skull pets, and in some embodiments, the collection of skull pets includes a plurality of skull pets. The guide plate maintains the structure of the collection of scalpets. The collection of scalpets is configured to exit the housing and to enter the housing, and when configured to generate an incision skin pixel at the target site. An incision skin pixel is incorporated.

  The skull pet device described herein satisfies the rapidly expanding aesthetic market for equipment and techniques for aesthetic surgical skin tightening. In addition, embodiments allow for the repeated incorporation of skin grafts from the same donor site while removing the alteration of the donor site. The embodiments described herein are configured to excise excess loose skin without leaving a visible scar. In this case, all areas of excessive skin relaxation can be excised with the pixel array dermatome, and the technique can also be performed in areas previously prohibited for the visibility of surgical incisions. The technical effects achieved through the embodiments described herein include smooth and tightened skin without visible or long scars along the anatomical boundary.

  Embodiments described in detail herein include pixel skin tissue transplantation devices and methods configured to provide the ability to repeatedly capture split-skin grafts without leaving a visible scar at the donor site. Is done. During the procedure, a pixel array dermatome (PAD) is used to capture skin grafts from selected donor sites. During the capture operation, the pixelated skin graft is placed on a semi-porous flexible adhesive film. The incorporated skin graft / membrane hybrid is then applied directly to the recipient's skin defect site. Partially excised donor sites are closed by applying an adhesive sheet or bandage (eg, Flexzan® sheeting, etc.) that functions as a large butterfly dressing for a given period of time (eg, a week) . Closing the intradermal skin defect generated by PAD accelerates the primary healing process. In the process, the normal epidermis-dermis architecture is reorganized in an anatomical manner to minimize scarring. As occurs after the operation, the adhesive film is desquamated (dropped) together with the stratum corneum of the transplanted tissue. The membrane can then be removed from the recipient bed without disturbing the transplanted tissue.

  Many of the effects achieved by pixel skin tissue transplantation techniques are worthy of explanation. Since the skin graft is pixelated, it can provide a drainage gap between the skin plug components, thereby increasing the "takes" rate compared to the sheet skin graft. In the first week after surgery, skin grafts “takes” at the recipient site by the process of angiogenesis. There, new blood vessels from the skin defect recipient bed grow in the new skin graft. The semi-porous membrane guides the leachate to the bandage.

  The flexible membrane is configured with elastic recoil characteristics. Its properties promote the juxtaposition of component skin plugs within the graft / membrane hybrid, promote primary adjacent healing of the skin graft plug, and convert the skin graft's pixelated appearance into a more uniform sheet form Is done. Furthermore, the membrane aligns the microarchitectural component skin plug so that the dermis is aligned with the dermis and the epidermis is aligned with the epidermis, thus facilitating a primary healing process that reduces scarring.

  The dermatome detailed herein has many major clinical applications. Partial skin excision for skin tightening, partial hair transplantation for alopecia, and partial skin uptake for skin transplantation. The partial skin excision of an embodiment includes capturing a skin plug using an adhesive membrane, but a partially dissected skin plug can be removed without capturing. The paradigm of incision, removal and closure best describes the clinical application of skin tightening. The embodiments described herein are configured to facilitate incision and removal. In addition, in order to provide a larger sculpture array with multiple sculptures, the embodiment includes a novel means of incising the skin surface.

  A pixel array medical system, apparatus or device, and method for skin transplantation, skin resection, and hair transplantation are described. In the following description, numerous specific details are introduced to provide a thorough understanding of the embodiments of the specification and a description to enable it. However, one of ordinary skill in the art will recognize that these embodiments may be practiced without one or more of the specific details, or with other components, systems, and the like. In other instances, well-known structures and operations are not shown or described in detail to avoid obscuring aspects of the disclosed embodiments.

  The following terms are intended to have the following general meaning as they are used herein. However, the terms are not limited to the meanings described herein. This is because the meaning of any term may include other meanings when understood or applied by those skilled in the art.

As used herein, “first degree burn” includes superficial burns that do not destroy the dermis from the epidermis. The first burn is visible as erythema (redness) of the skin.
As used herein, “second degree burn” includes relatively deep burns in which the epidermis is destroyed from the epidermis and the epidermis is denatured by a variable thickness. Most second-degree burns are accompanied by blister formation. Deep second-degree burns can usually turn into third-degree burns of the entire thickness due to oxidation and infection.

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

  “Ablation” as used herein includes removal of tissue by destruction of the tissue, for example, heat removal of skin lesions with a laser.

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

  As used herein, “Backed Adherent Membrane” includes an elastic adhesive membrane that obtains a crossed skin plug. The supported adhesive film of the embodiment is supported on the outer surface to maintain the alignment of the skin plugs during uptake. After the incorporation of the skin plug, the backing is removed from the adhesive film with the incorporated skin plug. The membrane of the embodiment is porous to allow drainage when placed at the recipient site. The membrane of the embodiment has elastic recoil characteristics. Thereby, when the backing is removed, it causes the sides of the skin plugs to approach each other and promotes healing as a sheet graft tissue at the recipient site.

  As used herein, “burn scar contraction” includes the tightening of scar tissue that occurs during the wound healing process. This process is more likely to occur with untreated third-degree burns.

  As used herein, “burn scar contracture” includes a band of scar tissue that restricts the range of motion of the joint or distorts the appearance of the patient, ie, facial burn scar contracture.

  As used herein, a “dermatome” includes a device that “cuts the skin” or captures a sheet-like layered graft. Examples of drum dermatomes include Padgett and Reese dermatomes. The electric dermatome is an electrical version of the Zimmer dermatome and paget dermatome.

  As used herein, “dermis” is the primary structural support and includes the deep layers of the skin that contain primarily non-cellular collagen fibers. Fibroblasts are cells in the dermis that produce collagen protein fibers.

  As used herein, “donor site” includes an anatomical site from which skin graft tissue is taken up.

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

  As used herein, “excise” includes surgical removal of tissue.

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

  As used herein, “FTSG” includes full thickness skin grafts where the full thickness of the skin is incorporated. With the exception of instruments as described herein, the donor site is closed as a surgical incision. For this reason, FTSG is limited to the surface area that can be taken.

  As used herein, “granulation tissue” includes highly angiogenic tissue that grows in response to a lack of skin in a full thickness skin defect. Granulation tissue is an ideal base in skin transplant recipient sites.

  As used herein, “Healing by primary intention” includes a wound healing process in which the normal anatomical configuration is reorganized with minimal scar tissue formation. Formally, scars are unlikely to be visible.

  As used herein, “Healing by secondary intention” refers to a more coherent form of healing in which the normal anatomical composition is poorly aligned and more scar collagen is produced. Including no wound healing process. Formally, scars tend to be visible.

  As used herein, “homograft” includes transplanted tissue that is taken from a different person and applied as a temporary biological bandage to a patient's recipient site. Many allografts are taken up as cadaver skin. Temporary “takes” of allogeneic transplantation can be partially achieved by immunosuppression, but allotransplantation is eventually replaced by autologous transplantation if the patient survives.

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

  As used herein, “Mesh Split Thickness Skin Graft” is a split skin graft whose surface has been expanded by repeatedly incising a skin graft tissue captured by a device called a “mesher”. including. Mesh split grafts have a higher “take” ratio than sheet-like grafts. This is because mesh layered grafts allow drainage through the transplanted tissue and better match the irregularities of the contours of the recipient site. However, it produces an ugly reticulated implant appearance at the recipient site.

  “PAD” as used herein includes a pixel array dermatome, which is a class of equipment for partial skin ablation.

  As used herein, a “PAD kit” includes a disposable single use procedure kit comprising a perforated guide plate, a sculpture stamper, a guide plate frame, a supported adhesive film, and a transverse blade. .

  As used herein, a “perforated guide plate” includes a perforated plate that includes the entire implantation uptake area, where the holes in the guide plate are aligned with a stamper with handle or a slip-on PAD scalpet. The plate also functions as a guard to prevent unintentional laceration of the adjacent skin. The multiple holes of the guide plate may be round, oval, square, rectangular and / or triangular, etc., but may be of different shapes, but not limited thereto.

  “Pixelized full-thickness skin graft” as used herein is a full-thickness skin graft captured by the device described herein with no reduced, well-visible scar at the donor site Including full thickness skin grafts. The transplant will have an improved appearance at the recipient site, similar to the sheet-like FTSG, but will better fit the recipient site and have a higher percentage of “take” due to drainage gaps between the skin plugs. Another significant advantage of pixelated FTSG compared to sheet-like FTSG is the ability to implant a wider surface that would otherwise require STSG. This advantage is due to the ability to be taken while reducing visible scars from multiple donor sites.

  As used herein, “Pixelated Graft Harvest” includes skin grafts taken from a donor site with the devices detailed herein.

  As used herein, “pixelated split skin graft” includes partial layer skin grafts captured by an SRG device. Skin grafts share the advantages of mesh skin grafts without ugly donor sites or ugly recipient sites.

  As used herein, “recipient site” includes a skin defect site to which a skin graft is applied.

  As used herein, “resect” includes excision.

  As used herein, “scalpet” includes a single-edged knife that cuts through skin and soft tissue.

  As used herein, “scalpet” includes terms describing a small geometric shape (eg, circular, oval, rectangular, square, etc.) sculpt that cuts through a skin plug.

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

  As used herein, a “scalpet stamper” includes the handle-equipped skull pet array instrument component of a PAD kit that cuts a skin plug through a perforated guide plate.

  As used herein, "scar" includes visually noticeable morphological malformations from irregular collagen tissue deposition following a wound or irregular collagen tissue deposition following a wound.

  As used herein, “sheet-like full-thickness skin graft” includes what refers to applying FTSG to a recipient site as a continuous sheet. The appearance of FTSG is superior to that of STSG, so it is mainly used for skin grafts in visually noticeable areas such as the face.

  As used herein, “sheet-like layered skin grafts” are continuous sheets and include partial layer skin grafts with typical donor site malformations. As used herein, a “skin defect” includes the lack of a full layer of skin that can include deeper structures such as subcutaneous fat layers and muscles. Skin defects can be caused by a variety of reasons, such as surgical removal of burns, trauma, or cancer and correction of congenital deformities.

  As used herein, a “skin pixel” includes a piece of skin comprising the epidermis and a split or full-thick dermis, cut out by a sculpture. The skin pixel may include a skin appendage such as a hair follicle with or without a subcutaneous fat cuff. Also includes skin plugs.

  As used herein, a “skin plug” includes a round (or other geometric) skin piece with a epidermis and a split or full-thick dermis, cut out by a scalpet, Crossed by a cutting blade and obtained by an adhesive back membrane.

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

  As used herein, the “subcutaneous fat layer” includes a layer directly below the skin and mainly composed of fat cells called lipid cells. This layer serves as the main isolation layer from the environment.

  As used herein, a “crossing blade” is a horizontally positioned single-edged blade that is inserted into a slot in a perforated plate frame or attached to an outrigger arm of a drum dermatome, as detailed herein. Including. The crossing blade crosses the base of the incision skin plug.

  “Wound healing” as used herein includes essential biological processes that result from any type of wound, whether one or more of thermal, kinematic, and surgical.

  As used herein, “Xenograft” includes transplanted tissue taken from different species and applied as a temporary biological bandage to a patient's recipient site.

  Multiple embodiments of the pixel array medical system, apparatus or device, and method used are detailed herein. The systems, apparatus or devices, and methods described herein provide for sagging skin without visible scars through devices used in various surgeries, such as plastic surgery, for skin transplantation. Includes minimally invasive surgical approaches for tightening skin excision and additionally for hair transplantation. In certain embodiments, the device is a disposable device. Embodiments herein avoid the clinical variability of surgical-related scars and electromagnetic heating of the skin, and perform small-scale multi-pixel ablation of skin as a minimally invasive alternative to large-scale plastic surgical excision of skin . The embodiments herein may be used for hair transplantation and may be used on body parts that are prohibited plastic surgery for visibility of surgical scars. In addition, the approach allows skin grafting operations to be performed while reducing scars at the patient's donor site by taking a transcutaneous incision from the donor's tissue site and placing it at the recipient's skin defect site.

  For many patients with aging-related skin relaxation (such as, but not limited to, the neck and face, arms, axilla, thighs, knees, buttocks, abdomen, braline, chest drop), the minimally invasive pixels herein Array medical devices and methods perform pixelated crossings and cuts of excess skin, replacing plastic surgery with scarring. In general, the techniques described herein are performed in an office setting under local anesthesia to minimize perioperative discomfort, but are not limited thereto. Only a short recovery period is required compared to the long healing phase from plastic surgery. Preferably, bandages and support garments wrapped around the treatment area are applied for a pre-specified period (eg, 5 days, 7 days, etc.). There is no or minimal pain associated with this technique.

  Relatively small skin defects (eg, in the range of about 0.5 mm to 4.0 mm) produced by the devices described herein are closed by applying an adhesive Flexan® sheet. The Flexan® sheet functions as a large butterfly bandage and may be pulled in an orientation (“vector”) that maximizes aesthetic contouring of the treatment area. A compressible elastic garment may be applied over the bandage to further aid in aesthetic contouring. After completion of the initial healing phase, a large number of small linear scars within the treatment area will have reduced visibility compared to a larger plastic surgical incision in the same area. Due to the delayed wound healing response, additional skin tightening is likely to occur over several months. Other potential applications of the embodiments described herein include hair transplantation, treatment of alopecia, treatment of snoring / sleep apnea, orthopedic / physical therapy, vaginal tightening, Treatment of female urinary incontinence and gastrointestinal sphincter tightening.

  Severe burns are classified by the total amount of burnt body surface and the depth of thermal destruction. The method used to manage these burns is highly dependent on this classification. First and second degree burns are usually managed in a non-surgical manner with topical cream application and burn bandages. Deeper third-degree burns include full-thickness thermal destruction of the skin, producing full-thickness skin defects. Surgical management of this severe injury usually involves removing the scab from burns and applying a split-skin graft.

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

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

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

  The pixel skin grafting technique of the embodiment is used as a full-thickness skin grafting. Many clinical applications, such as facial skin transplants and hand surgery and treatment of congenital deformities, are best performed with full-thickness skin transplants. The texture, color and overall morphology of full thickness skin grafts will be closer to the skin next to the defect than split skin grafts. For this reason, full-thickness skin grafts in visually conspicuous areas have an appearance advantage over split-skin grafts. The main drawback of full-thickness skin grafts under conventional techniques is the long linear scar generated from surgical sutures of full-thickness donor site defects. This scar limits the size and availability of full thickness skin grafts.

  In comparison, full-thickness skin grafting of the pixel skin grafting technique described herein is less restrictive on its size and availability because the linear scar at the donor site is removed. Thus, many skin defects that are usually covered with split-skin skin grafts will instead be treated with pixelated full-thickness skin grafts.

  Pixel skin grafting techniques provide the ability to incorporate split and full thickness skin grafts while minimizing visible scars at the donor site. During the procedure, a pixel array dermatome (PAD) device is used to capture skin grafts from selected donor sites. During the capture operation, the pixelated skin graft is placed on the adhesive film. Although the adhesive film of embodiment contains a semi-porous flexible adhesive film, it is not limited to this. The incorporated skin graft / membrane hybrid is then applied directly to the recipient's skin defect site. The partially excised donor site is closed by applying an adhesive Flexzan® sheeting that functions as a large butterfly dressing for a week. Closing a relatively small (eg, 1.5 mm) intradermal circular skin defect facilitates the primary healing process. In the process, the normal epidermis-dermis architecture is reorganized in an anatomical manner to minimize scarring. As it occurs about one week after the operation, the adhesive film is desquamated (collapsed) with the stratum corneum of the transplanted tissue. The membrane can then be removed from the recipient bed without disturbing the transplanted tissue. Thus, donor site healing occurs rapidly with minimal discomfort and scarring.

  Since the skin graft at the recipient defect site using the pixel skin graft technique is pixelated, it provides a drainage gap between the skin pixel components, thereby taking “takes” compared to the sheet skin graft. ) "Can be increased. In the first week (approximately) after surgery, the skin graft tissue “takes” at the recipient site by the process of angiogenesis. There, new blood vessels from the skin defect recipient bed grow in the new skin graft. The semi-porous membrane guides the leachate (fluid) to the bandage. Furthermore, the flexible membrane is designed with an elastic recoil characteristic. Its properties promote the juxtaposition of component skin pixels within the graft / membrane hybrid, promote primary adjacent healing of the skin graft pixels, and transform the skin appearance of the skin graft into a uniform sheet form. The In addition, the membrane aligns the microarchitectural component skin pixels so that the dermis is aligned with the dermis and the epidermis is aligned with the epidermis, thus facilitating a primary healing process that reduces scarring. In addition, pixelated skin grafts are more easily adapted to irregular recipient sites.

  The embodiments described herein include a pixel skin ablation technique, also referred to as a pixel technique. For many patients with aging-related skin relaxation (neck and face, arms, armpits, thighs, knees, buttocks, abdomen, braline, chest drop, etc.), partial resection of excess skin is a plastic surgery that causes scarring. Replace a considerable segment of. In general, the pixel technique is performed under local anesthesia in an office setting. The postoperative recovery period includes wearing support clothing for a number of days (eg, 5, 7, etc.) pre-designated in the treatment area (eg, 5 days, 7 days, etc.). It is expected that there will be no or relatively little pain associated with the technique. Small (eg 1.5 mm) circular skin defects are closed by applying an adhesive Flexan® sheet. The Flexan® sheet functions as a large butterfly bandage and is pulled in an orientation (“vector”) that maximizes aesthetic contouring of the treatment area. A compressible elastic garment may be applied over the bandage to further aid in aesthetic contouring. After completion of the initial healing phase, many small linear scars within the treatment area will not be visually noticeable. In addition, additional skin tightening will occur over a period of months due to the delayed wound healing response. The pixel approach is therefore a minimally invasive alternative to large scars in plastic surgery.

  The pixel array medical device of the embodiment includes a PAD kit. FIG. 1 shows a PAD kit placed at a target site under an embodiment. The PAD kit includes a flat perforated guide plate (guide plate), a sculpture punch or device containing a sculpture array (FIGS. 1-3), a supported adhesive film or substrate (FIG. 4), and a skin pixel crossing. A blade and (FIG. 5), but not limited thereto. The skull pet punch of the embodiment is a device that can be held by hand, but is not limited thereto. In an alternative embodiment, the guide plate is optional. This is detailed herein.

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

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

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

  Referring to FIG. 1, during the procedure using the PAD kit, a perforated guide plate is applied to the skin ablation / donor site. A scalp punch is applied through at least a collection of holes in the perforated guide plate to cut through the skin pixels. If the punch sculpture array contains fewer sculptures than the total number of holes in the guide plate, the sculpture punches are applied multiple times to multiple sets of holes. After one or more successive applications of the scalp punch, the incision skin pixel or plug is captured on the adhesive substrate. The adhesive substrate is applied to capture the skin pixels or plugs from which the adhesive has been extruded. For example, the top surface of the adhesive substrate of the embodiment is oriented within the frame (if a frame is used) with the adhesive side down and pressed onto the perforated plate to capture the extruded skin pixels or plugs It is done. As the membrane is lifted, the captured skin pixels are traversed at its base by a traversing blade.

  FIG. 6 illustrates skin pixel removal under an embodiment. The adhesive substrate is lifted from the target site and pulled back (separated). This action floats or pulls the incision skin pixel or plug. While the adhesive substrate is being lifted, a transverse blade is used to traverse the base of the incision skin pixel. FIG. 7 is a side view showing removing an incision skin pixel across a blade with a PAD kit, under an embodiment. Crossing the skin pixel or plug base completes pixel capture. FIG. 8 is an isometric view showing blade / pixel interaction during an approach using a PAD kit, under an embodiment. FIG. 9 is another view of the procedure using the PAD kit (excluding the blade for clarity), according to the embodiment, with the cut-in and acquired skin pixels or plugs and cut-outs. FIG. 5 shows both a previous non-resected skin pixel or plug. At the donor site, the pixelated skin ablation site is closed by applying Flexan® sheeting.

  Guide plates and scalp devices are also used to generate skin defects at recipient sites. The skin defect is configured to accept skin pixels captured or captured at the donor site. The guide plate used at the recipient site may be the same as the guide plate used at the donor site, or may be different with different patterns or hole configurations.

  Skin pixels or plugs placed on the adhesive substrate during traversal are then transferred to a skin defect site (recipient site). They are applied as pixelated skin grafts at the recipient skin defect site. The adhesive substrate has an elastic recoil characteristic, which allows a closer alignment of skin pixels or plugs within the skin graft. The incision skin pixel can be applied directly from the adhesive substrate to the skin defect at the recipient site. Application of the incision skin pixel at the recipient site includes aligning the incision skin pixel with the skin defect and inserting the incision skin pixel into the corresponding skin defect at the recipient site.

  The pixel array medical device of the embodiment includes a pixel array dermatome (PAD). The PAD comprises a flat array of relatively small circular sculptures that are held on a substrate (eg, an investing plate). A scalpet combined with a substrate is referred to herein as a scalpet array, a pixel array, or a scalpet plate. FIG. 10A is a side view of a portion of a pixel array, showing a sculpture held on an investing plate, under an embodiment. FIG. 10B is a side view of a portion of a pixel array according to an alternative embodiment, showing a sculpture held on an investing plate. FIG. 10C is a top view of the sculpture plate according to the embodiment. FIG. 10D is an enlarged view of a portion of a sculpture plate under an embodiment. Scalpet plates are applied directly to the skin surface. The one or more skull pets of the skull pet array include one or more of a pointed surface, a needle, and a needle including a plurality of tips.

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

  In order to leverage existing surgical instruments, the array of embodiments is used in conjunction with, or as a modification to, a drum dermatome, such as a paget dermatome or a leeds dermatome. The Paget Drum Dermatome, referred to herein, was originally developed by Dr. Earl Padget in the 1930s and continues to be widely used for skin transplantation by plastic surgeons around the world. Later, a Paget dermatome Leeds-type modification was developed to better calibrate the thickness of incorporated skin grafts. The drum dermatome according to the embodiment is disposable (every operation), but is not limited thereto.

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

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

  In one embodiment, the pixel drum 100 incorporates a sculpture array 106 on the surface of the drum 100, thereby providing a plurality of small (eg, 0.5-1. 5 mm) Create a circular incision. In certain embodiments, the boundary shape of the sculpture may be designed to reduce pinking (“trap door”) while creating a skin plug. The circumference of each skin plug can be extended by a sculpt to a semi-circular, oval or square skin plug in a non-limiting example instead of a circular skin plug. In certain embodiments, the length of the scalpet 106 may vary depending on the thickness of the skin area selected for skin grafting purposes by the surgeon, ie, the split or full layer.

  When the drum 100 is applied to the skin surface, a blade 108 provided inside the drum 100 traverses the base of each skin plug generated by the sculpture array. Inner blade 108 is connected to central drum accelerator / handle assembly 102 and / or connected to an outrigger attached to central accelerator assembly 102. In an alternative embodiment, the inner blade 108 is not connected to the drum accelerator assembly 102 and the skin incision base is traversed. In some embodiments, the inner blade 108 of the pixel drum 100 is manually oscillated or moved by an electric motor. Depending on the density of the circular sculpture on the drum, variable areas of the skin (eg, 20%, 30%, 40%, etc.) are traversed in the area of excess skin relaxation.

  In one embodiment, an additional pixel drum harvester 112 is provided within the drum 100 and incorporates a crossed / pixelated skin incision / plug (pixel graft tissue) from the tissue of the pixel donor to provide a pixel drum. The skin transplantation operation is performed by aligning on the adhesive films 110 arranged inside 100. A narrow space for the inner blade 108 is created between the sculpture array 106 and the adhesive film 110.

  In one embodiment, the blade 108 is provided outside the drum 100 and the sculpture array 106 where the base of the incision circular skin plug is traversed. In other embodiments, the outer blade 108 is connected to the drum accelerator assembly 102 when the skin incision base is traversed. In an alternative embodiment, the outer blade 108 is not connected to the drum accelerator assembly 102 when the skin incision base is traversed. The adhesive film 110 draws and aligns the crossed skin segment and is then placed on the patient's skin defect site. The blade 108 (whether internal or external) may be a windowed layer of blades aligned with the sculpture array 106, but is not limited thereto.

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

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

  During the uptake of the drum dermatome approach, the PAD sculpture array is applied directly to the skin surface. A drum dermatome is placed on top of the sculpture array to place a load on the underlying skin surface in order to incise the skin pixels circumferentially. As the load continues to be applied, the incision skin pixels are pushed through the holes in the sculpture array and captured on the drum dermatome adhesive film. A dermatome cutting outrigger blade (placed on top of the sculpture array) traverses the base of the extruded skin pixel. The membrane and pixelated skin composite is then removed from the dermatome drum and applied directly to the recipient skin defect as a skin graft.

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

  FIG. 13A is an isometric view of the application of a drum dermatome (e.g., paget dermatome) to a sculpture plate, according to an embodiment, wherein the adhesive film is rolled before the drum is rolled over the investing plate. Applies to that drum of Dermatome. FIG. 13B is a side view of a portion of a drum dermatome, showing the position of the blade relative to the sculpture plate, under an embodiment. FIG. 13C is a side view of a portion of a drum dermatome, according to an embodiment, showing different positions of the blade relative to the sculpture plate. FIG. 13D is a side view of a drum dermatome with other positions of the blade relative to the sculpture plate, under an embodiment. FIG. 13E is a side view of a drum dermatome with a cross-cutting blade clip, according to an embodiment, showing the crossing of skin pixels with the blade clip. FIG. 13F is a bottom view of a drum dermatome along a sculpture plate, under an embodiment. FIG. 13G is a front view of a drum dermatome along a sculpture plate, under an embodiment. FIG. 13H is a rear view of a drum dermatome along a sculpture plate, under an embodiment.

  Depending on the clinical application, Drum dermatome disposable adhesive membranes can be used to place / place excised relaxed skin and to incorporate / align pixelated skin grafts.

  Embodiments described herein include a pixel-on-lay sleeve (POS) used with a dermatome, such as a paget dermatome or a leeds dermatome.

  FIG. 14A shows an assembled view of a dermatome with a pixel onlay sleeve (POS), under an embodiment. The POS comprises a dermatome and a blade, which are incorporated together with an adhesive backer, adhesive and a sculpture array. The adhesive backer, adhesive and sculpture array are integrated into the device, but are not limited to this.

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

  POS, also referred to herein as a “sleeve”, provides a disposable drum dermatome onlay for partial excision of excess relaxed skin and partial skin transplantation of skin defects. The onlay sleeve is used in conjunction with a Paget dermatome or a Leeds dermatome as disposable components. The POS of the embodiment is a three-sided slip-on disposable sleeve that engages a drum dermatome. The device comprises an adhesive surface and a sculpture drum array with an internal transverse blade. The transverse blade of the embodiment includes a single-edged cutting surface that is swung across the inner peripheral surface of the sculpture drum array.

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

  The embodiments described herein include a slip-on PAD configured as a disposable device with either a Paget dermatome or a Leeds dermatome. FIG. 15A shows a slip-on PAD that slides on a paget drum dermatome, under an embodiment. FIG. 15B shows an assembly view of a slip-on PAD installed on a paget drum dermatome, under an embodiment.

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

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

  The pixel instrument embodiments described herein include a pixel drum dermatome (PD2) that is a disposable instrument or device. PD2 includes a cylinder or rotating / rotating drum coupled with a handle, and the cylinder includes a sculpture drum array. The inner blade is connected to the drum shaft / handle assembly and / or to an outrigger attached to the central shaft. According to the PAD and POS described herein, multiple small pixelated excisions of the skin are made directly into the area of skin relaxation so that skin tightening can be enhanced while minimizing visible scars.

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

  The PD2 device applies the entire rotating / rotating drum to the skin surface. There, a plurality of small (eg, 1.5 mm) circular incisions are created at the target site by the “Scalpet Drum Array”. The base of each skin plug is then traversed by an internal blade. The inner blade is coupled to the central drum accelerator / handle assembly and / or to an outrigger attached to the central accelerator. Depending on the density of the circular skullpet on the drum, a variable percentage of the skin is traversed. Although PD2 makes it possible to cross part of the surface area of the skin (eg 20%, 30%, 40%, etc.) without leaving visible scars in the area of excessive skin relaxation, Is not limited to this.

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

  The pixel array medical systems, instruments or devices, and methods described herein may cause or enable cellular and / or extracellular responses that are essential for the clinical outcome to be achieved. For pixel dermatomes, the physical contraction of the skin surface occurs due to pixelated ablation of the skin, i.e. the creation of skin plugs. In addition, subsequent skin tightening results from a delayed wound healing response. As detailed herein, each pixelated ablation initiates a mandatory wound healing sequence in multiple phases.

  The first phase of this sequence is the inflammatory phase, where degranulation of mast cells releases histamine into the “wound”. Histamine release causes dilation of the capillary bed and increases vascular permeability into the extracellular space. This initial wound healing response occurs within the first day and appears as erythema on the skin surface.

  The second phase (of fibrosis) begins within 3-4 days of the “wound”. During this phase there is fibroblast metastasis and mitotic growth. Wound fibrosis involves the deposition of new collagen and myofibroblastic contraction of the wound.

  Histologically, the deposition of new collagen can be identified microscopically as cell consolidation and thickening of the dermis. Although this is a static process, the wound tension increases considerably. Another component of fibroproliferation is that it is a dynamic physical process that causes multidimensional contraction of the wound. This component feature of fibroproliferation is due to active cellular contraction of myofibroblasts. Morphologically, the myoblastic contraction of the wound will be visualized as a two-dimensional tightening of the skin surface. Overall, the effect of fibroproliferation is dermal contraction with a reinforced framework due to the deposition of new collagen as a static support scaffold material. The clinical effect manifests as a delayed tightening of the skin with a smooth feel over several months. In general, the clinical endpoint is a skin envelope that looks more youthful in the treatment area.

  The third and final phase of the delayed wound healing response is maturity. During this phase, strengthening and remodeling of the treatment area occurs due to increased interlinkage of the (dermal) collagen fiber matrix. This final stage begins within 6 to 12 months after the “wound” and may last at least 1 to 2 years. Small pixelated excision of the skin preserves the normal dermal architecture during this delayed wound healing process, which does not involve the production of noticeable scars. The scar often occurs with surgical removal of larger skin. Finally, the release of epidermal growth hormone results in the associated stimulation and rejuvenation of the epidermis. A delayed wound healing response can be triggered with scar collagen deposition in tissues with minimal existing collagen matrix (such as muscle and fat).

  In addition to skin tightening for aesthetic purposes, the pixel array medical systems, devices or devices, and methods described herein have additional medical related applications. In certain embodiments, the pixel array device can traverse variable portions of any soft tissue structure without resorting to standard surgical excision. Specifically, reducing the actinic damage area of the skin via the pixel array device will reduce the incidence of skin cancer. For the treatment of sleep apnea syndrome and snoring, pixelated mucosal reduction (soft palate, base of tongue and pharyngeal sidewall) via a pixel array device will reduce the significant unhealth associated with more standard surgery. Let's go. For vaginal cap delivery trauma, pixelated skin and vaginal mucosal resection via a pixel array device will re-establish normal pre-partum shape and function without A & P resection. Related female stress urinary incontinence can also be corrected in a similar manner.

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

  The PAD includes an apparatus with a housing configured to contain a scalpel device. The sculpture device includes a substrate and a sculpture array, and the sculpture array includes a plurality of sculptures arranged in a configuration on the substrate. The substrate and the plurality of scalpets are configured to exit and enter the housing, and the plurality of scalpets are configured to generate a plurality of incision skin pixels at the target site when exiting. The proximal end of the control device is configured to be hand held. The housing is configured to be removably coupled with a receiver that is a component of the control device. The control device includes a proximal end that includes a drive mechanism and a distal end that includes a receiver. The control device is configured to be disposable, but alternatively the control device is configured to perform at least one of cleaning, disinfection, and sterilization.

  The sculpture array is configured to exit in response to activation of the drive mechanism. The scalpet device of the embodiment is configured such that the sculpture array exits the sculpture device and enters the sculpture device in response to the activation of the drive mechanism. The alternative embodiment sculpture device is configured to cause the sculpture array to exit the sculpture device upon activation of the drive mechanism and back into the sculpture device upon release of the drive mechanism. .

  FIG. 18 shows a side perspective view of a PAD assembly, under an embodiment. The PAD assembly of the present embodiment includes a control device including a sculpture device including a sculpture array and an actuator or a trigger, which is configured to be handheld. Although the control device is reusable, an alternative embodiment includes a disposable control device. Embodiment scalpet arrays are configured to generate or create an incision array (eg, 1.5 mm, 2 mm, 3 mm, etc.), as detailed herein. Embodiments of the scalpet device include a spring-loaded scalpet array configured to incise the skin as detailed herein, although embodiments are not limited thereto.

  FIG. 19A shows a top perspective view of a sculpture device used with a PAD assembly, under an embodiment. FIG. 19B shows a bottom perspective view of a sculpture device used with a PAD assembly, under an embodiment. The sculpture device includes a housing configured to receive a substrate coupled to or including a plunger. The housing is configured such that the proximal end of the plunger protrudes from the top surface of the housing. The housing is configured to be removably coupled to the control device, and the length of the plunger is configured to protrude from the top surface by a distance that contacts the control device and actuator when the scalpet device is coupled to the control device. The

  The substrate of the sculpture device is configured to hold a number of sculptures forming a sculpture array. The sculpture array comprises a predesignated number of sculptures to be suitable for the procedure in which the sculpture device assembly is used. The sculpture device includes at least one spring mechanism that is configured to provide a downward or impact or punching force in response to activation of the sculpture array device. This force helps to create an incision (pixelated skin excision site) with a sculptpet array. Alternatively, the spring mechanism may be configured to provide an upward or retracting force to assist in retraction of the skullpet array.

  One or more of the skull pet device and the control device of the embodiment include an encryption system (e.g., EPROM). The encryption system is configured to prevent unauthorized use and piracy of the skull pet device and / or control device, but is not limited thereto.

  During surgery, the skull pet device assembly is applied once to the target area, or alternatively, subsequently applied within the designated target treatment area of skin relaxation. As detailed herein, the pixelated skin resection sites within the treatment area are then closed by applying Flexan sheeting, and these pixelated resection directional closures are used for aesthetic modification of the treatment site. Done in a direction that provides maximization.

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

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

  Yet another alternative embodiment PAD device includes a vacuum component or system and an RF component or system. The PAD of the present embodiment includes a vacuum system or component within the handpiece for aspirating and removing incision skin pixels. The vacuum component is removably coupled to the PAD device and its use is optional. The vacuum component is configured or coupled to create a low pressure zone in or adjacent to one or more of the housing, the scalpel device, the scalpel array, and the control device. The low pressure zone is configured to remove the incision skin pixel. In addition, the PAD device includes an RF component that provides or couples energy in or adjacent to one or more of the housing, sculpture device, sculpture array, and control device. Configured to be coupled to it. The RF component is removably coupled to the PAD device and its use is optional. The energy provided by the RF component includes one or more of thermal energy, vibration energy, rotational energy, acoustic energy, and the like.

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

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

  In addition to partial incision at the donor site, partial skin tissue transplantation involves the incorporation and placement (eg, on an adhesive film) of a skin plug for transfer to the recipient site. Similar to partial skin ablation, the use of a duty-driven RF cutting edge on the sculpture array makes it easier to cut the donor skin plug. The base of the incision sculpture is then traversed and incorporated as detailed herein.

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

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

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

  Software control allows different variations to provide an optimal solution for the combined sequence of RF cutting and electromechanical cutting and vacuum assist. Examples include, but are not limited to, electromechanical cutting with vacuum assist, RF cutting with electromechanical cutting and vacuum assist, RF cutting with vacuum assist, and RF cutting with vacuum assist. Examples of synthetic software controlled duty cycles include pre-cutting vacuum skin stabilization period, RF cutting duty cycle with vacuum skin stabilization period, RF cutting duty cycle with vacuum skin stabilization and electromechanical cutting period, Electromechanical cutting with a vacuum skin stabilization period and post-cutting RF duty cycle to heat conductively heat the deeper dermis layer and / or dermis tissue layer and cause a wound healing response for skin tightening; Including, but not limited to, a post-cut vacuum period for skin tightening.

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

  In other skin graft embodiments, the pixel graft is placed on an irradiated cadaver dermal matrix (not shown). When cultured on the dermal matrix, full-thickness skin grafts for patients immunologically identical to the pixel donor are generated. In an embodiment, the cadaver dermis matrix may be resected in a cylinder with a size similar to the captured skin pixel graft, in which case the pixelated graft is systematically aligned within the cadaver dermis framework. Can do. FIG. 22 shows a cylindrically cut cadaver dermis matrix that resembles a size-captured skin pixel graft under an embodiment. In certain embodiments, the rate of donor site uptake may be determined in part depending on the induction of normal dermal tissue at the recipient's skin defect site. That is, the normal (smooth) surface topology of the skin graft is promoted. According to the adhesive membrane embodiment or the dermal matrix embodiment, the pixel drum harvester has the ability to incorporate a large surface area for implantation while significantly reducing or eliminating visible scars at the patient's donor site. Including.

  In addition to the pixel array medical device described herein, embodiments include a drug delivery device. In most cases, parenteral administration of the drug is still accomplished by syringe and needle injection. To circumvent the negative features of needle and syringe systems, transdermal drug local absorption through an occlusive patch has been developed. However, both of these drug delivery systems have major drawbacks. Human aversion to needle injection has not softened during its nearly two-century period of use. Variable systemic absorption of subcutaneous or intramuscular drug injection reduces the efficacy of the drug and increases the likelihood of side effects on the patient. Depending on the drug liquid or aqueous carrier fluid, topically applied occlusive patches suffer from variations in absorption through the epidermal barrier. For patients who require local anesthesia across a large surface of the skin, neither syringe / needle injection nor surface anesthesia is ideal. Syringe / needle “field” injections are often painful and can inject an excessive amount of local anesthesia that can cause systemic toxicity.

  Surface anesthesia rarely provides the level of anesthesia necessary for skin related surgery.

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

  FIG. 24A is a side view of a needle array drug delivery device 300 according to an embodiment. FIG. 24B is an upper isometric view of the needle array drug delivery device 300, under an embodiment. FIG. 24C is a lower isometric view of the needle array drug delivery device 300, under an embodiment. The drug delivery device 300 comprises a flat array 312 of sharp needles of uniform length disposed on a manifold 310 and is used for drug administration. In this exemplary embodiment, the injectable drug is held in a syringe 302 that is plugged into a disposable adapter 306 with a handle. The seal 308 can be used to ensure that the syringe 302 and the disposable adapter 306 are firmly coupled together. When the syringe plunger 304 is pushed, the medicine held in the syringe 302 is conveyed from the syringe 302 to the disposable adapter 306. When the needle array 312 is pressed against the patient's skin until the manifold 202 hits the skin, the drug is further administered through the flat array 312 of sharp needles at a uniform depth into the patient's skin.

  Use of the drug delivery device 200 may have as many clinical applications as there are drugs that require percutaneous injection or absorption. As a non-limiting example, some potential applications include injection of local anesthesia, injection of neuromodulators such as botulinum toxin (botox), injection of insulin, and replacement of estrogen and corticosteroids ,including.

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

  Another application of pixel skin graft capture with a PAD (pixel array dermatome) device detailed herein is alopecia. Alopecia is a common aesthetic disease that is common in middle-aged men but is also found in aged baby boomer women. The most common form of alopecia is androgenetic alopecia (MPB), which occurs in the area from the top of the scalp to the frontal region. Male pattern baldness is a gender-linked characteristic and is inherited in offspring by the X chromosome from the mother. For men, only one gene is needed to represent this trait. Since the gene is recessive, female pattern alopecia requires inheritance of both X-linked genes from both father and mother. Expression varies from patient to patient and is often expressed by age of onset and amount of frontal / partial / occipital hair loss. Variations in MPB phenotypic expression from patient to patient depend on the genotype translation variability of this gender-linked characteristic. Since MPB is inherited, the need for hair transplantation is enormous. Other non-genetic related etiologies are found in a more limited population segment. These non-genetic etiologies include trauma, bacterial infections, lupus erythematosus, radiation and anticancer drug treatment.

  Various treatment options have been proposed to the public. These include FDA approved coatings such as minoxidil and finasteride. These drugs have had limited success because they need to convert dormant hair follicles into the active growth phase. Other treatments include wigs and hair weaving. Conventional means are also surgical hair transplants, which involve transferring hair plugs, strips and flaps from a hairy scalp to a hairless scalp. Often, conventional hair transplantation involves transferring multiple single hair micrographs from a hairy scalp to the hairless scalp of the same patient. Alternatively, the donor plug is first captured as a hair strip and then divided into micrographs for transfer to the recipient scalp. In any case, this multi-step procedure is very expensive and involves hours of surgery on the average patient.

  The traditional hair transplant market has been hampered by long hair transplant procedures performed in several stages. A typical hair transplantation procedure involves the transfer of a hair plug from the bald scalp donor site to the bald scalp to frontal scalp recipient site. For many procedures, each hair plug is individually transferred to the recipient scalp. During the surgery, hundreds of plugs are implanted and this takes hours to do. The post-operative “take” or survival rate of the implanted hair plug is variable depending on factors that limit angiogenesis at the recipient site. Exercise bleeding and mechanical damage are key factors that reduce angiogenesis and “take” of hair transplant tissue.

  Embodiments described herein include a surgical instrument configured to transfer several hair grafts at a time, which are held together and aligned at a scalp recipient site. To do. The technique described in this specification using the PAD of the embodiment reduces the annoyance and time required by conventional instruments.

  FIG. 25 shows the structure of the human skin. The skin contains two horizontal layers called the dermis and epidermis and acts as a biological barrier to the external environment. The epidermis is an envelope layer and includes a layer capable of growing epidermal cells. Epidermal cells migrate upward and “mature” into a non-viable layer called the stratum corneum. The stratum corneum is a lipid-keratin hybrid and functions as the main biological barrier. This layer is always peeled and reconstructed in a process called desquamation. The dermis is the underlying layer that is the main structural support of the skin, and is largely extracellular and consists of collagen fibers.

  In addition to the horizontal stratified epidermis and dermis, the skin contains vertically aligned elements or cellular appendages. It contains a hair follicular sebaceous unit, which contains a hair follicle and a sebaceous gland. Each of the follicular sebaceous unit includes a sebaceous gland and a hair follicle. The sebaceous glands are closest to the surface and release sebum (oil) into the shaft of the hair follicle. The base of the hair follicle is called a valve. The base of the valve has a deep reproductive component called the dermal papilla. The hair follicles are typically arranged at an angle with respect to the skin surface. The hair follicles in a given area of the scalp are arranged to be parallel to each other. Although the follicular sebaceous unit is common throughout the entire outer skin, the density and activity of these units within the region of the scalp are key to the overall appearance of the hair.

  In addition to the follicular sebaceous unit, sweat glands extend vertically through the skin. They provide a water-based leachate that helps regulate body temperature.

  Apocrine sweat glands in the axilla and groin result in more irritating sweat, which causes body odor. For the rest of the body, the eccrine sweat glands drain hypoallergenic sweat to regulate temperature.

  Hair follicles go through different physiological cycles of hair growth. FIG. 26 shows the physiological cycle of hair growth. The presence of testosterone in genetic men produces a variable degree of alopecia in the scalp from the parietal to frontal. Basically, the hair follicle enters a resting state by entering the resting period without returning to the growth period. Male pattern baldness occurs when the hair fails to return from resting to growing.

  The PAD of the embodiment is configured for collective loading of plugs with hair accompanied by collective transplantation of hair-carrying plugs into a scalp without hair. This shortens conventional hair transplant surgery. In general, the devices, systems and / or methods of the embodiments are used to capture and align a large number of small hair carrying plugs in a single surgical step or process. Also, the recipient site is prepared by performing multiple pixel excision of the scalp without hair using the same instrument. A plurality of hair plug transplant tissues are transferred to a prepared recipient site in a lump and transplanted in a lump. As a result, hundreds of hair-carrying plugs can be transferred from the donor site to the recipient site through the use of a simplified approach. Thus, hair transplantation using the embodiments described herein provides a solution that is a simple procedure that is simpler, simpler and saves considerable time over cumbersome and multi-step conventional processes.

  Hair transplantation using the pixel dermatome of the embodiment facilitates improvements over the conventional standard hair follicle unit extraction (FUT) hair transplant approach. In general, under the technique of the embodiment, the hair follicle to be taken up is taken from the occipital scalp of the donor. In doing so, the hair at the donor site is partially cut and the perforated plate of the embodiment is placed on the scalp and oriented to provide maximum yield. FIG. 27 illustrates uptake of donor hair follicles under an embodiment. The skull pet of the skull pet array is configured to reach the subcutaneous fat layer to obtain a hair follicle. As detailed herein, once the hair plugs are incised, they are incorporated onto the adhesive membrane by traversing the base of the hair plug with a transverse blade. By applying an adhesive film before traversing the base, the original mutual arrangement of the hair plugs at the donor site is maintained. The aligned matrix of hair plugs on the adhesive membrane is then implanted in bulk into the recipient site of the scalp from the top of the recipient to the front.

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

  An adhesive film carrying the incorporated hair plug is applied over the same pattern of scalp defect at the recipient site. For each row, each hair-carrying plug is inserted into the recipient defect in its mirror image relationship. FIG. 29 shows the arrangement of incorporated hair plugs at a recipient site, under an embodiment. The alignment between plugs is maintained. Thus, hair that grows from an implanted hair plug lines up as naturally as it grows at the donor site. A more uniform alignment between the original scalp and the transplanted hair will also occur.

  Specifically, the donor site hair is partially cut to prepare for placement or placement of the perforated plate on the scalp. A perforated plate is placed at the occipital scalp donor site to provide maximum yield. FIG. 30 shows the placement of a perforated plate at the donor site of the occipital scalp, under an embodiment. Mass uptake of the hair plug is accomplished using a spring-loaded pixelated device with an impact punch handpiece with a skull pet disposable end. Embodiments are configured for the incorporation of individual hair plugs using off-the-shelf FUE extraction devices or biopsy punches. The pore size of the perforated plate supplied covers ready-made technology.

  A skull pet with a skull pet array disposable end is configured to reach the subcutaneous fat layer to obtain a hair follicle. FIG. 31 shows the penetration depth of the skull pet into the skin when the skull pet is configured to penetrate the subcutaneous fat layer and obtain a hair follicle under the embodiment. Once the hair plugs are incised, they are incorporated on the adhesive film by traversing the base of the hair plug with a transverse blade, but is not limited to this. FIG. 32 illustrates hair plug uptake using a perforated plate at the occipital donor site, under an embodiment. By applying the adhesive film of the embodiment, the original mutual arrangement of the hair plugs is maintained. An adhesive film is applied before traversing the base of the resected pixel, but is not limited to this. The aligned matrix of hair plugs on the adhesive membrane is then implanted in bulk into the scalp recipient site from the parietal to frontal.

  Additional single hair plugs may be incorporated through the perforated plate. This is used, for example, to create a visible hairline. FIG. 33 shows the generation of a visible hairline under the embodiment. Visible hairline is determined and made with manual FUT technology. Visible hairline and mass transplantation of vertices may be performed simultaneously or as separate stages. If visible hairline and mass transplant are performed simultaneously, the recipient site is developed starting with a visible hairline.

  Implanted hair plug implantation involves preparing a recipient site by excising a hairless skin plug in a pattern that is structurally identical to the pattern of the captured occipital scalp donor site. FIG. 34 illustrates the preparation of a donor site for generating identical skin defects at a recipient site using a patterned perforated plate and a spring pixelated device, under an embodiment. The recipient site of the embodiment is prepared for mass implantation of hair plugs using the same perforated plate and spring pixelated device used at the donor site. A scalp defect is generated at the recipient site. These scalp defects have the same geometric shape as the plugs incorporated on the adhesive film.

  An adhesive film carrying the incorporated hair plug is applied over the same pattern of scalp defect at the recipient site. For each row, each hair follicle possession or hair possessing skin plug is inserted into a recipient defect that is in its mirror image. FIG. 35 illustrates implantation of an incorporated plug by inserting the incorporated plug into a corresponding skin defect created at the recipient site, under an embodiment. The alignment between plugs is maintained. Thus, hair that grows from an implanted hair plug lines up as naturally as it grows at the donor site. A more uniform alignment between the original scalp and the transplanted hair will also occur.

  The clinical endpoint varies from patient to patient, but a higher rate is expected than the hair plug "takes" as a result of improved angiogenesis. FIG. 36 illustrates a clinical endpoint using a pixel dermatome instrument and technique, under an embodiment. The combination of a better “take”, a shorter surgical period and a more natural looking result enables the pixel dermatome device and technique of the embodiment to overcome the shortcomings of conventional hair transplant approaches.

  Embodiments of pixelated skin grafts for skin defects and pixelated skin resections for skin relaxation are detailed herein. These embodiments remove skin pixel fields in relaxed skin areas where skin tightening is desired. Skin defects created by this approach (eg, in the range of about 1.5-3 mm in diameter) are small enough to provide primary healing without leaving visible scars. Occlusion of a plurality of skin defect wounds is directed to produce a desired contouring effect. Animal experiments with pixel removal techniques have performed well.

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

  Additional skin tightening will occur over a period of months from the delayed wound healing response. As a result, the pixel approach is the least invasive alternative for skin tightening in areas where large scars of conventional cosmetic surgery should be avoided.

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

  The first phase of this sequence is the inflammatory phase, where degranulation of mast cells releases histamine into the “wound”. Histamine release causes dilation of the capillary bed and increases vascular permeability into the extracellular space. This initial wound healing response occurs within the first day and appears as erythema on the skin surface.

  Within a few days of the “wound”, the second phase of healing or fibrosis begins. During fibrosis, there is fibroblast metastasis and mitotic proliferation.

  Fibrosis has two key features. That is, the deposition of new collagen and the myofibroblastic contraction of the wound. Histologically, the deposition of new collagen is microscopically identified as cell compaction and thickening of the dermis. Although this is a static process, the skin tension increases considerably. Myoblastic contraction is a dynamic physical process that causes two-dimensional tightening of the skin surface. This process results from active cell contraction of myofibroblasts and the deposition of contractile proteins within the extracellular matrix. Overall, the effect of fibroproliferation is dermal contraction and the deposition of new collagen as a static supporting scaffold material with a reinforcing framework. The clinical effect manifests as a delayed tightening of the skin with a smooth feel over several months. The clinical endpoint is a skin envelope that looks more youthful in the treatment area.

  The third and final phase of the delayed wound healing response is maturity. During maturation, strengthening and remodeling of the treatment area occurs due to increased interlinkage of the (dermal) collagen fiber matrix. This final stage begins within 6 to 12 months after the “wound” and may last at least 1 to 2 years. Small pixelated excision of the skin preserves the normal dermal architecture during maturation, but this does not involve the production of noticeable scars. The scar often occurs with surgical removal of larger skin. Finally, the release of epidermal growth hormone results in the associated stimulation and rejuvenation of the epidermis.

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

  Eleven days after surgery, all resections within the area designated by the tattoo were healed primarily, and photographic and dimensional measurements were made. FIG. 39 is an image 11 days after surgery, showing the primary healing of the ablation with the measured margin, under the embodiment. At 29 days after surgery, photographic and dimensional measurements were subsequently made. FIG. 40 is an image after 29 days of surgery under the embodiment, showing the ablation is primarily cured and the primary maturation of the ablation field continues with the measured margin. is there. FIG. 41 is an image after 29 days from surgery under the embodiment, showing the ablation primarily heals and the primary maturation of the ablation field continues with measured lateral dimensions. It is.

  Photographic and dimensional measurements were repeated 90 days after surgery. The skin in the test area was completely smooth to the touch. FIG. 42 is an image after 90 days after surgery, according to an embodiment, showing the ablation primary healing and primary maturation of the ablation field along with measured lateral dimensions. It is.

  The partial ablation described herein is performed intradermally or across the entire thickness of the dermis. The ability to incise the skin with a scalpet (eg, round, square, oval, etc.) is enhanced by the addition of additional forces. The additional force includes a force applied to the sculpture or sculpture array, for example, the force includes one or more of a rotational force, a kinematic impact force, and a vibration force, all of which are for partial excision of the skin. Detailed herein.

  The skull pet device of the embodiment generally includes a skull pet assembly and a housing. The sculpture assembly includes a sculpture array, which includes a plurality of sculptures and force or drive components. The sculpture assembly includes one or more alignment plates that accurately maintain and position the sculpture according to the array of sculpture arrays and force from the operator (eg, z-axis) to the target tissue to be excised Configured to communicate. The sculpture assembly includes a spacer, which is configured to maintain the alignment plate so that the alignment plates are a fixed distance apart from each other and coaxial with the sculpture array.

  The shell is configured to maintain the spacer and alignment plate and includes attachment points for the housing and drive shaft. Alignment plates and / or spacers are attached or connected to the location of the shell (eg, mating, welding (eg, ultrasonic, laser, etc.), heat stake, etc.), thus providing a solid assembly and sculpture array It has become difficult to tamper with and use for other purposes. In addition, the shell can protect the drive mechanism, i.e., gears and skullpets, from contamination during use, and can lubricate gears (if necessary) to reduce torque requirements and extend gear life. And

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

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

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

  By reducing the force required to penetrate the skin, the ability to incise the skin with a circular scalpet is significantly enhanced. Such a reduction is brought about by the rotational movement around the central axis and / or the addition of impact forces along the central axis. FIG. 43 is a sculpture showing an applied rotational force and / or impact force according to an embodiment. This enhanced rotational configuration has an effect similar to a surgeon incising the skin with a standard scalpet. There, the surgeon cuts the skin surface more efficiently by using a combination of movement across the skin (kinetic energy) and simultaneous application of compression (axial force). The impact force is similar to using a staple gun or by moving the hypodermic needle quickly before hitting the skin.

  A consideration in the configuration of the sculpture rotation is the amount of torque used to drive the sculptures at a desired speed. This is because the physical size and power of the system used to drive the sculpture array increases as the required torque increases. In order to reduce the incision force required in the sculpture array, the columns or rows or segments of the array may be driven individually or in turn during application of the array. Approaches for rotating the sculpture include, but are not limited to, gears, spirals, slots, inner spirals, pin drives, and friction (elasticity).

  Scalpet arrays configured for partial ablation using a combination of rotation and axial incision use one or more device configurations for rotation. For example, the device's sculpture array uses one or more of a gear rotation or vibration mechanism, an outer helical rotation or vibration mechanism, an inner helical rotation or vibration mechanism, a slot rotation or vibration mechanism, and a pin-driven rotation or vibration mechanism. Although configured to rotate, it is not limited to this. Each of the rotating mechanisms used in the various embodiments is described in detail herein.

  FIG. 44 shows a gear sculpture and an array including gear sculptures, under an embodiment. FIG. 45 is a lower perspective view of an ablation device including a sculpture assembly with a gear sculpture array, according to an embodiment. The device comprises a housing (drawn as a transparent object for clarity of details) configured to include a gear sculpture array for application of rotational torque for sculpture rotation. FIG. 46 is a lower perspective view of a sculpture assembly (housing not shown) with a gear sculpture array, according to an embodiment. FIG. 47 is a detailed view of the gear sculpture array under the embodiment.

  The gear sculpture array includes a number of sculptes appropriate to the ablation technique in which the array is used, with a gear connected to each sculpture. For example, the gear is fitted on or around the skull pet, but the embodiment is not limited thereto. The gear sculpture is configured as a unit or array so that each sculpture rotates with the next sculpture. For example, when fitted, the gear sculptures are mounted together on the alignment plate, where each sculpture engages and rotates with the next four sculptes and is thus maintained in the correct alignment. The gear sculpture array is driven by, but is not limited to, at least one rotating outer shaft with a gear at the distal end. The rotating shaft is configured to provide or transmit an axial force that presses the array sculpture against the skin during the incision. Alternatively, an axial force may be applied to the plate that maintains the skullpet.

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

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

  The helical sculpture configuration includes a sleeve configured to fit into an end region of the sculpture, and the outer region of the sleeve includes one or more helical screws. As each scalpet fits into the sleeve, the sleeved scalpet is configured as a unit or array such that each scalpet rotates with the next scalpet.

  Alternatively, the helical screw may be formed on each scalpet or as a component of each scalpet.

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

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

  FIG. 58 shows a slot sculpture and an array including slot sculptures, under an embodiment. The slot sculpture configuration includes a sleeve configured to fit in an end region of the sculpture, the sleeve including one or more spiral slots.

  Alternatively, each skull pet includes a spiral slot without the use of a sleeve. The sleeved skull pet is configured as a unit or array such that the upper regions of each skull pet slot are aligned next to each other. The outer drive rod is aligned with the top of the slot and is fitted horizontally along the top. When the drive rod is driven downward, the result is a rotation of the sculpture array. FIG. 59 shows a portion of a slot sculpture array (eg, four (4) sculpts) with a drive rod, under an embodiment. FIG. 60 illustrates an exemplary slot sculpture array (eg, 25 sculptures) with a drive rod, under an embodiment.

  FIG. 61 shows a vibrating pin drive assembly with a sculpture, under an embodiment. The assembly includes a lower plate and an intermediate plate connected or coupled to the sculpture and configured to maintain the sculpture. The upper plate or drive plate is located in the area above the sculpture and the intermediate plate and includes a drive slot or slot. The pin is connected or coupled to the top of the sculpture, and the top of the pin extends beyond the sculpt. The slot is configured to receive a pin and to allow the pin to loosely fit. The slot is positioned relative to the pin so that the rotation or vibration of the upper plate causes the sculpture to rotate or vibrate through the pin trajectory within the slot.

  One or more components of the sculpture device include adjustments configured to control the amount (eg, depth) of sculpture exposure during deployment at the target site of the sculpture array. For example, the adjustments of the embodiments are configured to collectively control the length of the skull pet deployment of the skull pet array. Alternative embodiment adjustments are configured to collectively control the length of a collection or partial deployment of a skullpet in a skullpet array. In another exemplary embodiment, the adjustment is configured to individually control the length of each deployment of individual scalpets in the set of scalpets of the scalpet array. Skullpet depth control includes a number of mechanisms configured for adjustable control of the depth of the skullpet.

  The depth control of the embodiment includes an adjustable collar or sleeve provided on each skull pet. The collar is configured to move along the length of the skullpet (eg, slidable, etc.) and to prevent the skullpet from entering the target tissue beyond a depth controlled by the position of the collar Composed. Before being used in surgery, the position of the collar is adjusted by the user of the skull pet device, which is one of manual adjustment, automatic adjustment, electronic adjustment, pneumatic adjustment and adjustment under software control. Including the above.

  An alternative embodiment depth control includes an adjustable plate configured to move along the length of the skullpet of the skullpet array. The plate is configured to prevent intrusion of the skullpet array into the target tissue beyond a depth controlled by the position of the plate. In this way, the sculpture array is deployed into the target tissue by a depth equivalent to the length of the sculpture protruding from the plate. Prior to use in surgery, the position of the plate is adjusted by the user of the scalpet device, which is one of manual adjustment, automatic adjustment, electronic adjustment, air pressure adjustment and adjustment under software control. Including the above.

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

  Embodiments include a mechanical sculpture array in which axial and rotational forces are manually applied by a pressing force from a device operator. FIG. 63 illustrates a skull pet assembly that includes a skull pet array (eg, helical) configured to be manually driven by an operator, under an embodiment.

  Embodiments include and / or connect or couple with a rotation source configured to provide rotation (eg, RPM) and rotation torque suitable for incising the skin in combination with axial force Is done. A suitable rotation of the skullpet is set according to the best balance between rotational speed and increasing cutting efficiency and increasing friction loss. Suitable rotations for each sculpture array configuration include the size of the array (number of sculptures), sculpture section geometry, sculpture and alignment plate material selection, gear material and lubricant use, and skin machine Based on one or more of the physical properties.

With respect to the forces to be considered in the configuration of the skullpet and the skullpet array described herein, FIG. Parameters that are considered in determining the force that can be applied under an embodiment include:
Average skull pet radius: r
Scalp speed: ω
Scalpet axial force: F _n (Scalpet is applied perpendicular to the skin)
Skin friction coefficient: μ
Friction force: F _f
Skull Pet Torque: τ
Motor power: P _hp

During the initial application, the torque used to rotate the sculpture is the axial force (applied perpendicular to the surface of the skin), the coefficient of friction between the sculpette and the skin, Is a function of This frictional force initially acts on the cut surface of the skull pet. On the first application to the skin of a skullpet:
F _f = μ · F _n
τ = F _f · r
P _hp = τ · ω / 63025
The initial force for the sculpture to penetrate the skin is a function of the sculpting sharpness, the axial force, the skin tension, and the coefficient of friction between the skin and the sculpture. After the sculpture has pierced into the skin, the frictional force increases because there is an additional frictional force acting on the side wall of the sculpt.

  An ablation device of an embodiment includes a motion impact incision device and a method for non-rotational piercing of the skin. The approach to push the sculpture directly into the skin consists of an axial force press, a single axial force press plus a motion impact force, and the sculpture is moved at high speed to impact the skin. Piercing, including but not limited to. FIG. 65 illustrates compression by steady axial force using a sculpture, under an embodiment. Pressing with a steady axial force places the skullpet in direct contact with the skin. Once deployed, a continuous and steady axial force is applied to the skullpet until it penetrates the skin and through the dermis to the subcutaneous fat layer.

  FIG. 66 represents compression plus motion impact force due to a steady single axial force using a sculpture, under an embodiment. Pressing plus a moving impact force due to a steady single axial force places the sculpture in direct contact with the skin. Contact is maintained by applying an axial force. The distal end of the sculpture is struck by other objects, thereby imparting additional kinetic energy along the central axis. These forces cause the sculpture to penetrate the skin and through the dermis to the subcutaneous fat layer.

  FIG. 67 shows that the sculpture is moved at a certain speed and applied to the skin under the embodiment. The skull pet is placed at a distance from the target area of the skin. By applying an exercise force to the skullpet, the desired speed for penetrating the skin is achieved. Due to the motor force, the sculpture penetrates the skin and reaches the subcutaneous fat layer through the dermis.

  The scalpet of the embodiment includes various cutting surfaces and blade geometries suitable for the incision method of the technique including the scalpet. Scalpet blade geometries include, but are not limited to, for example, straight edges (eg, cylinders), diagonal, multi-needle tips (eg, saw blades, etc.), and sinusoidal shapes. As an example, FIG. 68 represents the tips of multiple needles under an embodiment.

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

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

  Further, the skull pet includes one or more types of oval or round skull pets. Round sculptures include, but are not limited to, round sculpts with oblique tips, round sculptures with multiple pointed tips or teeth, and round sculpts with multiple pointed tips or teeth. . FIG. 70 shows a side view, a front view (or rear view), and a side perspective view of a round skullpet with an oblique tip under an embodiment. FIG. 71 shows a round sculpture with a serrated edge, under an embodiment.

  The ablation device of the embodiment is configured to include an extrusion pin corresponding to the skull pet. FIG. 72 shows a side view of an ablation device (housing is shown as transparent for clarity of clarity), including a scalpel assembly with a scalpel array and pusher pin, under an embodiment. FIG. 73 is a top perspective cross-sectional view of an ablation device (housing is shown as transparent for clarity of clarity), including a scalpel assembly with a scalpel array and pusher pin, according to an embodiment. Show. FIG. 74 shows a side view and an upper perspective view of a skull pet assembly including a skull pet array and push pin, under an embodiment.

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

  Embodiments herein include the use of a vibrating component or system, which is for facilitating skin incision with rotational torque / axial force and is rotated using vibration. It is for facilitating skin incision by a direct impact without any. FIG. 75 is a side view of an ablation device including a sculpture assembly with a sculpture array assembly connected to a vibration source, according to an embodiment.

  Embodiments herein include an electrodynamic skull pet array generator.

  FIG. 76 shows a sculpture array driven by an electrodynamic source or sculpture array generator, under an embodiment. The function of the generator is power driven but not electronically controlled. However, the embodiment is not limited to this. The platform of the embodiment includes control software.

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

  Embodiments herein include a sculpture array generator that includes and / or is coupled to an electromagnetic radiation source. The electromagnetic radiation source includes, for example, one or more of a radio frequency (RF) source, a laser source, and an ultrasound source. Provide electromagnetic radiation to aid in cutting with a skull pet.

  Embodiments include a sculpture mechanism configured as a “sewing machine” sculpture, or a sculpture that repeatedly enters and exits under one or more of manual control, electrodynamic control, and electronic control. Including a skull pet array. This embodiment includes a moving sculpture or sculpture array for excising sites line by line. For example, ablation may take the form of a stamped approach. In this approach, the sculpette or sculpture array may move or the array may roll over the surface to be treated, and a desired ablation density may be achieved with a sculpture ablation at a given distance of travel. .

  The partial ablation devices described herein are configured for partial ablation and implantation. There, a partially incised skin plug is taken in by a vacuum that takes the plug into the lumen of each skullpet shaft. The skin plug is then inserted into the separate docking station described herein by the proximal pin array. The proximal pin array pushes the skin plug out of the skullpet shaft.

  FIG. 77 is a diagram of an ablation device including a vacuum system, under an embodiment. The vacuum system includes a vacuum tube and a vacuum port on / in the device housing and is configured to generate a vacuum in the housing by drawing air from the housing. The embodiment vacuum is configured to provide a skin vacuum stent / fixture for a sculpture incision, thereby improving depth control and increasing cutting efficiency.

  An alternative embodiment vacuum is configured for vacuum capture or intake of skin plugs and / or hair plugs through one or more of the sculpture lumen and the array manifold housing. FIG. 78 shows, under an embodiment, a vacuum manifold applied to a target skin surface to remove / take in a cut skin / hair plug. The vacuum manifold is configured for direct application to the skin surface and is coupled or connected to a vacuum source. FIG. 79 shows, under an embodiment, a vacuum manifold with an integrated wire mesh that is applied to a target skin surface to remove / take a cut skin / hair plug.

  Additionally, the use of an external vacuum manifold with a suction-assisted liposuction device allows percutaneous removal of surface subcutaneous fat through a partially excised skin defect in a field partially generated for the treatment of cellulite. Can be removed. FIG. 80 illustrates a vacuum manifold with an integrated wire mesh configured to vacuum remove subcutaneous fat under an embodiment.

  The external vacuum manifold includes an integrated docking station (described herein) that incorporates a skin plug for implantation and may be configured for placement therewith. The docking station may be one or more of static, stretchable, and / or retractable.

  The partial ablation device described herein comprises a separate docking station configured as a platform for collecting partially incorporated skin plugs into a more uniform skin sheet for skin grafting. . The docking station includes a porous grid matrix, which comprises the same pattern and density of pores as the skull pet of the skull pet array. A retention canister located below each hole is configured to retain and maintain an array of incorporated skin plugs. In certain embodiments, the epidermal surface is upward at the level of the pores. In an alternative embodiment, the docking station can be partially retracted, thereby allowing the docked skin plug to become more dense before being captured on the adhesive membrane. The partial skin graft captured on the adhesive film is then defatted with an integral or non-integral transverse blade. In another alternative embodiment, the adhesive film itself has an elastic recoil characteristic, whereby the capture skin plugs are arranged or placed in a close arrangement. Regardless of the embodiment, the partial skin graft / adhesion membrane contraction composite is applied directly to the recipient site defect.

  Embodiments include a retractable docking station or tray, which accepts the plug when the incorporated skin and / or hair plug is removed or ejected from the skullpet via the push pin and causes the arrangement of the plug. Configured to maintain. FIG. 81 represents a retractable docking station and inserted skin pixel, under an embodiment. The docking station is formed from an elastic material, but is not limited thereto. The docking station is configured to extend from a first shape to a second shape that aligns the pixel receptacle with the sculpture array on the handpiece. FIG. 82 is a top view of a stretched configuration (left) and a non-stretched configuration (right) of a docking station (eg, elastic), according to an embodiment.

  The pixels are ejected from the sculpture array and enter the docking station, which continues until the docking station is full, and then the docking station is relaxed to its unstretched shape, thereby bringing the pixels closer together it can. A flexible semi-permeable membrane with adhesive is stretched on one side and placed on the docking station (adhesive side facing down). As the pixel attaches to the membrane, it is lifted from the docking station. The film returns to its normal unstretched state, thereby exerting the effect of pulling the pixels closer together. The membrane is then placed over the recipient defect.

  The ablation device described herein includes the administration of a medicament through the ablation defect created by the ablation device described herein. In this case, the ablation site is configured to be used as a locally applied injection site for administration or application of a medicament for adipocyte reduction (lipolysis) during or after ablation surgery.

  Embodiments herein may be configured for hair transplantation, in which the hair plug is vacuumed into the skullpet at the donor site and the incorporated hair plug is partially excised. Including bulk injection (without a separate collection reservoir) directly into the recipient site defect. Under this embodiment, the donor sculpture array placed on the occipital scalp has a relatively larger diameter than the sculpture that is a component of the sculpture array placed to generate the defect at the recipient site. A skull pet is provided. After incorporation of the hair plug at the donor site, the defect created at the recipient site is plugged with the incorporated hair plug transferred in the sculpture array.

  Due to the elastic contraction of the incised dermis, the elastically contracted diameter of the hair plug incorporated in the occipital scalp is the elasticity of the partially excised defect of the recipient site in the parietal-frontal-occipital scalp Will be similar to the contracted diameter. In one embodiment, a hair plug incorporated into a donor sculpture array is extruded directly with a proximal pin within the sculpture lumen and a pattern of partial defects generated by the recipient sight sculpture array. May be the same pattern. The sculpt of the sculpture array (including the donor hair plug) placed at the donor site is aligned (eg visually) to the pattern of the partially excised field of the defect at the recipient scalp site. . Once aligned, the proximal pin in each sculpture shaft advances downward along the sculpture shaft, pushing the hair plug into a partially excised defect in the recipient site. Thereby, simultaneous transplantation of a plurality of hair plugs to the recipient site is realized. This method of mass implanting a hair plug into a partially excised recipient site (eg, of a bald scalp) maintains the hair shaft alignment with other mass implanted hair plugs of that recipient scalp site Probability is higher. Directed occlusion of the donor site field is performed with, but is not limited to, the most medically effective vector.

  The partial ablation devices described herein are configured for tattoo removal. Many patients want to remove the dye tattoo for a variety of reasons later in life. In general, tattoo removal involves removal of pigments that have penetrated into the dermis. Traditional tattoo removal approaches have been described, from thermal removal of pigment to direct surgical excision. Laser thermal removal often causes depigmentation and surface scarring. Surgical excision of a tattoo requires a linear scar that cannot be avoided by surgery. For many patients, the trade-off between tattoo removal and its sequelae can be marginal.

  Using partial excision to remove the tattoo can minimize visible scars while partially removing a significant portion of the dermal pigment. The partial ablation extends beyond the tattoo boundary, so that the ablation mixes with non-excision skin and non-tattoo skin. Most notably, tattoo pattern blur occurs even though not all of the residual pigment is removed or possible. In one embodiment, a first partial ablation is performed using a sculpture array, and a subsequent partial ablation is performed with a single sculpture ablation for the remaining dermal pigment. As with other applications described herein, directed occlusion is performed with the most medically effective vector.

  The partial ablation devices described herein are configured for the treatment of cellulite. This aesthetic distortion has resisted effective treatment for decades because its pathological mechanism of action is multifactorial. Cellulite is a combination of skin relaxation due to aging or weight loss and the growth and enhancement of superficial fat vesicle formation. The ugly cobblestone appearance of the skin is often seen on the buttocks and the left and right thighs. Effective treatment should resolve each contributor to distortion.

  The partial ablation device described herein is configured for partial ablation of the skin to tighten the treated skin and at the same time reduce protruding fat vesicles that contribute to cobblestone surface morphology . Through the same partially excised defect created for skin tightening, superficial fat vesicles are aspirated percutaneously using a locally applied vacuum. In one embodiment, a clear manifold suction cannula is applied directly to the partially excised skin surface. The appropriate vacuum pressure used in the suction assisted liposuction (SAL) unit is determined by visually measuring that the appropriate amount of subcutaneous fat is aspirated and excised. The appropriate period of manifold application is also a factor monitored in surgery. When combined with partial skin tightening, only a relatively small amount of fat is aspirated to provide a smoother surface morphology. As with other applications described herein, a partially excised field is closed with a directed occlusion.

  The partial ablation devices described herein are configured for abdominal streak and scar correction. Visible scars are distortions that require a clear distinction of scars from adjacent normal skin. Scar discrimination is generated by texture changes, pigment changes and trajectory changes. In order to make the scar less visible, these three components of the scar must be resolved in the scar correction, thereby significantly reducing the visual impact. Severe scars, called contractures across joints, can limit the range of motion. Often, scar correction is performed operatively, where the scar is cut oval and carefully closed by careful joining of the non-scar skin resection margin. However, the surgical correction reintroduces the current surgical scar and replaces the existing scar with the current surgical scar. Current surgical scars may be manifested or may only be partially blurred by Z or W plastic surgery.

  Scars are diagnostically divided into hypertrophic and dysplastic types. Hypertrophic scars often have raised contours and irregular textures and are deeper pigmented. In contrast, dysplastic scars have a contour that is recessed below the level of the adjacent normal non-scarring skin. In addition, the color is pale (bleached) and the texture is smoother than normal neighboring skin. Histologically, hypertrophic scars have abundant irregular dermal scar collagen with superactive melanocytes. A dysplastic scar has little dermal collagen and little or no melanocyte activity.

  The partial ablation devices described herein are configured for partial scar repair of scars and do not reintroduce additional surgical scars, but rather significantly blur the visual impact of distortion. Instead of linear scars caused by surgery, partial excision of the scar reduces the pigment, texture and contour components as a whole. Partial correction is made along the direction of the scar line and extends beyond the scar boundary and usually into the skin. Scar partial correction includes direct partial excision of scar tissue with micro-interlacing of normal non-scar skin and residual scar. Basically, micro-W plastic surgery is performed along the entire length of the scar. As with other applications, the partially excised field is closed with a directed occlusion. An example of the use of partial correction includes correction of a hypoplastic postpartum abdominal striatum. The streak of the streak scar epithelium and the microinterlace between the dermis and the adjacent normal skin significantly reduce this distorted, linear and bleached appearance.

  The partial ablation devices described herein are configured for vaginal repair for postpartum relaxation and prolapse. Transvaginal delivery of a full-term fetus partially includes significant stretching of the vaginal opening and vaginal tract. During delivery, longitudinal extension of the vaginal tract occurs with cross-sectional expansion of the labia, vaginal opening and vaginal foramen. For many patients, birth trauma results in permanent stretching of the vaginal tract along the longitudinal and cross-sectional directions. Vaginal repair for prolapse is typically performed as an anteroposterior resection of the vaginal mucosa with the insertion of a prosthetic mesh. For patients with severe prolapse, this surgery may be necessary and additional support of the anteroposterior vaginal wall will be required. However, many patients with postpartum vaginal relaxation can be candidates for less invasive surgery.

  The partial ablation devices described herein are configured to partially excise the vaginal mucosa circumferentially to narrow the expanded vaginal tract in the labia and vaginal opening. If the vaginal tract is stretched, a pattern of partial excision may be performed in the longitudinal direction. Partial field directed occlusion may be assisted by a vacuum tampon. The vacuum tampon acts as a stent that forms a partially excised vaginal tract into a pre-natal state.

  The partial ablation devices described herein are configured for the treatment of snoring and sleep apnea. Although there are several health problems with snoring, the annoying voice effects that can be exerted on relationships with partners who sleep together can be significant. Mostly, snoring is due to phonetic vibrations of the oral and pharyngeal parenchyma structures in the oral cavity, pharyngeal cavity and nasal cavity during exhalation and inhalation. More specifically, vibrations of the soft palate, nasal concha, pharyngeal sidewall, and base of the tongue are anatomical key configurations that cause snoring. For many surgical and medical devices, the success in improving the situation has been limited. Surgical reduction of the soft palate is often plagued by long and painful healing due to bacterial contamination of the incision site.

  The partial ablation device described herein is configured to partially ablate the oropharyngeal mucosa to reduce age-related mucosal redundancy (and relaxation) in the oral cavity and pharyngeal parenchyma structures. No longer suffer from long-term bacterial contamination of the excised site. The reduction in size and relaxation of these structures reduces vibrations caused by the passage of air. The front and back direction of the soft palate using a porous dental retainer (which is locked to the tooth and wrapped around the back of the soft palate) (to apply local anesthesia to the partial resection field) Provide directed blockage. A more severe condition called sleep apnea syndrome has serious health problems due to hypoxia caused by upper airway obstruction during sleep.

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

  The partial ablation devices described herein are configured for partial skin culture / stretching, referred to herein as “Culturespansion”. The ability to organically grow skin would be a great achievement for patients with large skin defects such as burns and trauma and large congenital skin malformations such as port wine nevus and large “swimming” nevus. While previous capabilities have only been able to extend the viability of incorporated skin, one report showed that wound healing occurred with organotypic skin culture specimens. Better substrates, better culture media, and more effective filtration of metabolic byproducts have been reported to improve culture results. The use of gene expression proteinomics for growth hormone and wound healing stimuli is also promising. To date, however, there are no reports of organic skin growth.

  Partial incorporation of autologous donor skin for skin transplantation according to embodiments provides an opportunity for organ culturing of skin that has not existed before. Placement of partially incorporated skin graft tissue on a retractable docking station, as provided by the embodiments described herein, allows skin plugs to come into juxtaposed contact with each other. To do. Induction of the primary wound healing process can convert partial skin grafts into sheets by known or soon-to-be-developed organ culture methods. Furthermore, the use of mechanical skin stretching can significantly increase the surface area of organ-preserved / grown skin. In vitro substrate device iterations include, but are not limited to, an extensible docking station that includes a partially incorporated skin plug and a gradual and continuous stretching across the thickness of the organically cultured skin. And a separate substrate (eg, bent, flat, etc.) expander that can be controlled to provide. In addition, the use of organ skin stretch can provide a continuous and synergistic wound healing stimulus for organ growth. Gradual and continuous stretching is unlikely to cause the epidermis to detach from the dermis (basement membrane). In addition, organ skin stretch helps to avoid the risks associated with surgery and the pain associated with in vivo skin stretch.

  The partial ablation devices described herein allow a method for organ stretching of the skin. The method includes self-incorporation of skin from the patient's donor site. For example, using a square sculpture array provides a bond between the edges and vertices of partially incorporated skin plugs during transfer. The method includes the transfer of a partial skin plug to a retractable docking station, which maintains the arrangement of skin plugs and provides juxtaposition of the skin plugs. The docked skin plug is trapped in a porous adhesive membrane that maintains alignment and juxtaposition. The quasi-elastic recoil characteristics of the adhesive membrane provide additional contact and juxtaposition of the skin plug. The method involves the transfer of a cohesive membrane / partial graft hybrid to a culture bay. The bay includes a substrate and a culture medium that maintains viability and promotes organ wound healing and growth. After healing of the skin plug margin, the entire substrate is placed in a culture bath with a mechanical expander substrate. Organ stretching begins in a gradual and continuous manner. The stretched full thickness skin is autografted into a defect in the patient's recipient site.

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

  Embodiments described herein, together with one or more of the devices and methods detailed herein, and the devices and methods detailed in related applications incorporated by reference herein, And / or as a component thereof. In addition, the embodiments described herein can be used in devices and methods relating to partial excision of skin and fat.

  Embodiments include a novel minimally invasive surgical procedure with considerable advantages over conventional orthopedic surgery. Apply partial skin resection as a new stand-alone procedure in anatomical areas that exceed the limits of conventional orthopedic surgery due to the small trade-off between incision scar visibility and the amount of improvement obtained . Also, applying partial ablation of skin as an adjunct to established orthopedic surgery such as liposuction and using partial ablation significantly reduces the required incision length for a particular application. Shortening the incision has applicability in both the aesthetic and reconstructive aspects of orthopedics. Without limitation, the specification details both the procedural development of the partial ablation and the development of the device.

  The embodiments described herein are configured to remove multiple small sections of skin without leaving scars, instead of conventional linear resection of skin. Removal of multiple small sections of skin includes removal of loose excess skin without a visible scar. As an example, FIG. 83 shows removing loose excess skin without obvious scars under an embodiment. Removal of multiple subsections 8302 of the skin also includes tightening the skin without obvious scarring. For example, FIG. 84 illustrates tightening the skin without an obvious scar, under an embodiment. Removal of multiple subsections of skin 8402 further includes partial skin tightening, where the clinical endpoint results in three-dimensional tightening and contouring 8404 of the skin envelope.

  FIG. 85 shows three-dimensional contouring of the skin envelope, under an embodiment. Removal of multiple subsections 8502 of the skin further includes partial skin tightening, where the clinical endpoint results in three-dimensional tightening and contouring 8504 of the skin envelope.

  The clinical effectiveness of surgical operations requires a thorough understanding of the underlying processes that reliably lead to clinical endpoints. A number of operating mechanisms are described herein for partial skin tightening and contouring. The primary motion mechanism identified is the conversion of 2D partial skin tightening to 3D aesthetic contouring (see, eg, FIG. 3). Secondary motion mechanisms that cooperate with each other contribute to its principle clinical endpoint. Herein, according to the ability to achieve a clinical endpoint, a contributing operating mechanism is described, but not limited to.

  The density of partial ablation within the contoured partial field is a major determinant of 2D skin tightening that contributes to 3D contouring. In general, density is the percentage of partially excised skin within a partial field, but is not limited thereto. FIG. 86 shows a variable partial ablation density 8602 in the treatment area 8604, under an embodiment. Changing the density of partial ablation (“partial density”) can provide more selective skin tightening and contouring while providing a smoother transition to a non-partial ablation area. Thus, for example, transition to a non-partial ablation area includes, but is not limited to, partial density reduction.

  Additional embodiments include partial excision of fat associated with partial skin excision. FIG. 87 illustrates partial ablation of fat, under an embodiment. Directly under the skin is a subdermal fat layer and a subcutaneous fat layer, and anatomically continuous with the skin plug to be excised, partially with variable amounts of fat (based on depth and / or amount) Can be excised. In some embodiments, by controlling one or more of the depth of excision and the amount of fat to be excised at the target site, the amount of fat partially excised, and thus the amount of skin tightening and contouring. To control. Therefore, changing the density of partial ablation ("partial density") by controlling one or more of partial density, ablation depth and the amount of fat to be ablated will result in smoother non-partial ablation areas More selective skin tightening and contouring can be provided while providing a smooth transition. Thus, for example, transition to a non-partial ablation area includes, but is not limited to, a reduction in the combination of partial density, ablation depth, and the amount of fat to be ablated.

  An additional modality of partial fat excision is percutaneous vacuum ablation (PVR) of fat directly through a partial skin defect. In the embodiments herein, numerous clinical applications of partial fat excision are envisioned. The most important aesthetic application of partial fat excision is the reduction of cellulite. The combined continuous application of partial skin excision and partial fat excision directly solves the pathology underlying this aesthetic variant. Skin relaxation and protruding fat vesicles, which cause visible bouldering of the skin morphology, are each resolved with the application of this minimally invasive excision capability. FIG. 88 shows cobblestone formation 8802 on the skin surface.

  In addition, other common applications include the ability to change 3D contour abnormalities with a synthetic continuous approach of partial skin tightening and inward contouring from partial lipotomy. Partial field pre-operative topographical contour mapping helps to provide more predictable clinical outcomes. In particular, the topographical mapping of two-dimensional partial skin resection is combined with variable marking of fat excision. FIG. 89 shows a deeper level topographic mapping (dashed line) 89020 for partial lipotomy under an embodiment. The mapping also includes a feathering or transition zone to the non-ablated area where the partial density is reduced. Depending on the patient's pre-operative topographical marking, a variable amount of fat is partially excised consecutively with partial skin excision.

  The correction target area having the convex contour is subjected to deeper partial fat excision. The concave (or recessed) area to be corrected is corrected using partial skin ablation. The total result in the mapped partial field is the overall smoothing of the 3D contour with 2D tightening of the skin.

  The use of synthetic partial resection is most effective in reducing the length required in conventional orthopedic incisions and in removing iatrogenic incision skin excess ("dog ear"). Standard excision of skin lesions does not require additional scarring of the elliptical incision, but is significantly reduced in the linear dimensions required for occlusion of the excised lesion (see FIG. 94).

  An additional motion mechanism associated with partial skin ablation is the size of the overall contour pattern of the partial ablation field. The total amount of skin that is partially excised also depends on the size of the field that is partially excised. The larger the field, the more skin tightening occurs with the specified density of partial ablation. Further, a completely partially ablated field can include one or more treatment areas (eg, different ablation densities in different fields, etc.). FIG. 90 shows a plurality of treatment contours 9002, 9004 according to an embodiment.

  The patterned contour mechanism includes selective curvilinear patterning of each specific anatomical area for each specific patient. A topographical analysis with a digitally acquired image of the patient, including a digital wire mesh program drawn (and redrawn for enhanced contours), with selected anatomical regions and patient Useful for formatting size and curvilinear contours. Standard aesthetic orthopedic cutting patterns for specific anatomical regions are also useful for formatting partial ablation patterns. FIG. 91 shows a curvilinear treatment pattern 9102 according to an embodiment. FIG. 92 shows a digital image of a patient with a rendered digital wire mesh 9202 program, under an embodiment.

  The directional occlusion of the partially ablated field of the embodiment provides the ability to achieve enhanced aesthetic contouring by selectively tightening the skin. For most applications, the occlusion occurs perpendicular to the Langer skin secant, but may be made in different directions that can achieve the maximum aesthetic contour, such as an occlusion based on a static skin pull line. FIG. 93 shows a directional occlusion 9302 of a partially ablated field, under an embodiment. Directional occlusion may follow known occlusion vectors used in conventional orthopedic surgery. (For example, the face lift / face lift armpit component of the face is upward (corresponding to the horizontal occlusion of the partial field) and the neck component below the neck lower jaw angle (more vertical of the partial field) In a more complex topographical region such as the face or neck, multiple vectors of directional occlusions may be used.

  Embodiments include directional partial excision of the skin, which enhances the effectiveness of surgery. FIG. 94 shows directional partial resection of the skin, under an embodiment. This process is performed by pre-stretching the skin 9402 perpendicular to the preferred direction of maximum skin resection 9402 and performing a partial resection 9404 on the stretched skin.

  Embodiments include aesthetic contouring resulting from mechanical pulls (or vectors) generated from adjacent partial fields adjacent to the target contour. This effect on the partial field is based on orthopedic surgery directed at a distance from the target contour. In addition, a variable topographical transition of ablation density within the field and along the pattern contour is achieved, which provides selective contouring and a smoother transition to the non-ablated area.

  Additionally, a variable topographical transition of sculpture size resection within the patterned contour (and with different sculpture sizes in the array) provides selective two-dimensional skin tightening and three-dimensional contouring .

  The embodiments described herein produce a selective wound healing sequence with promotion of primary healing during the immediate postoperative period and promotion of delayed secondary contraction of the skin during the collagen growth phase. Facilitating accurate joining of skin margins is inherent to multiple (partial) resections of small segments of skin. That is, the skin margin aligns more closely before the occlusion than in the case of a larger linear incision in the skin, which is common with standard orthopedic incisions. The subsequent occurrence of wound contraction is also inherent in the partial ablation field. There, the extension of the partial ablation pattern provides a directional wound healing response along the longitudinal direction of the partial ablation pattern.

  Clinical methods of partial skin resection include methods of directional occlusion. Depending on the anatomical area, directional occlusion of the skin defect due to the cut in the partial ablation field achieves along the Langer skin secant, along the resting skin line and / or maximum aesthetic contouring Achieved in the direction of The direction in which the occlusion is most easily achieved may be used as an indicator for the most effective vector of directional occlusions. For many applications, the use of the Langer skin secant is used as an indicator to provide maximum aesthetic tightening. According to Dr. Langer's original work, the partially excised defect will extend in the direction of the Langer skin secant. In the anatomical region, directional occlusion occurs at right angles to the Langer skin secant, where the skin margin of each partially excised defect is closest.

  In continuous partial surgery performed next to or in succession to the orthopedic incision, the most important capabilities provided by the embodiments herein include the ability to shorten the incision. The need for elliptically cutting skin tumors is reduced both in the application of this technique and in the length of the incision. Thus, the need to cut out the lateral portion of the tumor resection is alleviated by partial resection in that same lateral direction. FIG. 95 illustrates the shortening of the incision through a continuous partial procedure, under an embodiment.

  Since the partial field according to the embodiment heals without visible scars, the total result is that the length of the cut scar is considerably reduced. Other applications within this category are the shortening of traditional orthopedic incisions used in breast reduction, breast fixation and abdominal surgery. The lateral extent of these incisions can be shortened without creating “dog ear” skin surpluses that could otherwise occur with the same length of incision. FIG. 96 is an exemplary illustration of “dog ear” skin surplus in chest reduction and abdominal surgery. For example, it is no longer necessary to extend the incision beyond the transverse lower breast for chest reduction or to extend beyond the iliac crest for abdominal surgery. A partial review of post-operative “dog ear” skin surplus can also be made without extending the existing incision.

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

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

  Embodiments include ancillary partial procedures used in a manner discontinuous with conventional orthopedic incisions. This category includes aspiration-assisted fat resection in which subcutaneous fat is removed by aspiration in lipodystrophic areas such as the buttocks and thighs. However, many patients have preexisting skin relaxation that is exacerbated by aspiration lipotomy. Tightening the skin envelope over these areas by partial ablation has several advantages for these patients. Many patients with skin relaxation and lipodystrophy are candidates for liposuction, although otherwise they do not qualify for the method. For patients with existing skin relaxation but with more pronounced lipodystrophy, greater contour reduction can be achieved without iatrogenic skin relaxation. The procedure may be performed as a single synthetic procedure for smaller partial excision or as a step-by-step procedure.

  Partial field directional occlusion is performed without suturing and is accomplished with the application of an adhesive stent membrane as detailed herein. Using a number of methods, the partial field is closed with an adhesive film. An exemplary method includes anchoring the membrane outside the periphery of the partial field. Tension is applied to the opposite side of the adhesive film. The body of the adhesive film is applied to the partial field, one row at a time, for the remaining skin in the field. The application direction follows the selected vector of directional occlusions. This application direction is sometimes perpendicular to the Langer skin secant, but is not so limited, and any application direction that provides maximum aesthetic contouring may be selected.

  Another method involves selectively closing a partial field utilizing the elasticity of an adhesive stent dressing. By this method, the end of the elastic stent dressing is stretched or pre-introduced, and then the stent dressing is applied to the partial field. When the end of the membrane is released, the partial defect is closed in a direction perpendicular to the elastic contraction due to the elastic contraction of the stent dressing.

  The embodiments detailed herein include a skin pixel array dermatome (sPAD), also referred to herein as a sculpture device. In general, a scalpet device includes a device comprising a carrier and a chuck connected to a distal region of the carrier. The device includes a skull pet assembly that includes one or more skull pets and a depth control device. The skull pet assembly includes a shank configured for retention with the chuck. Each sculpture includes a tube that includes a hollow region and a pointed distal end configured to penetrate tissue at a target site. The depth control device is configured to control the depth of penetration of the at least one scalpet into the tissue.

  An embodiment of a scalpel device includes an array of a group of multiple scalpets including a plurality of independent circular scalpets. The circular sculpture configuration allows for easier incision by applying rotational torque to the skin. Embodiments include a sculpture assembly and a sculpture, as described herein, in an electromechanical power source, a series of gears or other drive provided between each sculppet and the drive shaft. Combine or link through components. In addition, embodiments couple a vacuum source to the housing and create a vacuum in the housing. The vacuum is configured for use for one or more of removing or removing partially excised material (eg, skin, fat, etc.) and stent stabilization during incision. The same vacuum capability is also applicable as a pneumatic assist that applies additional axial (Z-axis) forces during the incision duty cycle.

  As detailed herein, a scalpel device includes numerous configurations.

  FIG. 97 is a skull pet device including a single shaving skull pet with depth control, under an embodiment. The shaving skull pet device includes a carrier connected to the shaving skull pet. The carrier includes a pen style carrier (see FIG. 99 and the like), but is not limited thereto. The shaving sculpture includes a hollow tube at the distal end (closest to the patient) and a solid at the proximal end (farthest from the patient). The sharpener includes a radial slot on the hollow tube and is positioned axially so that the excised tissue can be deflected radially outward of the skullpet. The shaving sculpture includes a set position along the length of the tube and hits the bottom inside the handpiece chuck. Thereby, the shaving feature can be accurately positioned with respect to the handpiece nose. The shaving sculpture device includes a depth control device with variable axial length, and the depth control device is used with the shaving sculpture to control the depth of cut into the tissue depending on the treatment site. be able to. The depth control device of the embodiment is directly coupled to or connected to the outer diameter of the carrier nose, but is not limited thereto.

  FIG. 98 is a skull pet device that includes a standard single skull pet, under an embodiment. The skull pet device includes a carrier connected to the skull pet. The carrier includes a pen style carrier (see FIG. 99 and the like), but is not limited thereto. A single skull pet includes, but is not limited to, a hollow tube that spans the entire length of the skull pet. The excised tissue remains in the sculpture, and then ascends the sculpture lumen and is placed in an internal cavity or receptacle contained in or coupled to or connected to the carrier. The adapter is configured as an interface between the outer diameter or surface of the skullpet and the inner region of the carrier chuck. The adapter is positioned along the sculpture axis and the subassembly is attached to the chuck. Thereby, the chuck is configured to hold the skull pet and adapter firmly to prevent axial misalignment. The adapter of the embodiment is configured to be used as a depth stop to achieve a complete tissue resection depth based on the treatment area.

  FIG. 99 is a skull pet device including a pen style gear reduction carrier, under an embodiment. The pen-style carrier is a more ergonomic handpiece that is configured to allow close working with the lighter. Although the carrier of the embodiment includes a motor with increased torque performance, the embodiment is not limited thereto.

  FIG. 100 is a skull pet device that includes a multi-scalpet (eg, 3 × 3) array, under an embodiment. The example sculpture array 10001 includes, but is not limited to, a 3 × 3 centerless array. The sculpture device operates as described herein with reference to differently configured sculpture devices, in which case the housing is configured to interface with a pen-style carrier, as depth control device 10002 Composed or includes it. A drive shaft 10004 provided at the center of the sculpture array is mounted in the carrier chuck. A sculpture assembly 10010 that includes a 3 × 3 array 10001 does not include, but is not limited to, a central sculpture (opposite the drive shaft). The array 10001 sculpture includes a sharp, thin-walled tube that allows the resected tissue to run up the sculpture lumen and into the proximal end of the housing (closer to the physician) Is possible.

  Embodiments include a skull pet device with a carrier that includes a surgical drill. FIG. 101 shows a scalpel device that includes a cordless surgical drill carrier 10102, under an embodiment. Surgical drills are an option for use with larger arrays that require more torque to ablate tissue on larger body surfaces (eg, abdomen, hips, arms, etc.). As detailed herein, a scalpet device using a drill carrier is a carrier array coupling for excised tissue management (CAC) 10104 for transporting large amounts of excised tissue from the proximal end of the housing. including. The CAC of the embodiment fixes the housing of the skull pet assembly to the drill, but the embodiment is not limited thereto.

  FIG. 102 illustrates an exemplary scalpet device comprising a 5 × 5 centerless array 10202 for use with a surgical drill carrier, under an embodiment. A scalpel device that uses a drill carrier includes a CAC 10204 coupled to a scalpel assembly 10206. As detailed herein, the CAC is configured for ablation tissue management for transporting large amounts of ablated tissue from the proximal end of the housing. The CAC of the embodiment fixes the housing of the skull pet assembly to the drill, but the embodiment is not limited thereto.

  Embodiments of the scalpet device include a vacuum assisted pneumatic ablation (VAPR) device or “VAPR”. FIG. 103 is a sculpture device including a vacuum-assisted pneumatic ablation device, under an embodiment. The VAPR includes a vacuum pressure configured to drive the skull pet from the skull pet assembly to the treatment site. The VAPR is coupled or connected to the drill via the CAC.

  FIG. 104 is a detailed view of the distal region of a VAPR sculpture device that includes a sculpture assembly coupled to a carrier drill using a CAC, under an embodiment. The CAC secures the VAPR housing to the drill. On the other hand, the tube (eg, hexagonal tube) is configured to allow the VAPR drive shaft to slide up and down during the procedure. A vacuum (not shown) supplied from the outside is coupled or connected to the VAPR through a vacuum port, but the embodiment is not limited thereto.

  FIG. 105 shows, under the embodiment, a VAPR scalpet assembly in a ready state (left) and that in a stretched treatment state (right). With the vacuum and drill operating, a single treatment cycle includes placing the VAPR at the treatment site and creating a seal between the housing and the treatment site. Once this seal is established, a vacuum coupled to the assembly housing pulls the piston with the rotating gear to the treatment site. After the desired depth of cut is achieved, the VAPR is withdrawn from the treatment site. This breaks the seal and the spring in the sPAD returns it to the ready state. The cycle can be repeated for different treatment sites.

  Embodiments include a spring assisted vacuum ablation (SAVR) sculpting device that operates in the same manner as a VAPR device. FIG. 106 shows a SAVR device in a ready state (left) and a retracted state (right) under an embodiment. The SAVR is coupled or connected to the drill via the CAC. The vacuum port is attached to or coupled to a separate vacuum supply, but is not limited thereto. The drive shaft slides up and down in a tube attached to the drill.

  The SAVR spring position and vacuum position are generally reversed from those of the VAPR. Both the spring and the vacuum port are provided on the proximal side of the piston, but are not limited thereto. The vacuum helps to lift the skin pixel through the sculpt and thus remove it from the treatment site. The spring provides an axial force for the rotating skullpet to enter the treatment site and cut the skin. The sculpture extends outside the housing in the array ready state.

  The treatment cycle begins with the placement of the skullpet over the desired treatment location. The vacuum is turned on and the drill is applied downward. Thereby, the piston and the sculpture are returned into the housing (retracted state). The drill rotates and the sculpture rotates. A spring force coupled to the rotation of the sculpture causes the ablation. The vacuum pulls up the pixels created by the ablation and then pulls it out of the housing. Once the desired cutting depth is achieved, the SAVR can be lifted from the treatment site and the cycle can be repeated at different treatment sites.

  Embodiments include a device comprising a carrier and a chuck connected to a distal region of the carrier. The device includes a skull pet assembly that includes at least one skull pet and a depth control device. The skull pet assembly includes a shank configured for retention with the chuck. The at least one sculpture includes a tube that includes a hollow region and a pointed distal end configured to penetrate tissue at a target site. The depth control device is configured to control the depth of penetration of the at least one scalpet into the tissue.

  Embodiments include a device comprising a carrier, a chuck connected to a distal region of the carrier, and a skull pet assembly having at least one skull pet and a depth control device. The skull pet assembly includes a shank configured for retention with the chuck, the at least one skull pet having a hollow region and a pointed distal end configured to penetrate tissue at a target site; Wherein the depth control device is configured to control the depth of penetration of the at least one scalpet into the tissue.

  The skull pet assembly includes a skull pet comprising a skull pet shaft that includes a distal end and a proximal end.

  The skull pet shaft includes a hollow region near the distal end and a solid region near the proximal end.

  The proximal end includes a region configured as the shank.

  The sculpture includes a distal region near the distal end configured to incise and receive tissue.

  The sculpture includes at least one of an orifice and a slot provided in the sculpture adjacent to the hollow region in the axial direction.

  The at least one of the orifice and the slot is configured to divert the received tissue radially outward from an inner region of the skullpet.

  The depth control device is configured to connect with the distal region of the carrier. The depth control device includes a vacuum manifold, and the vacuum manifold is configured to create a seal between the vacuum manifold and the target site.

  The skull pet assembly includes a skull pet with a skull pet shaft that includes a distal end and a proximal end, the skull pet shaft including a hollow interior region between the distal end and the proximal end.

  The proximal end includes a region configured as the shank.

  The sculpture includes a distal region near the distal end configured to incise and receive tissue.

  The proximal end is configured to pass the received tissue.

  The carrier includes a reservoir in an interior region, the proximal end of the sculpture is connected to the reservoir, and the reservoir is configured to hold the received tissue.

  The depth control device includes an adapter configured to receive the skull pet shaft.

  The chuck is configured to maintain an axial position of the adapter and the skullpet in the carrier.

  The depth control device includes a vacuum manifold, and the vacuum manifold is configured to create a seal between the vacuum manifold and the target site.

  A device includes a motor connected to the chuck and configured to drive the skull pet assembly.

  The carrier is configured to be held by hand.

  The skull pet assembly includes a plurality of skull pets.

  The plurality of skull pets are arranged to form a skull pet array.

  The sculpture array is a rectangular array.

  The sculpture array includes one of a 3 × 3 array and a 5 × 5 array.

  Each sculpture is configured to rotate about a central axis of the sculpture.

  The sculpture assembly includes a drive assembly connected to each sculpture, wherein the drive assembly is configured to provide a rotational force to a proximal region of each sculpette, and the rotational force causes each sculpette to move about the central axis. Rotate with

  The drive assembly includes a gear drive system.

  The drive assembly includes a friction drive system.

  The shank is configured as a drive shaft with a proximal end configured to connect with the chuck and a distal end configured to connect with the drive assembly.

  The device comprises a motor connected to the chuck and configured to drive the drive assembly via the drive shaft.

  The device comprises a housing configured as the depth control device.

  The housing is configured to at least partially receive the skull pet array.

  Each sculpture includes a sculpture shaft that includes a distal end and a proximal end, each sculpture including at least a hollow interior region near the distal end, the distal end configured to receive and cut through tissue Is done.

  A device comprises a housing configured to create a vacuum at the target site, the vacuum including an internal pressure of the housing that is relatively lower than ambient air pressure.

  A distal region of the housing is configured to form a vacuum seal when in contact with adjacent tissue adjacent to the target site.

  The housing includes a port coupled to a vacuum source.

  The vacuum is configured to remove the cut material from the target site.

  The vacuum is configured to extract subcutaneous fat through a void created from the incision skin pixel at the target site.

  The skull pet assembly includes a spring device configured to control the position of the skull pet array.

  The spring device is configured to control the movement of the sculpture array in the direction of contact at the target site by applying an axial force to the sculpture array.

  The vacuum is configured to control the position of the sculpture array relative to the target site.

  The skull pet assembly is configured to cooperate with the vacuum to control the position of the skull pet assembly.

  The vacuum is configured to control movement of the sculpture array in the direction of contact with the target site.

  The spring device is configured to control movement of the sculpting array away from the target site by applying an axial force to the sculpting array.

  The housing is configured as the depth control device.

  The housing is configured to at least partially receive the skull pet array.

  The device comprises a skull pet assembly coupling configured to attach the housing to the carrier.

  The at least one sculpture is configured to transmit an axial force to the target site. The axial force includes a continuous axial force, an impact force, and at least one of a continuous axial force and an impact force.

  The at least one sculpture includes a cylindrical sculpture that includes a cutting surface at a distal end of the at least one sculpture.

  The cutting surface includes at least one of a pointed tip, at least one pointed point, and a serrated edge.

  The cut surface includes a blunt edge.

  Embodiments include a device comprising a carrier comprising a chuck coupled to a distal region. The device includes a skull pet assembly including a skull pet and a depth control device. The skull pet assembly is configured for retention with the chuck. The sculpture array includes a plurality of sculptures, each sculpture including a tube that includes a hollow region and a distal end configured to penetrate tissue at a target site. The depth control device is configured to control the depth of penetration of the skull pet array into the tissue.

  Embodiments include a device comprising a carrier that includes a chuck connected to a distal region, and a skullpet assembly that includes a skullpet and a depth control device. The skull pet assembly is configured for retention with the chuck. The skull pet array includes a plurality of skull pets. Each sculpture includes a tube that includes a hollow region and a pointed distal end configured to penetrate tissue at a target site. The depth control device is configured to control the depth of penetration of the skull pet array into the tissue.

  Embodiments include a device comprising a carrier having a proximal region and a distal region. The proximal end is configured to be held by hand. The device includes a skull pet assembly comprising at least one skull pet and a depth control device configured to control the depth of tissue penetration at a target site of the at least one skull pet. The at least one sculpture includes a sculpture shaft including a proximal end and a distal end configured to penetrate the tissue. The skull pet shaft includes a hollow region adjacent to the distal end and configured to pass tissue received through the distal end. The sculpture shaft includes an orifice connected to the hollow region and configured to pass the received tissue from the sculpture shaft.

  An embodiment is a carrier comprising a proximal region and a distal region, wherein the proximal region is configured to be held by a hand, at least one sculpture, and the at least one sculpture A device comprising: a scalp assembly comprising: a depth control device configured to control the depth of penetration of the tissue at the target site. The at least one sculpture includes a sculpture shaft including a proximal end and a distal end configured to penetrate the tissue. The skull pet shaft includes a hollow region adjacent to the distal end and configured to pass tissue received through the distal end. The sculpture shaft includes an orifice connected to the hollow region and configured to pass the received tissue from the sculpture shaft.

  Embodiments include a device comprising a carrier having a proximal region and a distal region. The proximal end is configured to be held by hand. The device includes a skull pet assembly that includes a plurality of skull pets. The sculpture assembly includes a drive assembly configured to rotate each sculppet about a central axis by applying a rotational force to the plurality of sculptes. Each sculpture includes a sculpture shaft that includes a proximal end and a distal end configured to penetrate tissue at a target site. The skull pet shaft includes a hollow region adjacent to the distal end and configured to pass tissue received through the distal end. The sculpture shaft includes an orifice connected to the hollow region and configured to pass the received tissue from the sculpture shaft.

  An embodiment is a carrier comprising a proximal region and a distal region, wherein the proximal region is configured to be held by a hand, and a skull pet assembly comprising a plurality of skull pets, A scalpet assembly includes a drive comprising a drive assembly configured to apply a rotational force to the plurality of scalpets to cause each scalpet to rotate about a central axis. Each sculpture includes a sculpture shaft that includes a proximal end and a distal end configured to penetrate tissue at a target site. The skull pet shaft includes a hollow region adjacent to the distal end and configured to pass tissue received through the distal end. The sculpture shaft includes an orifice connected to the hollow region and configured to pass the received tissue from the sculpture shaft.

  Embodiments include a method that includes generating a protocol using patient data. The protocol includes at least one target site and a topographical map of partial skin ablation configured for application to the at least one target site. The method includes placing a carrier that includes a skull pet assembly including at least one skull pet and a depth control device at a target site. The at least one sculpture includes a tube that includes a hollow region and a pointed distal end configured to penetrate tissue at the at least one target site. A method cuts skin pixels circumferentially at the at least one target site using the sculpture assembly and performs partial ablation by controlling the penetration depth of the incision using the depth control device. Including that. The method includes removing the partially ablated skin pixel from the at least one target site via an orifice in the at least one skull pet.

  Embodiments include methods that include the following. Generating a protocol using patient data, the protocol comprising: at least one target site; and a topographical map of a partial skin resection configured for application to the at least one target site. Generating and positioning a carrier including a skullpet assembly comprising at least one skullpet and a depth control device at the target site, wherein the at least one skullpet is a hollow region; Positioning a tube including a pointed distal end configured to penetrate tissue at the at least one target site; and using the scalpel assembly to position a skin pixel at the at least one target site. Circumferentially Opening and partially excising by controlling the penetration depth of the incision using the depth control device, and from the at least one target site via an orifice in the at least one scalpet Removing the partially excised skin pixel.

  The protocol includes at least one of partial skin tightening and contouring. The partial excision includes partial excision of at least one of skin and fat.

  Said partial excision includes partial excision of the skin.

  The method includes determining partial field parameters. The parameter includes at least one of position, size and contour.

  The contour includes a plurality of contours corresponding to a plurality of positions.

  The contour includes curvilinear patterning.

  The method includes determining the density of partial skin resection. Density includes the percentage of partially cut skin within the partial field.

  The amount of partial skin tightening is proportional to the density.

  The method includes changing the density between regions of the partial field.

  The method includes defining a transition region between the partial field and an adjacent non-ablated region. The transition region has a relatively lower density than at least one other region of the partial field.

  The method includes performing a variable topographic transition of the density within the perimeter of the partial field, along the perimeter, or both within and along the perimeter. A smoother transition to selective contouring and non-ablated areas is generated.

  The method includes performing a variable topographical transition of the size of the at least one sculpt within the partial field. Selective contouring is generated.

  Said partial excision includes partial excision of fat.

  The method includes determining a boundary region within the partial field. The partial excision within the border region includes the partial excision of the fat.

  The partial excision of the fat includes a percutaneous vacuum excision of the fat.

  The percutaneous vacuum excision of the fat is through a separate incision.

  The partial excision of the fat includes a local percutaneous vacuum excision of the fat through a partial defect.

  The partial defect is generated using the partial excision of skin.

  The partial excision of skin includes a directional partial excision at the at least one target site. The directional partial ablation includes pre-stretching the skin at a right angle to a preferred direction of maximum skin ablation at the at least one target site.

  The partial excision includes a synthetic partial excision including the partial excision of skin and the partial excision of fat.

  Said partial excision of fat includes partial excision of tissue of at least one of the subcutaneous fat layer and the subdermal fat layer.

  The partial excision of fat includes partial excision of at least one fat layer, anatomically continuous with the partial excision of the skin adjacent to the at least one fat layer.

  Said partial excision of fat includes percutaneous vacuum excision of fat through a partial defect created by said partial excision of skin.

  The partial excision of the fat includes a percutaneous vacuum excision of the fat.

  The percutaneous vacuum excision of the fat is through a separate incision.

  The partial excision of the fat includes a local percutaneous vacuum excision of the fat through a partial defect.

  The partial defect is generated using the partial excision of skin.

  The method includes determining the amount of tissue removed during the partial excision of fat according to the amount of dimensional contours of the topographical map. The contouring includes three-dimensional contouring.

  The method includes removing a relatively large amount of tissue in an area that includes a convex contour.

  The method includes limiting the protocol to the partial excision of skin in an area that includes at least one of a concave contour and a flat contour.

  The protocol includes closing the incision using the synthetic partial excision. The size of the incision is reduced and / or iatrogenic incision skin excess is removed, or both.

  The method includes closing a partial field of the partial ablation using a directional occlusion. The directional occlusion selectively enhances contouring in the area of the partial field.

  The directional occlusion includes at least one of an occlusion in a substantially first direction, a substantially horizontal occlusion, a substantially vertical occlusion, and a directional occlusion in a plurality of directions.

  The directional occlusion includes the use of a Langer skin secant.

  The directional occlusion includes the use of a stationary skin pull line.

  The directional occlusion includes the use of an occlusion vector for surgical skin resection.

  The directional occlusion includes at least one of a bandage and an adhesive membrane instead of a suture.

  The at least one skull pet includes a plurality of skull pets configured to form a skull pet array.

  The method includes obtaining a digital image of a patient, wherein the patient data represents the digital image.

  The protocol is configured for at least one area of the human body.

  The at least one area includes at least one region of at least one of a face and a neck.

  The at least one area includes at least one region of the chest.

  The at least one area includes at least one region of at least one of an arm, an upper arm, an elbow, a leg, a middle thigh, a thigh side, a knee, and a patella.

  The at least one area includes at least one region of at least one of an abdomen, a back, a hip, and a groin.

  The method includes receiving the ablated skin pixel in a receptacle.

  The carrier includes a receptacle.

  The method includes generating a plurality of skin defects at a recipient site using the carrier.

  The method includes applying the ablated skin pixel to the skin defect by inserting each incision skin pixel into a corresponding skin defect at the recipient site.

  The method includes applying the ablated skin pixel to at least one skin defect at a recipient site.

  The method includes configuring the at least one scalpet with a scalpet shaft that includes a distal end and a proximal end.

  The method includes configuring the at least one sculpture to include a distal region near the distal end configured to receive the incision through tissue.

  The method includes configuring the at least one scalpet to include at least one of an orifice and a slot provided axially adjacent to the hollow region within the scalpet. The at least one of the orifice and the slot is configured to divert the received tissue radially outward from an inner region of the skullpet.

  The method includes configuring the depth control device to control the depth of the incision.

  The method includes configuring the at least one skull pet to include a skull pet shaft that includes a distal end and a proximal end. The skull pet shaft includes a hollow interior region between the distal end and the proximal end.

  The method includes: a distal region near the distal end configured to receive the at least one sculptpet through an incision in tissue; and a proximal end for passing the received tissue. Including configuring.

  The method includes configuring the at least one scalpet to include a cylindrical scalpet that includes a cutting surface on a distal end of the at least one scalpet. The cutting surface includes at least one of a pointed tip, at least one pointed point, and a serrated edge.

  The method includes applying a rotational force to at least one sculpt. The rotational force causes the at least one sculpt to rotate about a central axis of the at least one sculpt.

  The method includes configuring the carrier to include a housing at a distal region and applying a vacuum through the housing at the target site. The vacuum includes an internal pressure of the housing that is relatively lower than ambient air pressure.

  The method includes controlling the position of the at least one scalpet relative to the target site by configuring at least one of a spring in the housing and the vacuum.

  The method includes configuring the vacuum to remove at least one of the partially excised skin pixel and partially excised fat.

  Embodiments include a method that includes generating a protocol that includes a target site and a topographical map of a partial skin ablation configured for application to the target site. The method includes positioning a carrier including a plurality of skull pets at the target site. Each sculpture includes a sculpture shaft including a proximal end and a distal end configured to penetrate tissue at the at least one target site. At least one region of the skull pet shaft adjacent to the distal end is configured to pass tissue received through the distal end from an orifice of the skull pet shaft. The method includes performing a partial excision by incising a skin pixel at the target site with the plurality of skullpets. The method includes removing from the target site at least one of the partially excised skin pixel and fat.

  Embodiments include methods that include the following. Generating a protocol including a target site and a topographical map of a partial skin resection configured for application to the target site; and positioning a carrier including a plurality of scalpets at the target site Each skullpet including a skullpet shaft including a proximal end and a distal end configured to penetrate tissue at the at least one target site, the skull adjacent to the distal end. Positioning at least one region of the pet shaft configured to pass tissue received from the orifice of the skull pet shaft through the distal end, and dissecting a skin pixel at the target site with the plurality of skull pets Doing a partial resection, From serial target site, removing at least one of the partially resected skin pixels and fat.

  Embodiments include a method that includes configuring an ablation device to include a sculpture assembly comprising a sculpture array and a depth control device. The sculpture array includes a plurality of sculptures, each sculpture including a tube that includes a hollow region and a pointed distal end configured to penetrate tissue at a target site. The distal end includes at least one of a pointed region and a blunt region. The depth control device is configured to control the depth of penetration of the skull pet array into the tissue. The method includes configuring the ablation device at the target site to operate according to a protocol that includes a map of partial ablation. The method includes setting the ablation device to perform the partial ablation by incising a skin pixel at the target site. The method includes setting the ablation device to remove at least one of the partially ablated skin pixels and fat from the target site.

  Embodiments include methods that include the following. Configuring an ablation device to include a skull pet assembly comprising a skull pet array and a depth control device, the skull pet array including a plurality of skull pets, each skull pet having a hollow region and a target site A tube including a distal end configured to penetrate tissue at the distal end, the distal end including at least one of a pointed region and a blunt region, wherein the depth control device includes the skull pet array Configuring the ablation device to operate at a target site according to a protocol including a map of partial ablation, and configured to control a depth of penetration of the tissue into the tissue; Before performing the partial resection by incising a skin pixel at the site And setting the ablation device, wherein the target site, setting the ablation device to remove at least one of the partially resected skin pixels and fat.

  Embodiments include a method that includes generating a protocol that includes a target site and a topographical map of a partial skin ablation configured for application to the target site. The method includes an ablation device comprising a scalp assembly comprising at least one scalpet and a depth control device configured to control a depth of tissue penetration at a target site of the at least one scalpet. Comprising. The at least one sculpture includes a sculpture shaft including a proximal end and a distal end configured to penetrate the tissue. The skull pet shaft includes a hollow region adjacent to the distal end and configured to pass tissue received through the distal end. The sculpture shaft includes an orifice connected to the hollow region and configured to pass the received tissue from the sculpture shaft. The method includes setting the ablation device to perform the partial ablation by incising a skin pixel according to a protocol at the target site. The method includes setting the ablation device to remove at least one of the partially ablated skin pixels and fat from the target site.

  Embodiments include methods that include the following. Generating a protocol that includes a target site, a topographical map of a partial skin resection configured for application to the target site, at least one sculpette, and a target site of the at least one sculppet A depth control device configured to control a depth of tissue penetration in the ablation device, wherein the at least one scalpet is a proximal end And a distal end configured to invade the tissue, wherein the skullpet shaft is a hollow region adjacent to the distal end and is received through the distal end. A hollow region configured to pass through, wherein the skull pet shaft is Comprising an orifice connected to a region and configured to pass the received tissue from the sculpture shaft; and dissecting a skin pixel according to the protocol at the target site Configuring the ablation device to perform the partial ablation and setting the ablation device to remove at least one of the partially ablated skin pixels and fat from the target site.

  Throughout the description, words such as “comprise” and “comprising” are not exclusive or exhaustive unless the context explicitly requires otherwise. , In a comprehensive sense, ie in the sense of “including but not limited to”. Words using the singular or plural number also include the plural or singular number respectively. Furthermore, the terms “in this specification”, “below”, “above”, “below”, and like words when used in this application refer to the entire application and to specific parts of the application. It does not point to. When the word “or” is used with reference to a list of two or more items, the word covers all of the following interpretations of the word; any of the items in the list, any of the items in the list Any combination of all and list items.

  The above description of embodiments is not intended to be exhaustive or to limit the systems and methods to the precise forms disclosed. For purposes of illustration, specific embodiments and examples of medical devices and methods are described herein, but as those skilled in the art will recognize, within the scope of the systems and methods. Various equivalent changes are possible. The teachings on medical devices and methods provided herein can be applied not only to the systems and methods described above, but also to other systems and methods.

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

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

  Although certain aspects of the medical devices and methods and corresponding systems and methods are presented below in certain claim forms, the inventors have described the medical devices and methods in any claim form and Various aspects of corresponding systems and methods are envisioned. Accordingly, the inventors reserve the right to add further claims after filing the present application to pursue additional claim forms for other aspects of the medical device and method and corresponding system and method. .

Claims (118)

Career,
A chuck connected to a distal region of the carrier;
A skull pet assembly including at least one skull pet and a depth control device;
The skull pet assembly includes a shank configured for retention with the chuck, the at least one skull pet having a hollow region and a pointed distal end configured to penetrate tissue at a target site; A device, wherein the depth control device is configured to control the depth of penetration of the at least one scalpet into the tissue.   The device of claim 1, wherein the skull pet assembly includes a skull pet comprising a skull pet shaft that includes a distal end and a proximal end.   The device of claim 2, wherein the skull pet shaft includes a hollow region near the distal end and a solid region near the proximal end.   The device of claim 2, wherein the proximal end includes a region configured as the shank.   The device of claim 2, wherein the scalpet includes a distal region near the distal end configured to incise and receive tissue.   The device of claim 5, wherein the sculpture includes at least one of an orifice and a slot provided axially adjacent to the hollow region in the sculpture.   The device of claim 6, wherein the at least one of the orifice and the slot is configured to divert the received tissue radially outward from an inner region of the skullpet.   The device of claim 5, wherein the depth control device is configured to connect with the distal region of the carrier.   The device of claim 8, wherein the depth control device includes a vacuum manifold, the vacuum manifold configured to create a seal between the vacuum manifold and the target site.   The skullpet assembly includes a skullpet comprising a skullpet shaft including a distal end and a proximal end, the skullpet shaft including a hollow interior region between the distal end and the proximal end. Item 2. The device according to Item 1.   The device of claim 10, wherein the proximal end includes a region configured as the shank.   The device of claim 10, wherein the scalpet includes a distal region near the distal end configured to incise and receive tissue.   The device of claim 12, wherein the proximal end is configured to pass the received tissue.   14. The device of claim 13, wherein the carrier includes a reservoir in an interior region, the proximal end of the sculpture is connected to the reservoir, and the reservoir is configured to hold the received tissue.   The device of claim 10, wherein the depth control device includes an adapter configured to receive the skull pet shaft.   The device of claim 15, wherein the chuck is configured to maintain an axial position of the adapter and the skullpet in the carrier.   The device of claim 10, wherein the depth control device includes a vacuum manifold, the vacuum manifold configured to create a seal between the vacuum manifold and the target site.   The device of claim 1, comprising a motor connected to the chuck and configured to drive the skull pet assembly.   The device of claim 1, wherein the carrier is configured to be held by hand.   The device of claim 1, wherein the skull pet assembly includes a plurality of skull pets.   21. The device of claim 20, wherein the plurality of skull pets are arranged to form a skull pet array.   The device of claim 21, wherein the sculpture array is a rectangular array.   The device of claim 21, wherein the sculpture array comprises one of a 3 × 3 array and a 5 × 5 array.   The device of claim 21, wherein each sculpture is configured to rotate about a central axis of the sculpture.   The sculpture assembly includes a drive assembly connected to each sculpture, wherein the drive assembly is configured to provide a rotational force to a proximal region of each sculpette, and the rotational force causes each sculpette to move about the central axis. 25. The device of claim 24, wherein   26. The device of claim 25, wherein the drive assembly includes a gear drive system.   26. The device of claim 25, wherein the drive assembly includes a friction drive system.   26. The device of claim 25, wherein the shank is configured as a drive shaft comprising a proximal end configured to connect to the chuck and a distal end configured to connect to the drive assembly.   26. The device of claim 25, comprising a motor connected to the chuck and configured to drive the drive assembly via the drive shaft.   26. The device of claim 25, comprising a housing configured as the depth control device.   32. The device of claim 30, wherein the housing is configured to at least partially receive the skull pet array.   Each sculpture includes a sculpture shaft that includes a distal end and a proximal end, each sculpture including at least a hollow interior region near the distal end, the distal end configured to receive and cut through tissue 26. A device as claimed in claim 25.   26. The device of claim 25, comprising a housing configured to create a vacuum at the target site, wherein the vacuum includes an internal pressure of the housing that is relatively lower than ambient air pressure.   34. The device of claim 33, wherein a distal region of the housing is configured to form a vacuum seal when in contact with adjacent tissue adjacent to the target site.   34. The device of claim 33, wherein the housing includes a port coupled to a vacuum source.   34. The device of claim 33, wherein the vacuum is configured to remove a cut material from the target site.   37. The device of claim 36, wherein the vacuum is configured to extract subcutaneous fat through a void created from an incision skin pixel at the target site.   38. The device of claim 36, wherein the scalpel assembly includes a spring device configured to control the position of the scalpet array.   40. The device of claim 38, wherein the spring device is configured to control movement of the skullpet array in the direction of contact at the target site by applying an axial force to the skullpet array.   34. The device of claim 33, wherein the vacuum is configured to control the position of the sculpture array relative to the target site.   41. The device of claim 40, wherein the skull pet assembly is configured to cooperate with the vacuum to control the position of the skull pet assembly.   42. The device of claim 41, wherein the vacuum is configured to control movement of the skullpet array in the direction of contact with the target site.   43. The device of claim 42, wherein the spring device is configured to control movement of the skullpet array away from the target site by applying an axial force to the skullpet array.   34. The device of claim 33, wherein the housing is configured as the depth control device.   34. The device of claim 33, wherein the housing is configured to at least partially receive the skull pet array.   34. The device of claim 33, comprising a skull pet assembly coupling configured to attach the housing to the carrier.   The device of claim 1, wherein the at least one scalpet is configured to transmit an axial force to the target site.   48. The device of claim 47, wherein the axial force comprises at least one of continuous axial force, impact force, and continuous axial force and impact force.   The device of claim 1, wherein the at least one scalpet comprises a cylindrical scalpet that includes a cutting surface at a distal end of the at least one scalpet.   50. The device of claim 49, wherein the cutting surface includes at least one of a pointed tip, at least one pointed point, and a serrated edge.   50. The device of claim 49, wherein the cut surface includes a blunt edge. A carrier comprising a chuck connected to the distal region;
A skull pet assembly including a skull pet and a depth control device; and
The skull pet assembly is configured for retention with the chuck, the skull pet array includes a plurality of skull pets, and each skull pet is configured to invade tissue at a hollow region and a target site. And a distal end, wherein the depth control device is configured to control the depth of penetration of the skullpet array into the tissue. A carrier comprising a proximal region and a distal region, wherein the proximal region is configured to be hand held;
A skull pet assembly including at least one skull pet;
A depth control device configured to control the depth of penetration of the tissue at the target site of the at least one skull pet;
The at least one sculpture includes a sculpture shaft including a proximal end and a distal end configured to penetrate the tissue, wherein the sculpture shaft is a hollow region adjacent to the distal end. The sculpture shaft comprising a hollow region configured to pass tissue received through the distal end, the orifice being connected to the hollow region, wherein the received tissue from the sculpture shaft is A device that includes an orifice configured to pass therethrough. A carrier comprising a proximal region and a distal region, wherein the proximal region is configured to be hand held;
A skull pet assembly including a plurality of skull pets, and
The skull pet assembly includes a drive assembly configured to rotate each of the plurality of skull pets about a central axis by applying a rotational force to the plurality of skull pets, each skull pet including a proximal end. A pet shaft and a distal end configured to penetrate tissue at a target site, wherein the skull pet shaft is a hollow region adjacent to the distal end and is received through the distal end. A device wherein the sculpture shaft including a hollow region configured to pass therethrough is an orifice connected to the hollow region and configured to pass the received tissue from the sculpture shaft. Generating a protocol using patient data, the protocol comprising: at least one target site; and a topographical map of a partial skin resection configured for application to the at least one target site. Including, generating,
Positioning a carrier including a skullpet assembly comprising at least one skullpet and a depth control device at the target site, wherein the at least one skullpet is at a hollow region and at the at least one target site. Positioning, including a tube including a pointed distal end configured to invade tissue;
Performing a partial incision by circumferentially incising skin pixels at the at least one target site using the sculpture assembly and controlling the penetration depth of the incision using the depth control device;
Removing the partially ablated skin pixels from the at least one target site via an orifice in the at least one scalpet.   56. The method of claim 55, wherein the protocol includes at least one of partial skin tightening and contouring.   57. The method of claim 56, wherein the partial ablation comprises partial ablation of at least one of skin and fat.   57. The method of claim 56, wherein the partial ablation comprises partial skin excision.   59. The method of claim 58, comprising determining partial field parameters, wherein the parameters include at least one of position, size, and contour.   60. The method of claim 59, wherein the contour comprises a plurality of contours corresponding to a plurality of locations.   60. The method of claim 59, wherein the contour comprises curvilinear patterning.   60. The method of claim 59, comprising determining a density of the partial ablation of the skin, wherein the density includes a percentage of partially excised skin in the partial field.   64. The method of claim 62, wherein the amount of partial skin tightening is proportional to the density.   64. The method of claim 63, comprising changing the density between regions of the partial field.   64. Defining a transition region between the partial field and an adjacent non-ablated region, wherein the transition region has a relatively lower density than at least one other region of the partial field. The method described in 1.   Performing a variable topographical transition of the density within the perimeter of the partial field, or along the perimeter, or both within and along the perimeter, including selective contouring and non-ablation areas 64. The method of claim 63, wherein a smoother transition to is generated.   64. The method of claim 63, wherein selective contouring is generated comprising performing a variable topographical transition of the size of the at least one sculpt within the partial field.   60. The method of claim 59, wherein the partial ablation comprises partial ablation of fat.   69. The method of claim 68, comprising determining a boundary region within the partial field, wherein the partial ablation within the boundary region includes the partial ablation of the fat.   69. The method of claim 68, wherein the partial excision of the fat comprises a percutaneous vacuum excision of the fat.   71. The method of claim 70, wherein the percutaneous vacuum ablation of the fat is through a separate incision.   69. The method of claim 68, wherein the partial excision of the fat comprises a local percutaneous vacuum excision of the fat through a partial defect.   75. The method of claim 72, wherein the partial defect is generated using the partial excision of skin.   The partial ablation of skin includes a directional partial ablation at the at least one target site, and the directional partial ablation is perpendicular to a preferred direction of maximum skin ablation at the at least one target site 59. The method of claim 58, comprising pre-stretching.   59. The method of claim 58, wherein the partial excision comprises a synthetic partial excision comprising the partial excision of skin and the partial excision of fat.   76. The method of claim 75, wherein the partial excision of fat comprises partial excision of tissue of at least one of a subcutaneous fat layer and a subdermal fat layer.   76. The partial excision of fat comprises partial excision of at least one fat layer, anatomically continuous with the partial excision of the skin adjacent to the at least one fat layer. The method described in 1.   76. The method of claim 75, wherein the partial excision of fat comprises percutaneous vacuum excision of fat through a partial defect created by the partial excision of skin.   76. The method of claim 75, wherein the partial excision of the fat comprises a percutaneous vacuum excision of the fat.   80. The method of claim 79, wherein the percutaneous vacuum excision of the fat is through a separate incision.   76. The method of claim 75, wherein the partial excision of the fat comprises a local percutaneous vacuum excision of the fat through a partial defect.   84. The method of claim 81, wherein the partial defect is generated using the partial excision of skin.   76. The method of claim 75, comprising determining the amount of tissue removed during the partial excision of fat according to the amount of dimensional contours in the topographical map, wherein the contouring includes three-dimensional contouring.   84. The method of claim 83, comprising removing a relatively large amount of tissue in an area that includes a convex contour.   85. The method of claim 84, comprising limiting the protocol to the partial excision of skin in an area that includes at least one of a concave contour and a flat contour.   76. The protocol includes closing the incision with the synthetic partial excision, wherein the size of the incision is reduced and / or iatrogenic incision skin excess is removed, or both. The method described.   56. The method of claim 55, comprising closing a partial field of the partial ablation using a directional occlusion, wherein the directional occlusion selectively enhances contouring in an area of the partial field.   88. The directional occlusion comprises at least one of an occlusion in a substantially first direction, a substantially horizontal occlusion, a substantially vertical occlusion, and a directional occlusion in a plurality of directions. Method.   90. The method of claim 87, wherein the directional occlusion comprises the use of a Langer skin secant.   90. The method of claim 87, wherein the directional occlusion comprises the use of a stationary skin pull line.   90. The method of claim 87, wherein the directional occlusion comprises the use of a surgical skin resection occlusion vector.   88. The method of claim 87, wherein the directional occlusion comprises at least one of a bandage and an adhesive membrane instead of a suture.   56. The method of claim 55, wherein the at least one sculpture comprises a plurality of sculptures configured to form a sculpture array.   56. The method of claim 55, comprising obtaining a digital image of a patient, wherein the patient data represents the digital image.   56. The method of claim 55, wherein the protocol is configured for at least one area of a human body.   96. The method of claim 95, wherein the at least one area includes at least one region of at least one of a face and a neck.   96. The method of claim 95, wherein the at least one area includes at least one region of the chest.   96. The method of claim 95, wherein the at least one area includes at least one region of at least one of an arm, an upper arm, an elbow, a leg, an intermediate thigh, a thigh side, a knee, and a patella.   96. The method of claim 95, wherein the at least one area includes at least one region of at least one of an abdomen, back, buttocks, and groin.   56. The method of claim 55, comprising receiving the ablated skin pixel in a receptacle.   101. The method of claim 100, wherein the carrier includes the receptacle.   101. The method of claim 100, comprising generating a plurality of skin defects at a recipient site using the carrier.   105. The method of claim 102, comprising applying the ablated skin pixel to the skin defect by inserting each incision skin pixel into a corresponding skin defect at the recipient site.   105. The method of claim 102, comprising applying the ablated skin pixel to at least one skin defect at a recipient site.   56. The method of claim 55, comprising configuring the at least one sculpture with a sculpture shaft that includes a distal end and a proximal end.   106. The method of claim 105, comprising configuring the at least one scalpet to include a distal region near the distal end configured to receive an incision through tissue.   The at least one sculpture includes at least one of an orifice and a slot provided axially adjacent to the hollow region in the sculpture, and includes the orifice and the slot. 107. The method of claim 106, wherein the at least one of the plurality is configured to divert the received tissue radially outward from an inner region of the skullpet.   107. The method of claim 106, comprising configuring the depth control device to control the depth of the incision.   Configuring the at least one sculpture to include a sculpture shaft including a distal end and a proximal end, wherein the sculpture shaft is a hollow interior between the distal end and the proximal end. 56. The method of claim 55, comprising a region.   Configuring the at least one scalpet to include a distal region near the distal end configured to receive an incised tissue and a proximal end for passing the received tissue. 110. The method of claim 109, comprising:   Configuring the at least one scalpet to include a cylindrical scalpet that includes a cutting surface on a distal end of the at least one scalpet, the cutting surface being a pointed tip, at least one pointed point. 56. The method of claim 55, comprising at least one of an open point and a serrated edge.   56. The method of claim 55, comprising applying a rotational force to the at least one sculpt, wherein the rotational force rotates the at least one sculpt around a central axis of the at least one sculpt.   Configuring the carrier to include a housing at a distal region and applying a vacuum through the housing at the target site, wherein the vacuum is relatively lower than ambient air pressure. 56. The method of claim 55, comprising an internal pressure of   114. The method of claim 113, comprising controlling a position of the at least one sculppet relative to the target site by configuring at least one of a spring in the housing and the vacuum.   114. The method of claim 113, comprising configuring the vacuum to remove at least one of the partially excised skin pixel and partially excised fat. Generating a protocol that includes a target site and a topographical map of partial skin resection configured for application to the target site;
Positioning a carrier comprising a plurality of skull pets at the target site, each skull pet comprising a skull pet shaft comprising a proximal end and a distal portion configured to penetrate tissue at the at least one target site. Positioning, wherein at least one region of the skullpet shaft adjacent to the distal end is configured to pass tissue received through the distal end from an orifice of the skullpet shaft When,
Performing a partial excision by incising a skin pixel at the target site with the plurality of skullpets;
Removing from the target site at least one of the partially excised skin pixel and fat. Configuring an ablation device to include a skull pet assembly comprising a skull pet array and a depth control device, the skull pet array including a plurality of skull pets, each skull pet having a hollow region and a target site A tube including a distal end configured to penetrate tissue at the distal end, the distal end including at least one of a pointed region and a blunt region, wherein the depth control device includes the skull pet array Configured to control the depth of penetration of the tissue into the tissue;
Configuring the ablation device at the target site to operate according to a protocol that includes a map of partial ablation;
Setting the ablation device to perform the partial ablation by incising a skin pixel at the target site;
Setting the ablation device to remove at least one of the partially ablated skin pixels and fat from the target site. Generating a protocol that includes a target site and a topographical map of partial skin resection configured for application to the target site;
Configuring the ablation device to include a scalp assembly comprising at least one scalpet and a depth control device configured to control a depth of tissue penetration at a target site of the at least one scalpet. Wherein the at least one scalpet includes a scalpet shaft including a proximal end and a distal end configured to penetrate the tissue, the scalpet shaft including the distal end A hollow region adjacent to the hollow region configured to pass tissue received through the distal end, wherein the skull pet shaft is an orifice connected to the hollow region and from the skull pet shaft Comprising an orifice configured to pass the received tissue;
Setting the ablation device to perform the partial ablation by incising a skin pixel according to the protocol at the target site;
Setting the ablation device to remove at least one of the partially ablated skin pixels and fat from the target site.