Abstract: Systems and methods for securing a soft tissue graft to bone are provided herein. In one embodiment, a surgical implant can include an elongate body having a longitudinal axis extending therealong and having first and second through-holes that are offset to a first side of the longitudinal axis and a third through-hole that is offset to a second side of the longitudinal axis and that is positioned between the first and second through-holes. The implant can also include a suture length extending through the first, second, and third through-holes such that a self-locking knot is formed on a first side of the body and a plurality of suture loops are formed on a second side of the body opposite the first side.

Abstract: A method of treating a heart of a patient is provided, including implanting a first tissue anchor in cardiac tissue of the patient, the first tissue anchor attached to one or more tethers that are fixed to a coupling element. A second tissue anchor is implanted in the patient. The coupling element is coupled to a first coupling site of the second tissue anchor, thereby coupling the first tissue anchor to the second tissue anchor via the one or more tethers. Thereafter, after allowing at least 24 hours for tissue growth on the first tissue anchor to strengthen anchoring of the first tissue anchor in the cardiac tissue, tension is increased between the first and the second tissue anchors by decoupling the coupling element from the first coupling site and coupling the coupling element to a second coupling site of the second tissue anchor. Other embodiments are also described.

Abstract: Apparatus for use with a deployment tool is provided. The apparatus includes a tissue anchor configured to be delivered in a constrained state within the deployment tool. The tissue anchor includes a shaft and a tissue-coupling element, which extends from a distal end of the shaft and is configured to be advanced through an incision in a wall of a cardiac chamber and be coupled to a far outer side of the wall. A spring is disposed proximal to a sealing element, and is configured to distally push the sealing element against an inner side of the wall to seal the incision. Other embodiments are also described.

Abstract: The guidance and positioning device may be a system for creating a passage in tissue, positioning fasteners or other implants, and tensioning an elongated fastening member, like a suture, thread, wire, or pin. In some embodiments, the device may allow for the implantation of multiple sutures and fasteners in tissue. A fastener may be positioned at the distal end of a flexible pushrod. The fastener may be connected with the pushrod or may be loosely fitted with the distal end of the pushrod. A suture may be looped through or connected with the fastener such that one, two, or more sections, legs, strands, or portions of the suture extend from the fastener.

Abstract: A method and device for anchoring a length of self-retaining suture. The method of anchoring includes providing for an assembly having a length of self-retaining suture and a suture insertion device. The length of suture includes at least a portion of the length having a plurality of retainers thereon extending in a first direction. The insertion device has a length and a recess to receive a portion of the suture length. The method further includes placing a portion of the suture length in the recess and inserting the device into the body of a mammal until the recess reaches a predetermined location thereby forming an insertion pathway. The method further includes retrieving the insertion device from the body by moving the insertion device in a direction substantially opposed to the insertion pathway.

Abstract: A medical implement particularly useful in arthroscopic surgery, includes: a handle having a proximal end configured for manual gripping by a user, a distal end for manipulation during the surgery, an internal passageway extending through the handle from the proximal end to the distal end thereof, and a longitudinally-extending slot extending longitudinally through the handle from its outer surface to the passageway for side-loading the handle with a manipulatable member to be manipulated during surgery. A shield is located within the passageway in the handle. The shield is secured along one edge to the inner surface of handle defining the passageway, and includes an elastic section normally covering the longitudinally-extending slot. The elastic section of the shield is yieldable to permit side-loading of the manipulatable member into the passageway, but to prevent a side-loaded manipulatable member from passing outwardly from the passageway.

Abstract: A surgical instrument for use in passing suture through tissue is provided that includes first and second jaws disposed on a distal end of an elongate shaft and configured to grasp tissue therebetween, and a needle selectively movable along a longitudinal channel extending through an outer side wall of the first jaw. The first jaw has a cavity configured to seat a removable and replaceable suture magazine. The suture magazine can be coupled to a suture magazine carrier that is removed before the surgical instrument is activated cause to the needle to advance distally and thereby pass a suture coupled thereto through tissue in a patient's body. As the needle is retracted proximally, a subsequent suture portion, such as a loop, is loaded onto the needle. The jaws remain in the body during passing the suture through the tissue.

Abstract: Sutures with pre-tied knots for use in percutaneous surgical procedures and devices for easily and quickly tying complex suture knots are disclosed.

Abstract: A suture clip includes a body having a proximal end, a distal end, and a sidewall defining a lumen through the body from the proximal end to the distal end. At least one engaging arm is movable between a loaded condition in which the engaging arm is oriented substantially parallel with the sidewall of the body, and a relaxed condition in which the engaging arm is oriented transversely to the sidewall of the body and at least partially disposed within the lumen.

Abstract: Described herein are systems and methods for securing sutures that obviate the need for tying knots. A device can be applied to adjacent suture portions that heats the suture portions and causes the suture portions to fuse together, effectively securing the suture portions together without a knot. The device can include a handle, an outer shaft coupled to the handle, an inner shaft movable proximally and distally within the outer shaft; a suture holder at the distal end portion of the outer shaft, and an electrical heating element positioned within the outer shaft. Actuation of the device causes the inner shaft and the heating element to move distally relative to the outer shaft and the suture holder, such that the heating element moves into the proximity of the suture holder to fuse together sutures held by the suture holder.

Abstract: A surgical suture passer (10) having a hollow needle (11) with an axial lumen (12) and a handle (13) having the hollow needle (11) secured and retained at its proximal end (15). The handle (13) defines a planar recessed surface (21) and the lumen (12) of the hollow needle (11) is aligned with this planar recessed surface (21) when the needle is retained by the handle (13) whereby a suture positioned on the planar surface (21) may be advanced or retracted by direct finger engagement of the suture into and out of the hollow needle lumen (12).

Abstract: An apparatus and method is disclosed for securing tissue to a bone comprising a novel screw anchor for insertion into a bone by a novel rotational driver. The screw anchor and rotation driver enables the screw to be completely embedded into the bone while permitting a suture to be threaded through a transverse aperture in the screw. The rotation driver facilitates insertion and engagement of a capture with one of a series of protuberance formed along a length of a suture. In addition, the method is disclosed of forming the series of protuberance.

Abstract: Methods for deploying a fastener to close an incision or wound involve exposing the inner surface of each opposing side of the incision and inserting down into the exposed inner surfaces from above the fastener.

Abstract: Thresholds can be assigned for one or more parameters in connection with the operation of a surgical device. An ultimate threshold can trigger a desired action, including cessation of operations or modification of operations, if the ultimate threshold is reached, or predicted to be reached. In addition, a marginal threshold can trigger a desired action, including improving operations such as slowing operations where the value of a parameter is measured to be between the values defined by a marginal threshold and an ultimate threshold. Multiple thresholds, based on multiple parameters, can be defined, further enabling calibrated usage, such as slowing operations based on exceeding both a marginal threshold based on number of sterilization cycles and exceeding a marginal threshold based on extent to which current draw exceeds a certain value.

Abstract: A stapling assembly for use with a robotic device is disclosed. The stapling assembly comprises a first jaw, a second jaw rotatable relative to the first jaw between an open position and a closed position, an elongate shaft coupled to the first jaw, and a housing coupled to the elongate shaft. The housing comprises rotatable inputs operably engageable with the robotic device. A first system is configured to position the second jaw relative to the first jaw at a first rate. A second system is configured to position the second jaw relative to the first jaw at a second rate which is faster than the first rate.

Abstract: A powered surgical stapler comprising an outer housing body, a shaft housing rotatable relative to the outer housing body, an elongate shaft extending from the shaft housing and including a driver, an inner housing assembly configured to be removably attached to the outer housing body, a plurality of securing features, and a loading unit is disclosed. The inner housing assembly comprises a motor configured to output rotary motions, a battery, control electronics in signal communication with the motor and a shaft output configured to be driven by the motor. The plurality of securing features are configured to align and hold the inner housing assembly in a position which allows the shaft output to be operably attached to the driver. The loading unit is removably attachable to the elongate shaft and comprises an end effector configured to perform an end effector function in response to the rotary motions of the motor.

Abstract: A surgical device is disclosed which includes a handle assembly, an elongated member and a disposable loading unit. The handle assembly includes a mode selection mechanism configured to alternate the surgical device between a first grasping mode of operation and a second clamping mode of operation. The handle assembly includes a rotation control member and an articulation lever. The rotation control member is configured to facilitate rotation of the elongated member with respect to the handle assembly. The articulation lever is configured to facilitate articulation of the tool assembly about an axis substantially perpendicular to the longitudinal axis of elongated member. In one embodiment, the tool assembly includes a cartridge assembly having a plurality of staples and an anvil assembly configured to clamp and staple tissue in the second clamping mode of operation of the device.

Abstract: An end effector for use by a surgeon to staple an anatomical structure of a patient during a surgical procedure includes an anvil and a cartridge. Each of the anvil and the cartridge has a face that is positionable on the anatomical structure. The anvil is coupled to the cartridge at first and second ends. The anvil is movable relative to the cartridge to define a first gap between the faces at the first ends that is different from a second gap between the faces at the second ends.

Abstract: Devices for approximating multiple tissue edges internal to a body are disclosed.

Abstract: A staple cartridge for stapling the tissue of a patient is disclosed. The staple cartridge comprises a cartridge body, a plurality of staples, and a compressible tissue thickness compensator configured to adapt in thickness in response to the thickness of the tissue and adaptively apply different pressures to the tissue based on the thickness of the tissue captured within the staples. The compressible tissue thickness compensator comprises a plurality of fibers comprising a first matrix oriented in a first direction and a second matrix oriented in a second direction that is different than the first direction. A network of interstices is defined intermediate and among the first matrix and the second matrix. The network of interstices comprises a plurality of cavities that promote tissue and cellular ingrowth between the first and second matrices of fibers.

Abstract: A surgical stapler end effector assembly includes a staple cartridge, an end effector, and a buttress assembly. The cartridge included a plurality of staples and a deck. The cartridge is operable to drive the staples through the deck. The anvil includes an underside having a staple forming surface configured to receive staples driven through the deck. The buttress assembly is sized and configured to be coupled with the deck of the staple cartridge or the underside of the anvil. The buttress assembly includes a buttress body, a first adhesive layer, and a second adhesive layer. The first and second adhesive layers are formed of different materials. The first adhesive layer is laid over the buttress body. The second adhesive layer is laid over the first adhesive layer such that the first adhesive layer is interposed between the second adhesive layer and the buttress body.

Abstract: Illustrated and described is an anastomotic device for forming anastomoses, in particular of intestine anastomoses, with an introducer sheath for insertion into a body lumen, wherein a thrust bearing part is provided for the head section and within the head section an extendable and retractable knife and a retaining pin are arranged. According to the invention at least the actuating part and the head section of inter-connected fluid supply channel and at the head section at least one fluid outlet connected with the fluid supply channel are provided for producing a fluidic connection between the actuating part and the head section while inserting the head section into the body lumen and/or when pushing the introducer sheath into the body lumen, in which the fluidic connection is configured for discharging an inflation liquid into the body lumen.

Abstract: A valve (2) comprising: (a) membrane (50) and (b) a frame (10) in communication with the membrane so that the frame expands the membrane, the frame including: (i) a rod (4), (ii) a plurality of struts (12) connected to the rod at a distal end and extending generally radially outward as the struts extend away from the distal end and towards a proximal end; (iii) a plurality of anchors (30) that are in direct communication with the struts between the distal end and the proximal end, each of the plurality of anchors extending through an exit location (52) in the membrane.

Abstract: An implant may include a frame and a cover to facilitate endoluminal vessel occlusion, selective release of embolic material toward a target region, and/or endoluminal stenting. The frame of the implant provides radial expansion properties to secure the cover within a body vessel. The cover and/or the frame can occlude flow of a fluid through the body vessel.

Abstract: A catheter devices/systems and methods therefrom are described herein for treating acute kidney injury, especially the contrast-induced acute kidney injury wherein the devices may prevent the contrast dyes from entering into kidney and/or facilitate blood flow of kidney by said catheter system.

Abstract: A clip device for an endoscope of the present invention comprises an outer tubular body 70; an inner tubular body 80 provided in the outer tubular body 70; a line member 50 placed in the inner tubular body 80; and a pinching part 20, for holding an indwelling clip, connected to a distal side of the line member 50; wherein the pinching part 20 has two pinching base plates 30a and 30b, a blade part 40a is provided at a distal end of the pinching base plate 30a and formed toward an inside of the pitching base plate 30a, a blade part 40b is provided at a distal end of the pinching base plate 30b and formed toward an inside of the pinching base plate 30b, a Young's modulus of the blade part 40a is smaller than that of the pinching base plate 30a, and a Young's modulus of the blade part 40b is smaller than that of the pinching base plate 30b.

Abstract: A hemostatic method is performed as follows: A) An at-puncture hemostatic pressure is applied to a puncture in a blood vessel via a main geometric side, and at least one off-puncture hemostatic pressure is applied to at least one position away from the puncture via at least one auxiliary geometric side, wherein the off-puncture hemostatic pressure acts on the blood vessel either directly or indirectly. B) During the hemostatic process, an ongoing flow velocity of the blood in the blood vessel is obtained and is reduced to lower than a normal flow velocity in the blood vessel by applying the at-puncture and off-puncture hemostatic pressures simultaneously, wherein the at-puncture and off-puncture hemostatic pressures are lower than a systolic pressure in the blood vessel.

Abstract: The invention relates to a surgical system comprising: (i) a handheld device (100) comprising: a base (1), an end-effector (2) for mounting a surgical tool or tool guide, an actuation unit (4) connected to said base (1) and end-effector (2), a support unit (5) designed to make contact with the treated part to be treated or an adjacent region to provide a partial mechanical link between the base (1) or end-effector (2), and the part to be treated, (ii) a tracking unit (200), (iii) a control unit (300) configured to: (a) compute in real time an optimized path of the end-effector, (b) detect whether said computed path of the tool or end-effector can be achieved without changing the pose of the base, and, if not, determine a possible repositioning of the base with respect to the part to be treated, (c) configure the actuation unit so as to move the end-effector according to said computed path, and (d) iterate steps (a) to (c) until the planned volume has been treated, (iv) a user interface (400).

Abstract: A device for creating a void space in living tissue includes a handle from which a shaft extends. A tip is moveably attached to the distal end of the shaft. The angular position of the tip is controlled by the rotation of a knob mounted to the handle. The knob is mounted to the handle to project beyond opposed side surfaces of the handle and a surface that bridge between the side surfaces.

Abstract: Disclosed are a corer and a method using same. The corer includes a connecting sleeve, a power lever connected to the connecting sleeve, a hook cylinder having an upper end inserted into the connecting sleeve, and a cutting hook connected to a side of the hook cylinder. A full-length opening is vertically formed on a side wall of the hook cylinder. The upper end of the hook cylinder is detachably connected to the connecting sleeve. An arc slot perpendicular to the full-length opening is provided on a side of a lower end of the hook cylinder. The corer solves the problem that the existing corer is unable to extract an intact core because it is unable to transect a core base during non-penetrating coring.

Abstract: Methods and systems for installing an implant in an intramedullary canal are discussed. In an example, an intramedullary sounder tool has a sounder head including a plurality of teeth extending proximally from a distal tip towards a shank extending from the sounder head, each tooth comprising a distal cutting edge, a middle scraping edge, and a proximal cutting edge. The sounder head can be advanced into the intramedullary canal until the scraping edge engages cortical bone. If the scraping edge does not engage cortical bone, sounder tools having successively larger diameters can be advanced into the intramedullary canal until a scraping edge does engage the cortical wall, thereby avoiding cutting and damaging of the cortical bone. At such point, the width of the intramedullary canal and the implant used therein can be determined using markings on the shank that indicate the diameter of the sounder head.

Abstract: A glenoid device for preparing a shoulder joint of a patient includes a reusable guide holder having a body between an upper surface and a lower surface and a bore passing through the body of the guide holder. The glenoid device also includes a patient-specific glenoid guide having a body with an upper and lower surface. The lower surface of the patient-specific glenoid guide is configured as a negative surface of a glenoid face based on preoperative image scans of the shoulder joint of the patient. The upper face of the patient-specific glenoid guide is configured to be coupled and contact the lower face of the guide holder, such that the bore of the guide holder is aligned along a patient-specific bore through the body of the patient-specific glenoid guide and along a corresponding alignment axis of the patient-specific glenoid guide.

Abstract: A catheter having a distal balloon and a deformable guidewire shaft of the catheter. The deformable guidewire shaft is adjacent to and external to the balloon. Inflation of the balloon bends the deformable guidewire shaft in order to orient or deflect a distal tip of the deformable guidewire shaft in a desired direction to guide and direct a guidewire extending through the deformable guidewire shaft towards a specific endovascular region. For example, it may be desired to orient the distal tip of the guidewire shaft towards a target vessel of a bifurcation or the balloon catheter may be used to bypass a Chronic Total Occlusion (CTO).

Abstract: A catheter comprises an elongated carrier and a balloon carried by the carrier in sealed relation thereto. The balloon has an outer surface and is arranged to receive a fluid therein that inflates the balloon. The catheter further comprises a shock wave generator within the balloon that forms mechanical shock waves within the balloon, and a medicinal agent carried on the outer surface of the balloon. The medicinal agent is releasable from the balloon either before or in response to the shock wave.

Abstract: A rapid exchange (RX) catheter may provide a proximal seal against a guide catheter inner lumen so that aspiration may be applied through a guide catheter. The catheter may include an exit port that defines a transfer port for aspiration and may enable minimal frictional engagement with the guide catheter proximal of the exit port. Aspiration can be applied to the lumen of the guide catheter and may be directed to and effective at the tip of the RX aspiration catheter. A tip of the RX catheter may facilitate aspiration and retrieval of the clot by expanding under load and can also partially or fully occlude the vessel.

Abstract: A manipulator adapted to grasp and draw tissue comprises first and second arms having proximal ends and distal ends separated by a distance. First and second grasping surfaces each connected to and extending from respective distal ends of the first and second arms are biased toward each other by a respective spring force. When the first and second arms are actuated to reduce the distance, the manipulator is configured such that tissue arranged between the first and second grasping surfaces resist actuation of the first and second arms. The first and second arms are further actuatable to overcome the spring force of the first and second grasping surfaces so that the first and second grasping surfaces pivot at respective pivot points such that the distance between the distal ends of the first and second arms is reduced.

Abstract: A forceps includes an end effector assembly having first and second jaw members disposed in parallel orientation relative to one another. One or both of the jaw members is movable along a first axis relative to the other jaw member between a spaced-apart position and an approximated position for grasping tissue therebetween. The first and second jaw members are configured to maintain the parallel orientation therebetween upon movement of the jaw members between the spaced-apart and approximated positions. A drive bar is coupled to one or both of the jaw members. The drive bar is selectively movable along a second axis that is different from the first axis between first and second positions for moving the jaw members between the spaced-apart and approximated positions.

Abstract: A sizing forceps is provided for fixing a nerve in place, measuring the diameter of the nerve, and providing an efficient way to resect the nerve. A sizing forceps can have an upper and lower jaw with one or more aligned notches that form apertures for holding a nerve. The apertures can have predetermined sizes that can be used to measure the diameter of a nerve. A slicing slot in the upper and lower jaw allows a nerve within an aperture to be severed to obtain a non-frayed end.

Abstract: A surgical instrument includes a housing, a handle, an elongated shaft, an end effector assembly, a drive assembly, a support, a roller, and an extension depending from the handle. The end effector assembly includes a first jaw member and a second jaw member. At least one of the jaw members is movable with respect to the other jaw member. The drive assembly includes a drive bar extending at least partially through the elongated shaft such that longitudinal translation of the drive bar causes movement of the jaw members. The extension includes a proximal surface and a channel defined therein. The proximal surface is configured to contact a portion of the drive assembly such that movement of the handle with respect to the housing causes longitudinal translation of the drive bar. The channel is positioned for mechanical engagement by the roller.

Abstract: A surgical instrument includes a cutting member with an implement for cutting tissue, and a drive coupled to the cutting member to simultaneously rotate and translate the cutting member in response to a three applied to the drive. A method of cutting tissue includes positioning an outer member such that tissue is located within the outer member, engaging the tissue with an inner member, and simultaneously rotating and translating the inner member to cut the tissue. A tangential cutting force is applied to the tissue with the inner member to mechanically cut the tissue. The inner member is mechanically driven to undergo simultaneous rotation and translation.

Abstract: A method and a hand-held device for dermnaplaning is disclosed that includes a blade assembly which includes a blade, a blade holder and a safety cage. In accordance with an important aspect of the invention, the safety cage limits the amount of penetration of the blade into the facial skin to enable the device to be safely used by non-professionals. The dermaplaning device includes a vibration generator that causes the blade to vibrate at a predetermined frequency. Various embodiments of the hand-held dermaplaning device are disclosed for vibrating the blade.

Abstract: A surgical instrument is disclosed. The surgical instrument includes a transducer, a waveguide coupled to the transducer and defining a longitudinal axis, a tube comprising an outer surface, an end effector, and a protective sheath. The waveguide extends through the tube. The end effector includes a surgical blade extending from the waveguide. The surgical blade is asymmetric relative to the longitudinal axis. The surgical blade includes a cutting edge on a first side of the longitudinal axis, an atraumatic surface on a second side of the longitudinal axis, a distal tip, and a treatment portion. The cutting edge includes a proximal end. The treatment portion extends between the proximal end of the cutting edge and the distal tip. The protective sheath extends around at least a portion of the tube and along at least a portion of the surgical blade to the treatment portion.

Abstract: An energy treatment instrument includes a held unit capable of being held, and an electric-receiver-side resonator including an electric receiver coil wound around a coil axis, and resonating at the same resonance frequency as an electric-supplier-side resonator, thereby electric power being supplied from an electric supplier coil to the electric receiver coil. The energy treatment instrument includes an energy generator generating energy for use in a treatment by using the electric power supplied to the electric receiver coil, and a magnetic member including a magnetic material and located distant from the coil axis of the electric receiver coil.

Abstract: Various embodiments described herein are directed to ultrasonic blades. For example, an ultrasonic blade may comprise a proximally positioned straight section extending along a longitudinal axis and a distally positioned curved section coupled to the straight section and curved away from the longitudinal axis. The curved section may define a radius of curvature and subtend a first angle. A point of tangency between the curved section and the straight section may be positioned at either a node of the ultrasonic blade or an anti-node of the ultrasonic blade.

Abstract: Medical devices and methods for using medical devices are disclosed. A rotational atherectomy device may include an elongate shaft having a proximal end region, a distal end region and a lumen extending therein. The medical device may also include a cutting member positioned adjacent the distal end region of the elongate shaft. The cutting member may be radially expandable. The medical device may also include a sizing member positioned adjacent the cutting member. The sizing member may be radially expandable, and the radial expansion of the cutting member may be limited by radial expansion of the sizing member.

Abstract: Rotational atherectomy devices and systems can remove or reduce stenotic lesions in blood vessels by rotating one or more abrasive elements within the vessel. The abrasive elements can be attached to a distal portion of an elongate flexible drive shaft that extends from a handle assembly that includes a driver for rotating the drive shaft. In particular implementations, individual abrasive elements are attached to the drive shaft at differing radial angles in comparison to each other (e.g., configured in a helical array). The centers of mass of the abrasive elements can define a path that fully or partially spirals around the drive shaft. In some embodiments, a distal stability element with a center of mass aligned with the longitudinal axis is fixedly mounted to the drive shaft.

Abstract: The invention relates to a spatial dimension determination device for determining a spatial dimension of a target element like a vessel within an object (9), for instance, within a person. Movement parameters describing a movement of an introduction element (4) moved by a moving unit (2) like a robot and several images showing the introduction element are used for determining a dimensional relation between an image dimension and a real dimension. A further image showing the target element is provided, wherein a real dimension of the target element is determined based on an image dimension of the target element in the further image and based on the determined dimensional relation. An unknown real physical dimension of a target element within the object can therefore accurately be determined from an image of the target element by using, inter alia, the movement parameters.

Abstract: Systems and methods related to the location of target regions in imaging applications are generally described. Certain embodiments relate to devices and/or methods for image-guided identification of suitable regions at which to insert needles, catheters, and the like. Such systems and methods can be used in association with a variety of imaging technologies, including ultrasound imaging. In certain embodiments, the systems and methods described herein can be used in association with hand-held ultrasound imaging devices.

Abstract: Provided is an apparatus for loading a follicular unit to a needle for hair implant including a first slitless needle in which the other end of a hollow body has a wedge shape, one end of the hollow body has a tubular shape to facilitate force transmission, and an end surface of the one end is blunt, so as to be used in a transplantation region in hair transplant procedure, and a first instrument configured to push the follicular unit to an interior of the first needle to load the follicular unit to the interior of the first needle.

Abstract: The present invention provides for a method and apparatus for inserting and using dermal interstitial sensors in, for example, an analyte monitoring system. The present invention permits the proper positioning of a cannula tip and/or sensor(s) within the reticular dermis.