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Directional Tumescent Controlled Radiofrequency For Skeletal Neuromuscular Ablation
Sofya H. Asfaw MD, Gaby Doumit MD FRCSC, Melissa P. Piliang MD, Can Ozturk MD, Francis A. Papay MD FACS
Cleveland Clinic Foundation
2013-03-14
Presenter: Sofya H. Asfaw
Affidavit:
The resident participated in all aspects of this work including obtaining Institutional Review Board approval, experimental design, experimental completion, data analysis and project summary.
Director Name: Allan Siperstein
Author Category: Other Specialty Resident
Presentation Category: Basic Science Research
Abstract Category: Aesthetics
Percutaneous selective radiofrequency nerve ablation (RFA) is a minimally invasive method for treating glabellar frown lines. There is morbidity associated with burns and extraneous damage to non-targeted tissue. Tumescence may increase the safety profile. No studies document the histopathologic changes that occur after muscle and nerve have been targeted with and without tumescent. We conducted a pilot study to determine these effects.
Each gastrocnemius muscle (GC) of eight Lewis rats was ablated for either 30 (N=8) or 60 seconds (N=8) at 80°C. Sciatic nerves were ablated at the same temperature for 15 (N=8) or 30 seconds (N=8). Two rats were injected with tumescent. Five rats were sacrificed at 4 days and three at 4 weeks. All nerves and muscles were stained with hematoxylin and eosin (H&E) and analyzed.
At longer ablation times the nerves showed inflammation, necrosis and degeneration at 4 days. With tumescent there was inflammation, no necrosis and mild degeneration compared to the group without. The muscles showed inflammation and necrosis. At 4 weeks, the nerves showed severe constriction and the muscles were severely atrophic in rats without tumescent and with longer ablation times. No ambulation defects were observed.
RFA is effective in producing muscle and nerve damage in the rat GC without causing an ambulation defect. The use of directional tumescent lessens the degree of muscle inflammation and nerve necrosis. A larger study is needed to optimize variables for percutaneous RFA to produce a desired defect and determine if directional tumescence should be used as an adjunct.
