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Jeong J, Park JKH, Bin Choy Y, Shim JH, Kang SM, Nam SY, Najmiddinov B, Heo CY. Cyclic High Negative-Pressure External Volume Expansion Reduces Daily Device Application Time With Similar Effects on Recipient Site Preparation in a Murine Model. Plast Surg (Oakv) 2024; 32:100-106. [PMID: 38433789 PMCID: PMC10902493 DOI: 10.1177/22925503221088847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Introduction: Recipient site preparation using external volume expansion (EVE) increases graft survival in large-volume fat grafting. To improve patient compliance with using the device, we tested a new cyclic high negative-pressure (CHNP) mode that involves 1 h/day at -55 mm Hg, cycled between 1-second negative-pressure activation, followed by a 2-second deactivation period in an animal model. Material and Method: A miniaturized EVE device was applied to 30 8-week-old male Sprague-Dawley rats. The rats were assigned to 3 groups (no pressure for the control group, conventional -25 mm Hg for 8 h/day for conventional EVE, and CHNP mode for the CHNP group). After 28 days, micro-computed tomography was performed and skin biopsy specimens were obtained. Results: The CHNP group showed a 6.6-fold increase and the conventional EVE group showed a 4.4-fold increase in volume compared to the control group. Hematoxylin and eosin staining showed a similar increase in subcutaneous tissue thickness in both EVE groups, compared to the control group. Masson's trichome and proliferating cell nuclear antigen staining showed significantly higher collagen deposition and subdermal adipocytes in EVE groups. Immunohistochemistry against platelet endothelial cell adhesion molecule 1 showed 2.5- and 2.7-times higher vessel density in the conventional and CHNP EVE groups, respectively. There was no statistically significant difference in subcutaneous tissue thickness, collagen deposition, subdermal adipocyte proliferation, and vessel density between the 2 EVE groups. Conclusion: CHNP produced comparable results in recipient site preparation (subcutaneous tissue thickening and angiogenesis) compared to the conventional protocol, while markedly reducing the daily wear-time from 8 hours to 1 hour. Although further clinical data must be acquired, our new pressure setting seems promising and provides a more patient-friendly pre-expansion environment.
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Affiliation(s)
- Jinwook Jeong
- View Plastic Surgery Clinic, Seoul, Republic of Korea
| | - Joseph Kyu-hyung Park
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Korea
| | - Young Bin Choy
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hee Shim
- Department of Research Administration Team, Seoul National University Bundang Hospital, Seongnam, Korea
| | - So Min Kang
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Korea
| | - Sun-Young Nam
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Korea
| | - Bakhtiyor Najmiddinov
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Korea
| | - Chan Yeong Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Korea
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[Research progress of external volume expansion assisted autologous fat grafting for breast reconstruction]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:370-375. [PMID: 35293180 PMCID: PMC8923929 DOI: 10.7507/1002-1892.202111016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To review the application progress, mechanism, application points, limitations, and oncological safety of external volume expansion (EVE) assisted autologous fat grafting for breast reconstruction and provide a reference for optimizing the design of EVE. METHODS Based on the latest relevant articles, the basic experiments and clinical applications of EVE were summarized. RESULTS EVE can reduce interstitial fluid pressure, increase blood supply, and promote adipogenic differentiation, thereby benefiting the survival of transplanted fat. EVE assisted autologous fat grafting in clinical practice can improve the retention rate of breast volume and the outcome of breast reconstruction, meanwhile it doesn't increase the risk of local recurrence. But there is no standard parameters for application, and there are many complications and limitations. CONCLUSION EVE improves the survival of transplanted fat, but its complications and poor compliance are obvious, so it is urgent to further investigate customized products for breast reconstruction after breast cancer and establish relevant application guidelines.
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Tong X, Lu J, Zhang W, Wang S, Huang R, Zhang X, Huang J, Zhu Y, Xiao S, Ji S, Xia Z. Efficacy and safety of external tissue expansion technique in the treatment of soft tissue defects: a systematic review and meta-analysis of outcomes and complication rates. BURNS & TRAUMA 2022; 10:tkac045. [PMCID: PMC9741868 DOI: 10.1093/burnst/tkac045] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/26/2022] [Accepted: 09/07/2022] [Indexed: 12/14/2022]
Abstract
Abstract
Background
Currently, various external tissue expansion devices are becoming widely used. Considering the scarcity of relevant application standards, this systematic review was performed to explore the effectiveness and safety of external tissue expansion techniques for the reconstruction of soft tissue defects.
Method
A systematic review and meta-analysis on the efficacy and safety of external tissue expansion technique was conducted. A comprehensive search was performed in the following electronic databases: PubMed/Medline, Embase, Cochrane Library (Wiley Online Library), and Web of Science. Studies reporting patients with soft tissue defects under the treatment of external tissue expansion technique were included.
Results
A total of 66 studies with 22 different types of external tissue expansion devices met the inclusion criteria. We performed a descriptive analysis of different kinds of devices. A single-arm meta-analysis was performed to evaluate the efficacy and safety of the external tissue expansion technique for different aetiologies. The pooled mean wound healing time among patients with defects after fasciotomy was 10.548 days [95% confidence interval (CI) = 5.796–15.299]. The pooled median wound healing times of patients with defects after excisional surgery, trauma, chronic ulcers and abdominal defects were 11.218 days (95% CI = 6.183-16.253), 11.561 days (95% CI = 7.062-16.060), 15.956 days (95% CI = 11.916-19.996) and 12.853 days (95% CI=9.444-16.227), respectively. The pooled wound healing rates of patients with defects after fasciotomy, excisional surgery, trauma, chronic ulcers and abdominal defects were 93.8% (95% CI=87.1-98.2%), 97.2% (95%CI=92.2-99.7%), 97.0% (95%CI=91.2-99.8%), 99.5% (95%CI=97.6-100%), and 96.8% (95%CI=79.2-100%), respectively. We performed a subgroup analysis in patients with diabetic ulcers and open abdominal wounds. The pooled median wound healing time of patients with diabetic ulcers was 11.730 days (95% CI = 10.334-13.125). The pooled median wound healing time of patients with open abdomen defects was 48.810 days (95% CI = 35.557–62.063) and the pooled successful healing rate was 68.8% (95% CI = 45.9-88.1%). A total of 1686 patients were included, 265 (15.7%) of whom experienced complications. The most common complication was dehiscence (n = 53, 3.14%).
Conclusions
Our systematic review is the first to demonstrate the efficacy and safety of external tissue expansion in the management of soft tissue defects. However, we must interpret the meta-analysis results with caution considering the limitations of this review. Large-scale randomized controlled trials and long-term follow-up studies are still needed to confirm the effectiveness and evaluate the quality of healing.
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Affiliation(s)
- Xirui Tong
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
| | - Jianyu Lu
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
| | - Wei Zhang
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
| | - Siqiao Wang
- Tongji University School of Medicine, Tongji University , Shanghai, 200092 , China
| | - Runzhi Huang
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
| | - Xianliang Zhang
- Hospital of the 92426 Troops of the Chinese People’s Liberation Army , Tsingtao, 266400 , China
| | - Jie Huang
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
| | - Yushu Zhu
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
| | - Shichu Xiao
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
| | - Shizhao Ji
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
| | - Zhaofan Xia
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences , 168 Changhai Road, Yangpu District, Shanghai, 200433 , China
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Chen X, Lu F, Yuan Y. The Application and Mechanism of Action of External Volume Expansion in Soft Tissue Regeneration. TISSUE ENGINEERING PART B-REVIEWS 2021; 27:181-197. [PMID: 32821009 DOI: 10.1089/ten.teb.2020.0137] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Xihang Chen
- Department of Plastic and Cosmetic Surgery, Southern Medical University, Nanfang Hospital, Guangzhou, China
| | - Feng Lu
- Department of Plastic and Cosmetic Surgery, Southern Medical University, Nanfang Hospital, Guangzhou, China
| | - Yi Yuan
- Department of Plastic and Cosmetic Surgery, Southern Medical University, Nanfang Hospital, Guangzhou, China
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MacKay BJ, Dardano AN, Klapper AM, Parekh SG, Soliman MQ, Valerio IL. Multidisciplinary Application of an External Tissue Expander Device to Improve Patient Outcomes: A Critical Review. Adv Wound Care (New Rochelle) 2020; 9:525-538. [PMID: 32941124 PMCID: PMC7522632 DOI: 10.1089/wound.2019.1112] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Significance: Continuous external tissue expansion (CETE) is a versatile tool in soft tissue injury management, and could be an addition to the traditional reconstructive ladder. Recent Advances: This critical review discusses the principles and application of CETE, covering a company-sponsored consensus meeting on this emerging technology and highlighting the DermaClose® (Synovis Micro Companies Alliance, Inc., Birmingham, AL) device's unique approach to soft tissue injury management. There is clinical evidence to support the use of CETE in the management of a number of wound types, including fasciotomy, trauma, amputation, and flap donor sites. The device can be applied to open wounds, potentially avoiding the need for a skin graft or other more complex or invasive reconstruction options. DermaClose applies constant tension without restricting blood flow and does not require repeated tightening. Critical Issues: CETE is becoming more widely used by surgeons of different specialties, and numerous reports describing its efficacy and safety in wound management have been published. Surgeons using CETE must follow the correct technique and select patients carefully to achieve optimal outcomes. However, there is no single source of information or consensus recommendations regarding CETE application. Future Directions: Prospective evidence on the efficacy and safety of CETE in clinical practice is required to communicate the best techniques and share important experiences. This will help to solidify its place in the reconstructive ladder as a valuable additional option for surgeons.
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Affiliation(s)
- Brendan J. MacKay
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
- Department of Orthopaedic Surgery, University Medical Center, Lubbock, Texas
| | - Anthony N. Dardano
- Department of Plastic and Reconstructive Surgery, Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, Florida
| | - Andrew M. Klapper
- Department of Plastic and Reconstructive Surgery, Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, Florida
| | - Selene G. Parekh
- Department of Orthopaedic Surgery, North Carolina Orthopaedic Clinic, Durham, North Carolina
- Fuqua Business School, Duke University, Durham, North Carolina
| | - Mohsin Q. Soliman
- Overland Park General and Bariatric Surgery, HCA Physician Services, Overland Park, Kansas
| | - Ian L. Valerio
- Department of Plastic and Reconstructive Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
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Preconditioning with Foam-mediated External Suction on Flap Microvasculature and Perfusion in a Rodent Model. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2739. [PMID: 32983749 PMCID: PMC7489611 DOI: 10.1097/gox.0000000000002739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 01/31/2020] [Indexed: 12/16/2022]
Abstract
Foam-mediated external suction (FMES) has previously shown to improve tissue microcirculation. We hypothesized that preconditioning fasciocutaneous perforator flaps with FMES would augment perfusion and demonstrate greater capillary recruitment.
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Increasing Fat Graft Retention in Irradiated Tissue after Preconditioning with External Volume Expansion. Plast Reconstr Surg 2020; 145:103-112. [DOI: 10.1097/prs.0000000000006372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Giatsidis G, Succar J, Waters TD, Liu W, Rhodius P, Wang C, Nilsen TJ, Chnari E, Orgill DP. Tissue-Engineered Soft-Tissue Reconstruction Using Noninvasive Mechanical Preconditioning and a Shelf-Ready Allograft Adipose Matrix. Plast Reconstr Surg 2019; 144:884-895. [PMID: 31568297 DOI: 10.1097/prs.0000000000006085] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Adipose tissue defects leading to severe functional (disability) and morphologic (disfigurement) morbidity are often treated in plastic surgery with fat grafting, which can be limited by resorption, necrosis, and cyst formation. This study aimed to assess whether adipose scaffolds could provide an environment for in situ autologous fat grafting, and to study whether adipose cell migration and proliferation (adipogenesis) within scaffolds could be enhanced by preliminarily increasing the vascularity (preconditioning) of the surrounding tissue receiving the scaffolds. METHODS Using an established rodent model of subcutaneous tissue/scaffold grafting, the authors tested the potential of a human-derived, shelf-ready, injectable, decellularized allograft adipose matrix to reconstruct soft-tissue defects when used in combination with noninvasive mechanical (suction-induced) skin preconditioning. RESULTS Combined use of the allograft adipose matrix and noninvasive skin preconditioning significantly improved long-term volume retention (50 to 80 percent higher at a 12-week follow-up) and histologic quality of reconstructed tissues compared with standard of care (autologous adipose grafts). The components of the allograft adipose matrix supported adipogenesis and angiogenesis. Combining the allograft adipose matrix with living adipose grafts mitigated negative outcomes (lower long-term volume retention, higher presence of cystic-like areas). CONCLUSIONS This study suggests that the synergistic use of the allograft adipose matrix and noninvasive tissue preconditioning provides an effective solution for improving fat grafting. These strategies can easily be tested in clinical trials and could establish the basis for a novel therapeutic paradigm in reconstructive surgery.
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Affiliation(s)
- Giorgio Giatsidis
- From the Tissue Engineering and Wound Healing Laboratory, Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School; Department of Molecular Medicine, University of Padova; Preventive Medicine, University of New Mexico; Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; and the Musculoskeletal Transplant Foundation
| | - Julien Succar
- From the Tissue Engineering and Wound Healing Laboratory, Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School; Department of Molecular Medicine, University of Padova; Preventive Medicine, University of New Mexico; Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; and the Musculoskeletal Transplant Foundation
| | - Trevon D Waters
- From the Tissue Engineering and Wound Healing Laboratory, Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School; Department of Molecular Medicine, University of Padova; Preventive Medicine, University of New Mexico; Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; and the Musculoskeletal Transplant Foundation
| | - Wenyue Liu
- From the Tissue Engineering and Wound Healing Laboratory, Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School; Department of Molecular Medicine, University of Padova; Preventive Medicine, University of New Mexico; Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; and the Musculoskeletal Transplant Foundation
| | - Patrick Rhodius
- From the Tissue Engineering and Wound Healing Laboratory, Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School; Department of Molecular Medicine, University of Padova; Preventive Medicine, University of New Mexico; Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; and the Musculoskeletal Transplant Foundation
| | - Chenglong Wang
- From the Tissue Engineering and Wound Healing Laboratory, Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School; Department of Molecular Medicine, University of Padova; Preventive Medicine, University of New Mexico; Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; and the Musculoskeletal Transplant Foundation
| | - Todd J Nilsen
- From the Tissue Engineering and Wound Healing Laboratory, Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School; Department of Molecular Medicine, University of Padova; Preventive Medicine, University of New Mexico; Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; and the Musculoskeletal Transplant Foundation
| | - Evangelia Chnari
- From the Tissue Engineering and Wound Healing Laboratory, Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School; Department of Molecular Medicine, University of Padova; Preventive Medicine, University of New Mexico; Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; and the Musculoskeletal Transplant Foundation
| | - Dennis P Orgill
- From the Tissue Engineering and Wound Healing Laboratory, Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School; Department of Molecular Medicine, University of Padova; Preventive Medicine, University of New Mexico; Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; and the Musculoskeletal Transplant Foundation
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Delivery of External Volume Expansion through Microdeformational Interfaces Safely Induces Angiogenesis in a Murine Model of Intact Diabetic Skin with Endothelial Cell Dysfunction. Plast Reconstr Surg 2019; 143:453-464. [DOI: 10.1097/prs.0000000000005267] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Delayed Postconditioning with External Volume Expansion Improves Survival of Adipose Tissue Grafts in a Murine Model. Plast Reconstr Surg 2019; 143:99e-110e. [DOI: 10.1097/prs.0000000000005167] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Noninvasive Flap Preconditioning by Foam-Mediated External Suction Improves the Survival of Fasciocutaneous Axial-Pattern Flaps in a Type 2 Diabetic Murine Model. Plast Reconstr Surg 2018; 142:872e-883e. [DOI: 10.1097/prs.0000000000005038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Closed Incision Negative-Pressure Therapy (ciNPT) Reduces Minor Local Complications in Post-bariatric Abdominoplasty Body Contouring: a Retrospective Case-Control Series. Obes Surg 2018; 28:2096-2104. [DOI: 10.1007/s11695-018-3279-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Liu W, Luan J. Recent Advances on the Application of Negative Pressure External Volume Expansion in Breast Plastic Surgery. Aesthetic Plast Surg 2018; 42:112-117. [PMID: 29075815 DOI: 10.1007/s00266-017-0986-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND External volume expansion (EVE) has been effectively applied as an assistance to fat transplantation on breast plastic surgery. Many indicators and refinements have been made in clinical practice; meanwhile, the related mechanism and more optimized preclinical model also have been explored in experimental studies. METHODS A literature search was conducted using PubMed with the keywords: EVE, negative pressure, breast enlargement, breast augmentation, breast reconstruction, breast plastic surgery and breast aesthetic surgery. Studies dealing with the clinical and preclinical aspects of the subject and also in vitro experiments related to a certain period of negative pressure and adipose-derived cells were selected, and those only focused on negative pressure were excluded. RESULTS The indications, contraindications, complications and treatments of EVE in clinical practice were summarized. The experimental studies were mainly classified into two groups (mechanical and translational) according to their contents. Mechanical studies were further divided into inference experimental validation phase studies. For the experimental validation phase, EVE was verified to promote angiogenesis, while it still remained controversial whether it would enhance adipogenesis and cell proliferation. CONCLUSION Clinically, our experience is on the stage of exploration, and there is a lack of standardized guidelines on its clinical application. Experimentally, the previous studies showed some subtly different views on the functional mechanisms. However, it is not enough to regulate the clinical practice yet. Therefore, related basic studies and long-term clinical follow-up are needed. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Giatsidis G, Cheng L, Haddad A, Ji K, Succar J, Lancerotto L, Lujan-Hernandez J, Fiorina P, Matsumine H, Orgill DP. Noninvasive induction of angiogenesis in tissues by external suction: sequential optimization for use in reconstructive surgery. Angiogenesis 2017; 21:61-78. [DOI: 10.1007/s10456-017-9586-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/06/2017] [Indexed: 12/18/2022]
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Paul NE, Denecke B, Kim BS, Dreser A, Bernhagen J, Pallua N. The effect of mechanical stress on the proliferation, adipogenic differentiation and gene expression of human adipose-derived stem cells. J Tissue Eng Regen Med 2017; 12:276-284. [DOI: 10.1002/term.2411] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 11/16/2016] [Accepted: 01/13/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Nora E. Paul
- Department of Plastic Surgery and Hand Surgery - Burn Center; Uniklinik RWTH Aachen; Aachen Germany
| | - Bernd Denecke
- Interdisciplinary Center for Clinical Research; Uniklinik RWTH Aachen; Aachen Germany
| | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery - Burn Center; Uniklinik RWTH Aachen; Aachen Germany
| | - Alice Dreser
- Institute of Neuropathology; Uniklinik RWTH Aachen; Aachen Germany
| | - Jürgen Bernhagen
- Department of Vascular Biology; Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig Maximilians-University (LMU) of Munich; Munich Germany
- Munich Cluster for Systems Neurology (SyNergy); Munich Germany
| | - Norbert Pallua
- Department of Plastic Surgery and Hand Surgery - Burn Center; Uniklinik RWTH Aachen; Aachen Germany
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Adipose Tissue Formation Utilizing Fat Flap Distraction Technique. Sci Rep 2017; 7:5174. [PMID: 28701801 PMCID: PMC5507872 DOI: 10.1038/s41598-017-05547-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 05/31/2017] [Indexed: 01/21/2023] Open
Abstract
Co-regulation between adipocytes and supporting vasculature is considered an important process in adipose tissue generation. The objective of this study was to evaluate the mechanical and biological effects of a distraction technique on adipose tissue formation and maintenance. Based on the hypothesis that fat flaps gradually receding from each other can develop an adipose tissue construct, perforated polycarbonate syringe-shaped chambers were implanted in a rabbit model. Latency (1 week) and distraction (3 weeks) periods were followed by a consolidation period in the experimental groups (4, 8, and 12 weeks). In the distraction group, the volume of fat pad gradually increased up to 16 weeks. A transition zone was observed at 8 weeks, indicating the initiation of tissue generation. Histomorphologic analysis showed adipose and collagen connective tissue at 8 weeks. At 16 weeks, the relative composition was altered significantly. Adipose components occupied most of the tissue, and connective tissue was reduced. Blood vessels with endothelial lining were noted adjacent to adipocyte clusters, as well as in inter-adipocyte areas. The vessels had increased in number and were evenly distributed by 16 weeks. Our distraction technique produced more balanced adipose tissue generation than a non-distraction method, with co-development of adipose and vascular tissues.
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