Moderate-Intensity Intermittent External Volume Expansion Optimizes the Soft-Tissue Response in a Murine Model

Giatsidis, Giorgio; Cheng, Liying; Facchin, Federico; Haddad, Anthony; Lujan-Hernandez, Jorge; Lancerotto, Luca; Nabzdyk, Christoph S.; Matsumine, Hajime; Orgill, Dennis P.

doi:10.1097/prs.0000000000003190

Cited by 34 publications

(18 citation statements)

References 36 publications

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“… 31 There is growing body of evidence in small animal preclinical models on the impact of wound healing and skin expansion models that has demonstrated the stimulation of external suction on increased angiogenic and adipogenic potential. 10 , 12 , 13 , 16 , 19 , 31 , 33 External volume expansion has previously demonstrated an influence on histological structure of tissues, and has shown to increase adipogenic potential 10 , 17 in fat grafting, and potential utility in diabetic and radiation in small experimental animal models. 8 , 13 , 34 …”

Section: Discussionmentioning

confidence: 99%

“…Vascularization of tissue is essential to avoid complications in flap surgery and in the preconditioning of tissue and can have the possibility to reduce necrosis and reduce the risk of ischemic complications and the morbidity in patients. 8 – 10 There is a need for targeted approaches, supported by scientific rigor, to “mimic” ischemic preconditioning or flap delay, which can enhance the safety and reliability of flap design.…”

Section: Introductionmentioning

confidence: 99%

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Preconditioning with Foam-mediated External Suction on Flap Microvasculature and Perfusion in a Rodent Model

Mohan

Zhu

Michalak

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Background: 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. Methods: Gluteal perforator flaps were designed on sixteen 400 g rats. Continuous FMES at −125 mm Hg was applied on one side (intervention) to precondition tissue for 5 days, with the contralateral side as a paired control. In group A, we assessed changes following pretreatment, after surgery, and 7 days postprocedure, and in group B, we evaluated changes during preconditioning alone. In group A (N = 8), control and intervention flaps were assessed using laser-assisted indocyanine green fluorescence angiography. In group B, flap regions were assessed using 4-dimensional computed tomographic angiography. All flaps were analyzed for microvessel density using micro–computed tomography and histological assessment using hematoxylin and eosin and CD3 immunohistochemistry. Results: Thirty-two flaps were included in this study (N = 16 intervention and matched controls). Four-dimensional computed tomographic angiography demonstrated 17% greater tissue perfusion in preconditioned flaps (mean, 78.7 HU; SD, 8.8) versus controls (mean, 67.3 HU; SD, 15.7; P < 0.01). Laser-assisted indocyanine green fluorescence angiography showed a 30% higher mean absolute intensity in preconditioned flaps versus controls (P < 0.01). Postsurgery mean absolute intensity in preconditioned flaps remained 21% higher than in controls (P = 0.03). Preconditioned flaps demonstrated a 2-fold increase in mean vessel volume of 9.1 mm3 (SD, 7) versus 4.5 mm3 (SD, 3) in controls (P = 0.04); there was a 33% higher mean area fraction of CD31 in preconditioned flaps, 3.9% (SD, 3) versus 2.9% (SD, 3) in controls (P = 0.03). Conclusion: FMES preconditioning has the potential to augment vascularity of tissue for flap harvest; however, further experimental studies are required to optimize strategies and evaluate long-term effects for clinical applications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Preconditioning with Foam-mediated External Suction on Flap Microvasculature and Perfusion in a Rodent Model

Mohan

Zhu

Michalak

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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“…4A). 35 Compared with a standard cup-shaped silicone interface, intermittent application of EVE with microdeformational, polyurethane foam-shaped interfaces was more effective and safer for preconditioning of tissues in a Db/Db mouse model (Fig. 4B).…”

Section: Animal Models Of Translational Preclinical Application Of Evementioning

confidence: 92%

The Application and Mechanism of Action of External Volume Expansion in Soft Tissue Regeneration

Chen

Yuan

2021

Tissue Engineering Part B: Reviews

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The reconstruction of large-volume soft tissue defects is a major problem in plastic surgery. Many plastic surgeons have focused on external volume expansion (EVE) because of its capacity to promote regeneration of soft tissues, including breast, subcutaneous fat, and skin. EVE is a minimally invasive and less costly tissue engineering approach that has shown great clinical potential. However, many challenges still need to be addressed before such technology can become a common clinical practice. Basic in vivo and in vitro studies have been performed to determine the possible mechanisms by which EVE promotes tissue regeneration and to design optimized animal models. EVE application was found to facilitate cell proliferation and migration, enhance adipogenesis, improve angiogenesis, and provide available space for soft tissue growth. Understanding the mechanical and chemical signals associated with EVE during tissue regeneration may enable the clinical adaptation of this technology. This article reviews the clinical application of EVE techniques, describes preclinical animal models, and evaluates the possible mechanisms by which EVE induces tissue regeneration.

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“…16 Giatsidis et al explored intermittent pressure using external expansion in 50 mice. 18 They found that it improved both angiogenic and adipogenic potential. Proposed mechanisms of action included moderate-to highintensity stimulation increasing the density of blood vessels without causing tissue damage.…”

Section: Figurementioning

confidence: 99%

Efficacy of an external volume expansion device and autologous fat grafting for breast reconstruction following breast conserving surgery and total mastectomy: Small improvements in quality of life found in a prospective cohort study

Howes

Watson

Fosh

et al. 2020

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Moderate-Intensity Intermittent External Volume Expansion Optimizes the Soft-Tissue Response in a Murine Model

Abstract: Application of moderate-intensity intermittent external volume expansion optimizes induction of angiogenesis and adipogenesis in soft tissues without tissue damage, holding potential for time-effective recipient-site preconditioning before fat grafting.

Cited by 34 publications

References 36 publications

Preconditioning with Foam-mediated External Suction on Flap Microvasculature and Perfusion in a Rodent Model

Preconditioning with Foam-mediated External Suction on Flap Microvasculature and Perfusion in a Rodent Model

The Application and Mechanism of Action of External Volume Expansion in Soft Tissue Regeneration

Efficacy of an external volume expansion device and autologous fat grafting for breast reconstruction following breast conserving surgery and total mastectomy: Small improvements in quality of life found in a prospective cohort study

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