Summary
Background
Tissue expansion has been widely used to provide additional soft tissue for clinical
reconstruction. Rapid expansion requires a much shorter clinical period than conventional
expansion; however, less natural skin growth occurs resulting in a larger stretch-back
ratio and insufficient extra soft tissue for clinical use. In this study, hyperbaric
oxygen therapy (HBOT) was used in the inflation phase of rapid expansion to increase
natural skin growth.
Methods
Twelve rabbits were divided into two groups. Each group received rapid expander inflation
every day. One group received HBOT and the other did not. Blood flow in the expanded
skin of each rabbit was assayed in the 10-day inflation phase. After the inflation
phase, a rectangular expanded flap of each rabbit was harvested. The instant stretch-back
ratio, tension, weight and histological characteristics of the flaps were evaluated.
Results
(1) After the second inflation day, the mean blood flow of the HBOT group became significantly
higher than that of the control with each day (P < 0.05). At the last day, the blood flow of the HBOT group increased to 131 ± 17 pu,
while the control group decreased to 35 ± 5 pu. (2) The mean instant stretch-back
ratio of the HBOT group under no-tension conditions was 29 ± 4%, which was significantly
less than that of the control group, 46 ± 3% (P < 0.01). (3) The mean flap tension of the HBOT group was 15.3000 ± 1.47648 g and
12.9833 ± 0.73598 g in the transverse and longitudinal axis, respectively, both significantly
smaller than that of the control group (33.9167 ± 4.78390 g and 26.5000 ± 2.45031 g,
respectively) (P < 0.01). (4) Mean per unit flap weight of the HBOT group was 0.221 ± 0.005 g cm−2, significantly heavier (P < 0.01) than that of the control group (0.143 ± 0.010 g cm−2). (5) Histologically, the epidermal layer and thickness of the expanded skin of the
HBOT group were much thicker than those of the control group, and more vessels were
visible in the subcutaneous tissue.
Conclusions
The use of HBOT in the inflation phase of rapid expansion can effectively promote
blood flow in the expanded skin, increase its natural skin growth and reduce the instant
stretch-back ratio and tension of expanded skin.
Keywords
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References
- The expansion of an area of skin by progressive distention of a subcutaneous balloon; use of the method for securing skin for subtotal reconstruction of the ear.Plast Reconstr Surg. 1957; 19: 124-130
- Reconstruction of the breast after radical mastectomy using temporary expander.Plast Surg Forum. 1980; 1 ([Letter]): 41
- Breast reconstruction after mastectomy using the temporary expander.Plast Reconstr Surg. 1982; 69: 195-208
- Tissue expansion: past, present, and future.J Am Acad Dermatol. 1990; 23: 813-825
- Intraoperative sustained limited expansion (ISLE) as an immediate reconstructive technique.Clin Plast Surg. 1987; 14: 563-573
- Accelerated tissue expansion with the “Overfilling” technique.Plast Reconstr Surg. 1988; 81: 204-207
- Continuous versus conventional tissue expansion: experimental verification of a new technique.Plast Reconstr Surg. 1991; 87: 10-15
- Rapid expansion: experimental and clinical experience.Clin Plast Surg. 1987; 14: 455-463
- Adjunctive agents to facilitate rapid tissue expansion.Ann Plast Surg. 1989; 23: 412-416
- Enhancement of tissue expansion by anticontractile agents.Plast Reconstr Surg. 1985; 76: 604-610
- Topical application of DMSO as an adjunct to tissue expansion for breast reconstruction.Br J Plast Surg. 1999; 52: 194-197
- Effects of hyperbaric oxygen on proliferative and apoptotic activities and reactive oxygen species generation in mouse fibroblast 3T3/J2 cell line.J Invest Med. 2003; 51: 227-232
- Effects of hyperbaric oxygen and platelet derived growth factor on medial collateral ligament fibroblasts.Undersea Hyperb Med. 2007; 34: 181-190
- Hyperbaric oxygen stimulates vasculogenic stem cell growth and differentiation in vivo.J Appl Physiol. 2009; 106: 711-728
- Morphologic analysis of the microcirculation during reperfusion of ischemic skeletal muscle and the effect of hyperbaric oxygen.Plast Reconstr Surg. 1993; 91: 1110-1123
- The effect of varying ambient oxygen tension on wound metabolism and collagen synthesis.Surg Gynecol Obstet. 1972; 135: 561-567
- Regulation of wound-healing angiogenesis: effect of oxygen gradients and inspired oxygen concentrations.Surgery. 1981; 90: 262-270
- Dose-dependent hyperbaric oxygen stimulation of human fibroblast proliferation.Wound Repair Regen. 1997; 5: 147-150
- Hyperoxic treatment induces mesenchymal-to-epithelial transition in a rat adenocarcinoma model.PLoS One. 2009; 4: e6381
- Chronic hyperbaric oxygen therapy and the human nasal mucosa: increased thickness of epithelium basement membrane and moderate neutrophilic infiltration.Rhinology. 2008; 46: 297-301
- Biomechanical comparison between conventional and rapid expansion of skin.Br J Plast Surg. 2003; 56: 660-666
- Physical, biomechanical, histologic, and biochemical effects of rapid versus conventional tissue expansion.Plast Reconstr Surg. 1989; 83: 687-691
- Dermal and epidermal response to soft-tissue expansion in the pig.Plast Reconstr Surg. 1988; 81: 390-397
- The determination of hydroxyproline in tissue and protein samples containing small proportions of this amino acid.Arch Biochem Biophys. 1961; 93: 440-447
- A monoclonal antibody to the carboxyterminal domain of procollagen type I visualizes collagen-synthesizing fibroblasts. Detection of an altered fibroblast phenotype in lungs of patients with pulmonary fibrosis.J Clin Invest. 1986; 78: 1237-1244
- The role and effectiveness of adjunctive hyperbaric oxygen therapy in the management of musculoskeletal disorders.J Postgrad Med. 2002; 48: 226-231
- Effects of hyperbaric oxygen therapy on rabbit skeletal muscle during extremity lengthening.Arch Orthop Trauma Surg. 2009; 129: 13-20
- Effects of hyperbaric oxygen therapy on distraction osteogenesis.Adv Ther. 2007; 24: 326-332
- Effects of hyperbaric oxygen therapy on an accelerated rate of mandibular distraction osteogenesis.J Plast Reconstr Aesthet Surg. 2009; 62: 1568-1572
- Early administration of hyperbaric oxygen therapy in distraction osteogenesis – A quantitative study in New Zealand rabbits.J Trauma. 2005; 58: 1230-1235
- Osteoblastic activity and neoangiogenesis in distracted bone of irradiated rabbit mandible with or without hyperbaric oxygen treatment.Int J Oral Maxillofac Surg. 2004; 33: 173-178
- Increased survival and vascularity of random-pattern skin flaps elevated in controlled, expanded skin.Plast Reconstr Surg. 1983; 72: 680-687
- Advances in tissue expansion.Clin Plast Surg. 1985; 12: 159-171
- The effect of stretching on formation of myofibroblasts in mouse skin.Cell Tissue Res. 1981; 220: 325-335
- Physical factors and angiogenesis.Ciba Found Symp. 1983; 100: 80-94
- Pathophysiology of skin flaps raised on expanded pig skin.Plast Reconstr Surg. 1984; 74: 59-67
- Response of random skin flaps to rapid expansion.J Trauma. 1985; 25: 947-952
- Enhanced capillary blood flow in rapidly expanded random pattern flaps.J Trauma. 1986; 26: 913-915
- Tissue-engineered skin in the healing of wound stumps from limb amputations secondary to purpura fulminans.Pediatr Dermatol. 2003; 20: 169-172
Article info
Publication history
Published online: April 18, 2012
Accepted:
March 20,
2012
Received in revised form:
February 23,
2012
Footnotes
☆This article has not been presented at any meetings.
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
