Shuyi Wei1, Dennis P Orgill1, Giorgio Giatsidis1. 1. From the Tissue Engineering and Wound Healing Laboratory, Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital and Harvard Medical School; Peking University People's Hospital; and the Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.
Abstract
BACKGROUND: External volume expansion promotes angiogenesis in tissues by inducing a subcritical hypoxia, mechanically stimulating endothelia, and creating mild inflammation. Application of external volume expansion to less-vascularized tissues with endothelial cell dysfunction poses a risk for ineffectiveness or ischemic damage. The authors investigated the effects of external volume expansion on a murine model of type 2 diabetes mellitus and tested whether the adoption of microdeformational interfaces optimizes its angiogenic properties while limiting complications to tissues. METHODS: Adult diabetic mice received stimulation with external volume expansion on their dorsal skin using a standard cup-shaped silicone interface, a polyurethane foam-shaped interface, or a silicone microarray chamber interface; controls received no treatment. Skin damage was assessed visually on the last day of stimulation and 5 days later. At 5-day follow-up, skin specimens (n = 5 per group) were procured and analyzed by histology to assess angiogenesis, adipose tissue and skin remodeling, and inflammation. RESULTS: All treatments significantly increased the density of blood vessels in skin compared to controls; the polyurethane foam-shaped interface showed the most robust effect (+80 percent). No relevant complications were observed using a polyurethane foam-shaped interface or silicone microarray chamber interface, but a cup-shaped silicone interface led to substantial skin damage and caused intense inflammation, fibrosis of the subcutaneous tissue, and dermal remodeling. CONCLUSION: The adoption of external volume expansion with microdeformational interfaces allows the effective and safe preconditioning of tissues with endothelial cell dysfunction and could improve outcomes in diabetic patients at high risk for surgical complications.
BACKGROUND: External volume expansion promotes angiogenesis in tissues by inducing a subcritical hypoxia, mechanically stimulating endothelia, and creating mild inflammation. Application of external volume expansion to less-vascularized tissues with endothelial cell dysfunction poses a risk for ineffectiveness or ischemic damage. The authors investigated the effects of external volume expansion on a murine model of type 2 diabetes mellitus and tested whether the adoption of microdeformational interfaces optimizes its angiogenic properties while limiting complications to tissues. METHODS: Adult diabeticmice received stimulation with external volume expansion on their dorsal skin using a standard cup-shaped silicone interface, a polyurethane foam-shaped interface, or a silicone microarray chamber interface; controls received no treatment. Skin damage was assessed visually on the last day of stimulation and 5 days later. At 5-day follow-up, skin specimens (n = 5 per group) were procured and analyzed by histology to assess angiogenesis, adipose tissue and skin remodeling, and inflammation. RESULTS: All treatments significantly increased the density of blood vessels in skin compared to controls; the polyurethane foam-shaped interface showed the most robust effect (+80 percent). No relevant complications were observed using a polyurethane foam-shaped interface or silicone microarray chamber interface, but a cup-shaped silicone interface led to substantial skin damage and caused intense inflammation, fibrosis of the subcutaneous tissue, and dermal remodeling. CONCLUSION: The adoption of external volume expansion with microdeformational interfaces allows the effective and safe preconditioning of tissues with endothelial cell dysfunction and could improve outcomes in diabeticpatients at high risk for surgical complications.
Authors: Anita T Mohan; Lin Zhu; Gregory J Michalak; Alexis T Laungani; Andrew J Vercnocke; Steven L Moran; Michel Saint-Cyr Journal: Plast Reconstr Surg Glob Open Date: 2020-08-18