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Lee CY, Mustakim KR, Eo MY, Kim SM. Gingivo-Periosteal Expansion of Edentulous Jaw Crest with An Osmotic Self-Inflatable Expander: A Preclinical in Vivo Study. J Craniofac Surg 2024; 35:00001665-990000000-01778. [PMID: 39038207 PMCID: PMC11346717 DOI: 10.1097/scs.0000000000010459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/09/2024] [Indexed: 07/24/2024] Open
Abstract
This study examined the biocompatibility and expansion volume of tissue expanders utilizing rabbits and beagles as experimental models. The self-inflatable expander was provided using a Tissue balloon® (Neobiotech Co., Seoul, Korea). In 9 adult rabbits, a Tissue balloon® was placed under the lateral mandibular periosteum via an extraoral approach. After 2, 3, and 4 weeks (n=3), the expanders were removed, and soft tissue and bone samples were collected for analysis. Histomorphometric analysis and measurements of expander characteristics were performed. In 5 Beagles, all premolars were extracted. Three months after extraction, tissue expanders were placed in the maxilla and mandible, adjacent to dental extraction sites, and removed after 3 weeks. Gingival parameters were measured before and after expansion. Blood perfusion in the oral mucosa was assessed using a laser Doppler flowmeter at different time points. After three weeks, dogs were euthanized, and tissue samples were collected for histologic analysis, focusing on inflammatory response, bone formation, and gingival thickness changes. In the rabbit study, measurements of size, weight, and volume showed significant increases over 4 weeks. Swelling peaked at 2 weeks postimplantation and then gradually stabilized. Histologic examination revealed no signs of inflammation, and expanders were covered by collagen-rich capsules. Some bone resorption was noted due to pressure from the expanders, but the resorption was not significant. In the beagle study, twenty tissue expanders were implanted; 1 expander was lost, and 9 wounds dehisced during soft tissue healing. However, no signs of infection were noted. Histologic evaluation showed bone atrophy, attributed to swelling pressure, at the recipient site. Gingival thickness was not decreased. Perfusion measurements indicated that expansion did not affect microvascular circulation adversely. Overall, both studies suggest that tissue expanders demonstrate biocompatibility and successful expansion volume in vivo, with minimal adverse effects on surrounding tissues and microvascular circulation.
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Selvaprithiviraj V, Vaquette C, Ivanovski S. Hydrogel based soft tissue expanders for orodental reconstruction. Acta Biomater 2023; 172:53-66. [PMID: 37866723 DOI: 10.1016/j.actbio.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/10/2023] [Accepted: 10/17/2023] [Indexed: 10/24/2023]
Abstract
Tension-free flap closure to prevent soft tissue dehiscence is a prerequisite for successful bone augmentation in orodental reconstructive surgery. Since soft tissue contour follows the underlying jaw bony architecture, resorption of alveolar (jaw) bone limits the availability of soft tissue for wound closure following major bone reconstruction, required to facilitate oral rehabilitation with endosseous dental implants following tooth loss. Although there are several clinical procedures to increase soft tissue volume, these techniques are complicated and technically demanding. Soft tissue expansion, an established technique in reconstructive surgery, is an ideal alternative to generate surplus soft tissue prior to bone augmentation and dental implant placement. Increase in tissue volume can be achieved by using soft tissue expanders (STEs). Contemporary STEs have evolved from silicone balloons to osmotically inflating hydrogel-based systems. Here, we provide an overview of STEs in clinical oral surgery, outline the current research in STEs, and an update on recent clinical trials as well as the associated complications. Also, the mechanism governing soft tissue expansion and the critical factors that control the expansion process are covered. Design considerations for STEs for intraoral applications are given particular attention. Finally, we present our perspectives on utilization of minimally invasive methods to administer STEs for orodental applications. STATEMENT OF SIGNIFICANCE: Soft tissue expansion is required for a range of reconstructive applications and more notably in regenerative dentistry for vertical bone augmentation. This review describes the commercially available soft tissue expanders along with the latest systems being currently developed. This review insightfully discusses the biological and physical mechanisms leading to soft tissue expansion and critically assesses the design criteria of soft tissue expanders. A particular focus is given on the development of a new generation of hydrogel-based soft tissue expanders; their chemistry and required physical properties for tissue expansion is described and the obstacles towards clinical translations are identified. Finally, the review elaborates on promising minimally invasive injectable hydrogel-based tissue expanders and highlights the beneficial features of these systems.
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Affiliation(s)
- Vignesh Selvaprithiviraj
- The University of Queensland, School of Dentistry, Centre for Oral Regeneration, Reconstruction and Rehabilitation (COR3), Herston, QLD, Australia
| | - Cedryck Vaquette
- The University of Queensland, School of Dentistry, Centre for Oral Regeneration, Reconstruction and Rehabilitation (COR3), Herston, QLD, Australia; Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, QLD, Australia, S. Ivanovski, School of Dentistry, University of Queensland, 288 Herston Rd, Herston, Brisbane, QLD 4072, Australia
| | - Saso Ivanovski
- The University of Queensland, School of Dentistry, Centre for Oral Regeneration, Reconstruction and Rehabilitation (COR3), Herston, QLD, Australia.
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Ellesøe AG, Shado R, Pereira IN, Madruga D, Hassan H. Soft tissue expansion using self-inflating osmotic hydrogel expanders prior to bone augmentation: healing and complications. Evidence-based review. BDJ Open 2023; 9:48. [PMID: 37952027 PMCID: PMC10640575 DOI: 10.1038/s41405-023-00175-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/08/2023] [Accepted: 10/09/2023] [Indexed: 11/14/2023] Open
Abstract
AIM This review aims to assess complication rates, soft tissue gain, and bone gain associated with the use of self-inflating osmotic hydrogel tissue expanders (SOHTEs) for soft tissue expansion (STE). METHODS A comprehensive search on Pubmed and Google Scholar databases was conducted to identify human studies using SOHTEs for STE; last searched in March 2023. Expansion phase details and expander variables were documented. Complication rates, soft tissue gain, and bone gain reported in each study were also recorded. The inclusion criteria encompassed human studies ranging from evidence levels II-IV (Oxford Centre for Evidence-Based Medicine Levels of Evidence), without specific date limits. For assessing bias in randomized controlled trials (RCTs), a Risk of Bias tool was employed. The synthesised results were presented through tables, sunburst plots, and bar charts. RESULTS A total of 13 studies were identified, comprising 4 RCTs, 1 cohort study, and 8 case-series. Employment of SOHTEs yielded an overall complication rate of 17% (24/140 sites), with expander perforation accounting for 9.3% (13/140) of the sites. Specific complication rates included dehiscence (1.4%, 2/140 sites), paraesthesia (1.4%, 2/140 sites), and infection (1.4%, 2/140 sites). All randomized controlled trials (RCTs) were categorised at Level II. The remaining investigations primarily consisted of Level IV case-series lacking controls. All studies demonstrated some concerns towards bias. CONCLUSION STE studies using SOHTEs exhibit a reduction in complications associated with bone augmentation in scenarios of inadequate soft tissue coverage. Preliminary evidence suggests potential benefits even in cases with sufficient soft tissue. Adherence to procedural precautions may reduce the risk of expander perforations, further diminishing complications. Subsequent studies should incorporate individual patient and expander variables in their reports to explore the impact of expansion phases on complication rates, as well as bone and soft tissue augmentation.
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Affiliation(s)
- Adam Gade Ellesøe
- Rey Juan Carlos University, Av. de Atenas, S/N, 28922, Alcorcón, Madrid, Spain
| | - Rawand Shado
- Barts & The London School of Medicine & Dentistry, Queen Mary University, Institute of Dentistry, Royal London Dental Hospital, Turner Street, E1 2AD, London, UK
| | - Ines Novo Pereira
- University of Porto, Faculty of Dental Medicine, R. Dr. Manuel Pereira da Silva, 4200-393, Porto, Portugal
| | - David Madruga
- Rey Juan Carlos University, Av. de Atenas, S/N, 28922, Alcorcón, Madrid, Spain
| | - Haidar Hassan
- Rey Juan Carlos University, Av. de Atenas, S/N, 28922, Alcorcón, Madrid, Spain.
- Barts & The London School of Medicine & Dentistry, Queen Mary University, Institute of Dentistry, Royal London Dental Hospital, Turner Street, E1 2AD, London, UK.
- Barts & The London School of Medicine & Dentistry, Queen Mary University, Centre for Cutaneous Research, Blizard Institute of Cell and Molecular Science, 4 Newark Street, Whitechapel, London, E1 2AT, UK.
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Mehta P, Sharma M, Devi M. Hydrogels: An overview of its classifications, properties, and applications. J Mech Behav Biomed Mater 2023; 147:106145. [PMID: 37797557 DOI: 10.1016/j.jmbbm.2023.106145] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/07/2023]
Abstract
The review paper starts with the introduction to hydrogels along with broad literature survey covering different modes of synthesis including high energy radiation methods. After that, paper covered broad classification of the hydrogels depending upon the basis of their source of origin, method of synthesis, type of cross-linking present and ionic charges on bound groups. Another advanced category response triggered hydrogels, which includes pH, temperature, electro, and light and substrate responsive hydrogels was also studied. Presented paper summarises chemical structure, properties, and synthesis of different kinds of hydrogels. Main focus was given to the preparation super absorbents such as: Semi-interpenetrating networks (semi-IPNs), Interpenetrating networks (IPNs) and cross-linked binary graft copolymers (BGCPs). The weak mechanical properties and easy degradation limit the uses of bio-based -hydrogels in biomedical field. Their properties can be improved through different chemical and physical methods. These methods were also discussed in the current research paper. Also, it includes development of hydrogels as controlled drug delivery devices, as implants and biomaterials to replace malfunctioned body parts along with their use in several other applications listed in the literature. Literature survey on the application of hydrogels in different fields like biomedical, nano-biotechnology, tissue engineering, drug delivery and agriculture was also carried out.
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Affiliation(s)
- Preeti Mehta
- Department of Applied Sciences, CEC-Chandigarh Group of Colleges, Landran, Mohali, 140307, Punjab, India.
| | - Monika Sharma
- Department of Applied Sciences, CEC-Chandigarh Group of Colleges, Landran, Mohali, 140307, Punjab, India.
| | - Meena Devi
- Department of Applied Sciences, CEC-Chandigarh Group of Colleges, Landran, Mohali, 140307, Punjab, India.
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Hassan N, Krieg T, Zinser M, Schröder K, Kröger N. An Overview of Scaffolds and Biomaterials for Skin Expansion and Soft Tissue Regeneration: Insights on Zinc and Magnesium as New Potential Key Elements. Polymers (Basel) 2023; 15:3854. [PMID: 37835903 PMCID: PMC10575381 DOI: 10.3390/polym15193854] [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] [Received: 06/29/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
The utilization of materials in medical implants, serving as substitutes for non-functional biological structures, supporting damaged tissues, or reinforcing active organs, holds significant importance in modern healthcare, positively impacting the quality of life for millions of individuals worldwide. However, certain implants may only be required temporarily to aid in the healing process of diseased or injured tissues and tissue expansion. Biodegradable metals, including zinc (Zn), magnesium (Mg), iron, and others, present a new paradigm in the realm of implant materials. Ongoing research focuses on developing optimized materials that meet medical standards, encompassing controllable corrosion rates, sustained mechanical stability, and favorable biocompatibility. Achieving these objectives involves refining alloy compositions and tailoring processing techniques to carefully control microstructures and mechanical properties. Among the materials under investigation, Mg- and Zn-based biodegradable materials and their alloys demonstrate the ability to provide necessary support during tissue regeneration while gradually degrading over time. Furthermore, as essential elements in the human body, Mg and Zn offer additional benefits, including promoting wound healing, facilitating cell growth, and participating in gene generation while interacting with various vital biological functions. This review provides an overview of the physiological function and significance for human health of Mg and Zn and their usage as implants in tissue regeneration using tissue scaffolds. The scaffold qualities, such as biodegradation, mechanical characteristics, and biocompatibility, are also discussed.
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Affiliation(s)
- Nourhan Hassan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
- Biotechnology Department, Faculty of Science, Cairo University, Giza 12613, Egypt
| | - Thomas Krieg
- Translational Matrix Biology, Medical Faculty, University of Cologne, 50923 Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50923 Cologne, Germany
- Center for Molecular Medicine (CMMC), University of Cologne, 50923 Cologne, Germany
| | - Max Zinser
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Kerpener Strasse 62, 50931 Cologne, Germany
| | - Kai Schröder
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Nadja Kröger
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
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6
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Chang Y, Zhang F, Liu F, Shi L, Zhang L, Zhu H. Self-swelling tissue expander for soft tissue reconstruction in the craniofacial region: An in vitro and in vivo evaluation. Biomed Mater Eng 2021; 33:77-90. [PMID: 34250925 DOI: 10.3233/bme-211224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Craniofacial soft-tissue defects mostly have an impact on the treatment of various oral diseases. Tissue expander is an important technique for tissue reconstruction, especially for soft tissues in reconstructive surgery. OBJECTIVE This research aimed to develop a new self-swelling tissue expander, namely hydrogel, for soft tissue reconstruction in craniofacial region. METHODS In vitro, the chemical and physical characteristics of hydrogel were evaluated by SEM, swelling rate, mechanical testing, EDS, and FT-IR. In vivo, the craniofacial implant model of SD rats were divided into group A as control, group B with hydrogels for 1 week expansion, group C for 2 weeks and group D for 4 weeks (n = 5), and the effects were analyzed by HE staining, histological and radiographic evaluation. RESULTS The in vitro results suggested that dry hydrogel possessed a uniform surface with micropores, the surface of post-swelling hydrogel formed three-dimensional meshwork. Within 24 hours, hydrogels expanded markedly, then slowed down. The mechanical property of hydrogels with longer expansion was better, whose main elements were carbon and oxygen. FT-IR also verified its molecular structure. In vivo, the wounds of rats recovered well, hydrogels could be removed as one whole piece with original shape and examined by radiographic evaluation, besides, the expanded skin and developed fibrous capsule formed surrounding hydrogels. CONCLUSION The new expander was designed successfully with good chemical and physical characteristics, and could be applied in an animal model to help tissue reconstruction.
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Affiliation(s)
- Yili Chang
- Department of Ophthalmology, Affiliated Eye Hospital of Nanchang University, China.,The Graduate School of Nanchang University, China
| | - Fubao Zhang
- The Graduate School of Nanchang University, China.,Department of Stomatology, The Third Affiliated Hospital of Nanchang University, China
| | - Feng Liu
- College of Chemistry, Nanchang University, China
| | - Lianshui Shi
- Department of Prosthodontics, Affiliated Stomatological Hospital of Nanchang University, China
| | - Lin Zhang
- Department of Prosthodontics, Affiliated Stomatological Hospital of Nanchang University, China
| | - Hongshui Zhu
- Department of Prosthodontics, Affiliated Stomatological Hospital of Nanchang University, China
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7
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Shou X, Zhang H, Wu D, Zhong L, Ni D, Kong T, Zhao Y, Zhao Y. Antigen-Presenting Hybrid Colloidal Crystal Clusters for Promoting T cells Expansion. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2021; 17:e2006955. [PMID: 33711196 DOI: 10.1002/smll.202006955] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/03/2021] [Indexed: 06/12/2023]
Abstract
T cell based-immunotherapy has been a powerful strategy to eradicate tumor cells in clinical trials. Effectively expanding the therapeutic T cells for clinical demand is still a challenge. Here, artificial antigen-presenting scaffolds are created for T cell ex vivo expansion. The antigen-presenting hybrid colloidal crystal clusters (HCCCs) with multiple stimuli are generated by internal encapsulation with prosurvival cytokines and surface decoration with activating antibodies to CD3ε and CD28, respectively. With the large loading capacity endowed by their abundant nanoporous structures, the antigen-presenting HCCCs can constantly release prosurvival cytokine IL-2. It is found that following the direct and multiple stimulations, the antigen-presenting HCCCs can effectively promote the expansion of T cells, which exhibits robust antitumor activity in vitro. Thus, the antigen-presenting HCCCs provide a novel expansion platform for clinical manufacturing of T cells.
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Affiliation(s)
- Xin Shou
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, 518060, China
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, 210096, China
| | - Hui Zhang
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, 210096, China
| | - Dan Wu
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, 325001, China
| | - Liping Zhong
- National Center for International Biotargeting Theranostics, Guangxi Key Laboratory of Biotargeting Theranostics, Collaborative Innovation Center for Targeting Tumor Theranostics, Guangxi Medical University, Guangxi, 530021, China
| | - Dong Ni
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, 518060, China
| | - Tiantian Kong
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, 518060, China
| | - Yongxiang Zhao
- National Center for International Biotargeting Theranostics, Guangxi Key Laboratory of Biotargeting Theranostics, Collaborative Innovation Center for Targeting Tumor Theranostics, Guangxi Medical University, Guangxi, 530021, China
| | - Yuanjin Zhao
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, 210096, China
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8
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Colazo JM, Evans BC, Farinas AF, Al-Kassis S, Duvall CL, Thayer WP. Applied Bioengineering in Tissue Reconstruction, Replacement, and Regeneration. TISSUE ENGINEERING PART B-REVIEWS 2020; 25:259-290. [PMID: 30896342 DOI: 10.1089/ten.teb.2018.0325] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPACT STATEMENT The use of autologous tissue in the reconstruction of tissue defects has been the gold standard. However, current standards still face many limitations and complications. Improving patient outcomes and quality of life by addressing these barriers remain imperative. This article provides historical perspective, covers the major limitations of current standards of care, and reviews recent advances and future prospects in applied bioengineering in the context of tissue reconstruction, replacement, and regeneration.
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Affiliation(s)
- Juan M Colazo
- 1Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,2Medical Scientist Training Program, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brian C Evans
- 3Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Angel F Farinas
- 4Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Salam Al-Kassis
- 4Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Craig L Duvall
- 3Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Wesley P Thayer
- 3Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee.,4Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Coletta R, Olivieri C, Persano G, Solari V, Inserra A, Morabito A. Expanding intestinal segment using osmotic hydrogel: An in vivo study. J Biomed Mater Res B Appl Biomater 2018; 107:1304-1309. [PMID: 30312527 DOI: 10.1002/jbm.b.34224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/19/2018] [Accepted: 08/12/2018] [Indexed: 12/13/2022]
Abstract
Intestinal circumferential expansion is essential for bowel lengthening in patients with Short Bowel Syndrome. We hypothesized use of an endoluminal osmotic hydrogel expander (EOHE) as a novel approach for intestinal expansion. An EOHE was introduced into an isolated intestinal segment of New Zealand rabbits, with a similar segment created as a control. After 4weeks, the segments were retrieved for analysis. Weight, inflammatory markers and fluoroscopy data was recorded weekly. EOHE allowed successful expansion of intestinal segments from 4.68 ± 0.35 to 9.79 ± 0.35 cm (p = 0.01). Increase in intestinal length was 167.8 ± 35.21% in segments with EOHE vs. 23.03 ± 4.2% in the control group (p < 0.01). A significant intestinal dilatation (214.4 ± 1.58 vs. 34.59 ± 1.23%, p < 0.01) was demonstrated. Hematoxylin and eosin stain revealed conservation of intestinal architecture with muscle hypertrophy and flattening of the epithelium possibly due to compression. No reduction of rabbit weight, inflammatory markers or liver damage was described. EOHE appears to produce safe intestinal expansion, achieving increased length and dilatation suitable for lengthening procedure. This approach may allow development of similar techniques to expand bowel in short bowel patients. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1304-1309, 2019.
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Affiliation(s)
- Riccardo Coletta
- Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.,Paediatric Autologous Bowel Reconstruction and Rehabilitation Unit, Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK.,Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Claudio Olivieri
- Division of General and Thoracic Surgery, Bambino Gesù Children Hospital, Rome, Italy
| | - Giorgio Persano
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Valeria Solari
- Paediatric Autologous Bowel Reconstruction and Rehabilitation Unit, Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Alessandro Inserra
- Division of General and Thoracic Surgery, Bambino Gesù Children Hospital, Rome, Italy
| | - Antonino Morabito
- Paediatric Autologous Bowel Reconstruction and Rehabilitation Unit, Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK.,Division of General and Thoracic Surgery, Bambino Gesù Children Hospital, Rome, Italy.,Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy.,Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
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10
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Yoo JM, Ben Amara H, Kim MK, Song JD, Koo KT. Oral tissue response to soft tissue expanders prior to bone augmentation: in vitro analysis and histological study in dogs. J Periodontal Implant Sci 2018; 48:152-163. [PMID: 29984045 PMCID: PMC6031766 DOI: 10.5051/jpis.2018.48.3.152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/15/2018] [Indexed: 01/25/2023] Open
Abstract
Purpose To determine whether the swelling and mechanical properties of osmotic self-inflating expanders allow or not the induction of intraoral soft tissue expansion in dogs. Methods Three different volumes (0.15, 0.25, and 0.42 mL; referred to respectively as the S, M, and L groups) of soft tissue expanders (STEs) consisting of a hydrogel core coated with a silicone-perforated membrane were investigated in vitro to assess their swelling behavior (volume swelling ratio) and mechanical properties (tensile strength, tensile strain). For in vivo investigations, the STEs were subperiosteally inserted for 4 weeks in dogs (n=5). Soft tissue expansion was clinically monitored. Histological analyses included the examination of alveolar bone underneath the expanders and thickness measurements of the surrounding fibrous capsule. Results The volume swelling ratio of all STEs did not exceed 5.2. In tensile mode, the highest mean strain was registered for the L group (98.03±0.3 g/cm), whereas the lowest mean value was obtained in the S group (81.3±0.1 g/cm), which was a statistically significant difference (P<0.05). In addition, the S and L groups were significantly different in terms of tensile strength (1.5±0.1 g/cm for the S group and 2.2±0.1 g/cm for the L group, P<0.05). Clinical monitoring showed successful dilatation of the soft tissues without signs of inflammation up to 28 days. The STEs remained volumetrically stable, with a mean diameter in vivo of 6.98 mm, close to the in vitro post-expansion findings (6.69 mm). Significant histological effects included highly vascularized collagen-rich fibrous encapsulation of the STEs, with a mean thickness of 0.67±0.12 mm. The bone reaction consisted of resorption underneath the STEs, while apposition was observed at their edges. Conclusions The swelling and mechanical properties of the STEs enabled clinically successful soft tissue expansion. A tissue reaction consisting of fibrous capsule formation and bone loss were the main histological events.
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Affiliation(s)
- Jung Min Yoo
- Department of Periodontology and Dental Research Institute, Translational Research Laboratory for Tissue Engineering (TTE), Seoul National University School of Dentistry, Seoul, Korea
| | - Heithem Ben Amara
- Department of Periodontology and Dental Research Institute, Translational Research Laboratory for Tissue Engineering (TTE), Seoul National University School of Dentistry, Seoul, Korea
| | | | | | - Ki-Tae Koo
- Department of Periodontology and Dental Research Institute, Translational Research Laboratory for Tissue Engineering (TTE), Seoul National University School of Dentistry, Seoul, Korea
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11
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Garner J, Davidson D, Eckert GJ, Barco CT, Park H, Park K. Reshapable polymeric hydrogel for controlled soft-tissue expansion: In vitro and in vivo evaluation. J Control Release 2017; 262:201-211. [PMID: 28751248 PMCID: PMC5603415 DOI: 10.1016/j.jconrel.2017.07.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/10/2017] [Accepted: 07/24/2017] [Indexed: 11/20/2022]
Abstract
Tissue expansion is the process by which extra skin is generated using a device that applies pressure from underneath the skin. Over the course of weeks to months, stretching by this pressure creates a flap of extra tissue that can be used to cover a defect area or enclose a permanent implant. Conventional tissue expanders require a silicone shell inflated either by external injections of saline solution or air, or by internal osmotic pressure generated by a hydrophilic polymer. In this study, a shell-free tissue expander comprised only of a chemically cross-linked biocompatible polymeric hydrogel is developed. The cross-linked network of hydrophilic polymer provides for intrinsically controlled swelling in the absence of an external membrane. The new type of hydrogel expanders were characterized in vitro as well as in vivo using a rat-skin animal model. It was found that increasing the hydrophobic polyester content in the hydrogel reduced the swelling velocity to a rate and volume that eliminate the danger of premature swelling rupturing the sutured area. Additionally, increasing the crosslinking density resulted in enough mechanical strength of the hydrogel to allow for complete post-swelling removal, without the hydrogel cracking or crumbling. No systemic toxicity was noted with the expanders and histology showed the material to be highly biocompatible. These expanders have an advantage of tissue expansion without requiring an external silicone membrane, and thus, they can be cut or reshaped at the time of implantation for applications in small or physically constrained regions of the body.
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Affiliation(s)
- John Garner
- Akina, Inc., West Lafayette, IN, United States
| | - Darrel Davidson
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - George J Eckert
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Clark T Barco
- Roudebush Veterans Affairs Medical Center, Indianapolis, IN, United States
| | - Haesun Park
- Akina, Inc., West Lafayette, IN, United States
| | - Kinam Park
- Akina, Inc., West Lafayette, IN, United States; Purdue University, Department of Biomedical Engineering, West Lafayette, IN, United States; Purdue University, Department of Pharmaceutics, West Lafayette, IN, United States.
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12
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Kaner D, Zhao H, Arnold W, Terheyden H, Friedmann A. Pre-augmentation soft tissue expansion improves scaffold-based vertical bone regeneration - a randomized study in dogs. Clin Oral Implants Res 2017; 28:640-647. [PMID: 27145448 PMCID: PMC5484302 DOI: 10.1111/clr.12848] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Soft tissue (ST) dehiscence with graft exposure is a frequent complication of vertical augmentation. Flap dehiscence is caused by failure to achieve tension-free primary wound closure and by the impairment of flap microcirculation due to surgical trauma. Soft tissue expansion (STE) increases ST quality and quantity prior to reconstructive surgery. We hypothesized that flap preconditioning using STE would reduce the incidence of ST complications after bone augmentation and that optimized ST healing would improve the outcome of bone regeneration. MATERIALS AND METHODS Self-filling tissue expanders were implanted in mandibular bone defects in ten beagle dogs. After expansion, alloplastic scaffolds were placed for vertical bone augmentation in STE sites and in control sites without STE pre-treatment. ST flap microcirculation was analysed using laser Doppler flowmetry. The incidence of graft exposures was evaluated after 2 weeks. Bone formation was assessed after 2 months, using histomorphometry and immunohistochemistry. RESULTS Test sites showed significantly less impairment of perfusion and faster recovery of microcirculation after bone augmentation. Furthermore, no flap dehiscences occurred in STE sites. Bone regeneration was found in both groups; however, significantly greater formation of new bone was detected in test sites with preceding STE. CONCLUSIONS Preconditioning using STE improved ST healing and bone formation after vertical augmentation. The combination of STE and the subsequent placement of alloplastic scaffolds may facilitate the reconstruction of severe bone defects.
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Affiliation(s)
- Doğan Kaner
- Department of PeriodontologyWitten/Herdecke UniversityWittenGermany
| | - Han Zhao
- Department of PeriodontologyWitten/Herdecke UniversityWittenGermany
- Multi‐disciplinary Treatment CenterBeijing Stomatological HospitalCapital Medical UniversityBeijingChina
| | - Wolfgang Arnold
- Department of Oral Biology and Materials ScienceWitten/Herdecke UniversityWittenGermany
| | - Hendrik Terheyden
- Department of Maxillofacial SurgeryRotes‐Kreuz‐Krankenhaus KasselKasselGermany
| | - Anton Friedmann
- Department of PeriodontologyWitten/Herdecke UniversityWittenGermany
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13
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Jamadi M, Shokrollahi P, Houshmand B, Joupari MD, Mashhadiabbas F, Khademhosseini A, Annabi N. Poly (Ethylene Glycol)‐Based Hydrogels as Self‐Inflating Tissue Expanders with Tunable Mechanical and Swelling Properties. Macromol Biosci 2017; 17. [DOI: 10.1002/mabi.201600479] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/30/2017] [Indexed: 01/20/2023]
Affiliation(s)
- Mahsa Jamadi
- Biomaterials Innovation Research Center Division of Biomedical Engineering Department of Medicine Brigham and Women's Hospital Harvard Medical School Cambridge MA 02139 USA
- Harvard‐MIT Division of Health Sciences and Technology Massachusetts Institute of Technology Cambridge MA 02139 USA
- Stem Cell and Regenerative Medicine Division National Institute of Genetic Engineering and Biotechnology Tehran 14977‐16316 Iran
| | - Parvin Shokrollahi
- Department of Biomaterials Iran Polymer and Petrochemical Institute Tehran 14977‐13115 Iran
| | - Behzad Houshmand
- Stem Cell and Regenerative Medicine Division National Institute of Genetic Engineering and Biotechnology Tehran 14977‐16316 Iran
- Department of Periodontics School of Dentistry Shahid Beheshti University of Medical Sciences Tehran 19839‐69411 Iran
| | - Mortaza Daliri Joupari
- Animal Biotechnology Department National Institute of Genetic Engineering and Biotechnology Tehran 14977‐16316 Iran
| | - Fatemeh Mashhadiabbas
- Department of Oral and Maxillofacial Pathology School of dentistry Shahid Beheshti University of Medical Sciences Tehran 19839‐69411 Iran
| | - Ali Khademhosseini
- Biomaterials Innovation Research Center Division of Biomedical Engineering Department of Medicine Brigham and Women's Hospital Harvard Medical School Cambridge MA 02139 USA
- Harvard‐MIT Division of Health Sciences and Technology Massachusetts Institute of Technology Cambridge MA 02139 USA
- Department of Physics King Abdulaziz University Jeddah 21569 Saudi Arabia
- Department of Bioindustrial Technologies College of Animal Bioscience and Technology Konkuk University Seoul 143‐701 Republic of Korea
| | - Nasim Annabi
- Biomaterials Innovation Research Center Division of Biomedical Engineering Department of Medicine Brigham and Women's Hospital Harvard Medical School Cambridge MA 02139 USA
- Harvard‐MIT Division of Health Sciences and Technology Massachusetts Institute of Technology Cambridge MA 02139 USA
- Department of Chemical Engineering Northeastern University Boston MA 02115‐5000 USA
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14
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Kim J, Hwang J, Seo Y, Jo Y, Son J, Paik T, Choi J. Engineered self-expander hydrogel for sustained release of drug molecules. J IND ENG CHEM 2016. [DOI: 10.1016/j.jiec.2016.07.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Pastrana HF, Cooper CL, Alucozai M, Reece LM, Avila AG, Allain JP. Synthesis and in vitro
safety assessment of magnetic bacterial cellulose with porcine aortic smooth muscle cells. J Biomed Mater Res A 2016; 104:2801-9. [PMID: 27376695 DOI: 10.1002/jbm.a.35824] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 06/09/2016] [Accepted: 06/30/2016] [Indexed: 12/27/2022]
Affiliation(s)
- Homero F. Pastrana
- Department of Electric and Electronic Engineering and Centro de Microelectrónica (CMUA); Universidad de los Andes; Bogotá D.C. 11001 Colombia
- Department of Electrical Computer Engineering, Birck Nanotechnology Center, Purdue University; West Lafayette IN
| | - Christy L. Cooper
- Department of Electrical Computer Engineering, Birck Nanotechnology Center, Purdue University; West Lafayette IN
- Department of Basic Medical Sciences; College of Veterinary Medicine, Purdue University; West Lafayette IN
| | - Milad Alucozai
- Department of Electrical Computer Engineering, Birck Nanotechnology Center, Purdue University; West Lafayette IN
- College of Health and Human Sciences; Purdue University; West Lafayette IN
| | - Lisa M. Reece
- Department of Electrical Computer Engineering, Birck Nanotechnology Center, Purdue University; West Lafayette IN
- Department of Basic Medical Sciences; College of Veterinary Medicine, Purdue University; West Lafayette IN
| | - Alba G. Avila
- Department of Electric and Electronic Engineering and Centro de Microelectrónica (CMUA); Universidad de los Andes; Bogotá D.C. 11001 Colombia
| | - Jean Paul Allain
- Department of Nuclear, Plasma, and Radiological Engineering; University of Illinois at Urbana-Champaign; Urbana IL
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Abstract
The problem of acoustic feedback in hearing aids could be solved potentially by applying a compliant hydrogel to the outer surface that would conform to the ear canal and block feedback. With this objective, several formulations of hydrogels were developed and their swelling and mechanical properties investigated. Hydrogel formulations were polymerized from hydroxyethyl methacrylate (HEMA) and N-vinyl-pyrrolidone (NVP), with various photo-initiators, crosslinkers, and swelling agents. The hydrogel that swelled most rapidly and yet remained undissolved in water had a monomer composition of 40 mol% HEMA, 60 mol% NVP, with 1 wt% polyethylene glycol dimethacrylate as a crosslinker, and 0.5 wt% 2,2-dimethoxy-2-phenyl-acetophenone as the photo-initiator. The tensile modulus, strength, hardness, and durability of the dry hydrogels were not a strong function of composition. In the swollen state, the mechanical properties were much reduced. The potential use of these materials on hearing aids has been discussed in this article.
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Affiliation(s)
- Sung-Il Choi
- Chemical Engineering Department, Brigham Young University, Provo, UT 84602, USA
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Lam J, Clark EC, Fong ELS, Lee EJ, Lu S, Tabata Y, Mikos AG. Evaluation of cell-laden polyelectrolyte hydrogels incorporating poly(L-Lysine) for applications in cartilage tissue engineering. Biomaterials 2016; 83:332-46. [PMID: 26799859 PMCID: PMC4754156 DOI: 10.1016/j.biomaterials.2016.01.020] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 12/26/2015] [Accepted: 01/01/2016] [Indexed: 12/21/2022]
Abstract
To address the lack of reliable long-term solutions for cartilage injuries, strategies in tissue engineering are beginning to leverage developmental processes to spur tissue regeneration. This study focuses on the use of poly(L-lysine) (PLL), previously shown to up-regulate mesenchymal condensation during developmental skeletogenesis in vitro, as an early chondrogenic stimulant of mesenchymal stem cells (MSCs). We characterized the effect of PLL incorporation on the swelling and degradation of oligo(poly(ethylene) glycol) fumarate) (OPF)-based hydrogels as functions of PLL molecular weight and dosage. Furthermore, we investigated the effect of PLL incorporation on the chondrogenic gene expression of hydrogel-encapsulated MSCs. The incorporation of PLL resulted in early enhancements of type II collagen and aggrecan gene expression and type II/type I collagen expression ratios when compared to blank controls. The presentation of PLL to MSCs encapsulated in OPF hydrogels also enhanced N-cadherin gene expression under certain culture conditions, suggesting that PLL may induce the expression of condensation markers in synthetic hydrogel systems. In summary, PLL can function as an inductive factor that primes the cellular microenvironment for early chondrogenic gene expression but may require additional biochemical factors for the generation of fully functional chondrocytes.
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Affiliation(s)
- Johnny Lam
- Department of Bioengineering, Rice University, Houston, TX, USA
| | - Elisa C Clark
- Department of Bioengineering, Rice University, Houston, TX, USA
| | - Eliza L S Fong
- Department of Bioengineering, Rice University, Houston, TX, USA
| | - Esther J Lee
- Department of Bioengineering, Rice University, Houston, TX, USA
| | - Steven Lu
- Department of Bioengineering, Rice University, Houston, TX, USA
| | - Yasuhiko Tabata
- Department of Biomaterials, Institute of Frontier Medical Sciences, Kyoto University, Kyoto, Japan
| | - Antonios G Mikos
- Department of Bioengineering, Rice University, Houston, TX, USA.
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Kim EL, Bernardino CR, Levin F. Orbital volume augmentation using expandable hydrogel implants in acquired anophthalmia and phthisis bulbi. Orbit 2016; 35:91-6. [PMID: 26928353 DOI: 10.3109/01676830.2016.1139593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this study is to describe our experience using expandable spherical hydrogel implants and injectable hydrogel pellets for orbital volume augmentation in cases of post-enucleation socket syndrome after acquired anophthalmia or phthisis bulbi. We retrospectively reviewed the clinical records of all adult patients who received an expandable hydrogel implant for orbital volume loss following enucleation or phthisis bulbi at the Emory Eye Center between 2004 and January 2007 and the Yale Eye Center between 2009 and 2011. The study included 9 women and 5 men with a mean age of 51.2 years old (range 35-76 years old). Follow-up spanned 6 to 71 months (median of 18.5 months). Four patients received spherical hydrogel implants and 10 patients received hydrogel pellet injections. On average, nine pellets (range 5-16) were placed in each patient over an average of 1.7 injections (range 1-3). Most commonly, five pellets were injected per session, as was the case for 13 of the 17 treatment sessions. Post-operative complications included 2 cases of pellet migration, one subcutaneously and one anteriorly due to insufficiently posterior implant placement, and 1 hospital admission for pain after injection of 10 pellets in one visit. All patients experienced an overall subjective improvement in cosmesis. Self-expandable hydrogel implants appear to offer several advantages over other existing options for orbital volume augmentation, as they are easy to place, generally well-tolerated, volume-titratable, and to the extent that our follow-up shows, may be a safe and durable means of treating orbital volume loss in patients with acquired anophthalmia and phthisis bulbi.
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Affiliation(s)
- Esther Lee Kim
- a Department of Ophthalmology , University of Southern California Eye Institute , Los Angeles , California , USA.,b Department of Ophthalmology & Visual Science , Yale Eye Center , New Haven , Connecticut , USA
| | - Carlo Rob Bernardino
- c Oculoplastics and Aesthetic Surgery , Vantage Eye Center , Monterey , California , USA
| | - Flora Levin
- b Department of Ophthalmology & Visual Science , Yale Eye Center , New Haven , Connecticut , USA
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Asa'ad F, Rasperini G, Pagni G, Rios HF, Giannì AB. Pre-augmentation soft tissue expansion: an overview. Clin Oral Implants Res 2015; 27:505-22. [PMID: 26037472 DOI: 10.1111/clr.12617] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to explore the development of soft tissue expanders, their different types and their potential applications prior to bone augmentation and implant placement. MATERIAL AND METHODS A review of pertinent literature was performed using PubMed to comprehend the dynamics of soft tissue expanders and determine the current position of their pre-augmentation applications. RESULTS There is promising, albeit preliminary information regarding the benefits of pre-augmentation soft tissue expansion. Findings cannot be generalised due to relatively small sample size. CONCLUSIONS Further clinical trials with larger sample sizes and long-term follow-up are needed before soft tissue expanders can be confidently applied in everyday clinical practice.
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Affiliation(s)
- Farah Asa'ad
- Department of Biomedical, Surgical and Dental Sciences, Foundation IRCCS Ca' Granda Polyclinic, University of Milan, Milan, Italy
| | - Giulio Rasperini
- Department of Biomedical, Surgical and Dental Sciences, Foundation IRCCS Ca' Granda Polyclinic, University of Milan, Milan, Italy
| | - Giorgio Pagni
- Department of Biomedical, Surgical and Dental Sciences, Foundation IRCCS Ca' Granda Polyclinic, University of Milan, Milan, Italy
| | - Hector F Rios
- Department of Periodontics and Oral Medicine, Michigan Center for Oral Health Research, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Aldo B Giannì
- Department of Biomedical, Surgical and Dental Sciences, Foundation IRCCS Ca' Granda Polyclinic, University of Milan, Milan, Italy
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20
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Two-Stage Cranioplasty: Tissue Expansion Directly over the Craniectomy Defect Prior to Cranioplasty. Craniomaxillofac Trauma Reconstr 2015; 9:355-360. [PMID: 27833717 DOI: 10.1055/s-0035-1549011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/01/2014] [Indexed: 10/23/2022] Open
Abstract
Performing a skull reconstruction for a long-term existing large cranium defect usually needs either skin enhancement or skin flaps and cranioplasty. This procedure can be accompanied with aesthetic and functional complications. The presented case describes a 27-year-old man in need of a cranial reconstruction following decompressive craniectomy as treatment for severe traumatic brain injury. Autologous cranioplasty after decompressive craniectomy failed due to bone flap infection. Because of cognitive behavioral problems, a protective helmet needed to be worn in awaiting cranioplasty. The final titanium cranioplasty was placed subsequent to scalp expansion. The expansion was realized by placing a temporary and custom-made polymethylmethacrylate (PMMA) plate over the defect with a tissue expander on top of it, using the existing scar and skull defect. Our reported technique avoids additional skin flap creation and accompanied complications such as additional scalp and bone damage. In cognitive damaged patients who need to wear a helmet constantly, this simple method provides, concurrently, protection of the brain and tissue expansion. We demonstrate a successful novel technical manner to provide scalp enhancement by positioning a temporary PMMA graft over the skull defect and placing the tissue expander on top of it.
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21
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Characterization of Olfactory Ensheathing Glial Cells Cultured on Polyurethane/Polylactide Electrospun Nonwovens. INT J POLYM SCI 2015. [DOI: 10.1155/2015/908328] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The aim of this research was to evaluate novel biomaterials for neural regeneration. The investigated materials were composed of polyurethane (PU) and polylactide (PLDL) blended at three different w/w ratios, that is, 5/5, 6/4, and 8/2 of PU/PLDL. Ultrathin fibrous scaffolds were prepared using electrospinning. The scaffolds were investigated for their applicability for nerve regeneration by culturing rat olfactory ensheathing glial cells. Cells were cultured on the materials for seven days, during which cellular morphology, phenotype, and metabolic activity were analysed. SEM analysis of the fabricated fibrous scaffolds showed fibers of a diameter mainly lower than 600 μm with unimportant volume of protrusions situated along the fibers, with nonsignificant differences between all analysed materials. Cells cultured on the materials showed differences in their morphology and metabolic activity, depending on the blend composition. The most proper morphology, with numerous p75+and GFAP+cells present, was observed in the sample 6/4, whereas the highest metabolic activity was measured in the sample 5/5. However, none of the investigated samples showed cytotoxicity or negatively influenced cellular morphology. Therefore, the novel electrospun fibrous materials may be considered for regenerative medicine applications, and especially when contacting with highly sensitive nervous cells.
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22
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Dhadse PV, Yeltiwar RK, Bhongade ML, Pendor SD. Soft tissue expansion before vertical ridge augmentation: Inflatable silicone balloons or self-filling osmotic tissue expanders? J Indian Soc Periodontol 2014; 18:433-40. [PMID: 25210255 PMCID: PMC4158582 DOI: 10.4103/0972-124x.138680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 11/01/2013] [Indexed: 11/30/2022] Open
Abstract
Recent advances in periodontal plastic surgical procedures allow the clinician to reconstruct deficient alveolar ridges in more predictable ways than previously possible. Placement of implant/s in resorbed ridges poses numerous challenges to the clinician for successful esthetic and functional rehabilitation. The reconstruction frequently utilizes one or combination of periodontal plastic surgical procedures in conjunction with autogenous bone grafting, allogenic bone block grafting, ridge split techniques, distraction osteogenesis, or guided bone regeneration (GBR) for most predictable outcomes. Current surgical modalities used in reconstruction of alveolar ridge (horizontal and/or vertical component) often involve the need of flap transfer. Moreover, there is compromise in tissue integrity and color match owing to different surgical site and the tissue utilized is insufficient in quantity leading to post surgical graft exposition and/or loss of grafted bone. Soft tissue expansion (STE) by implantation of inflatable silicone balloon or self filling osmotic tissue expanders before reconstructive surgery can overcome these disadvantages and certainly holds a promise for effective method for generation of soft tissue thereby achieving predictable augmentation of deficient alveolar ridges for the implant success. This article focuses and compares these distinct tissue expanders for their clinical efficacy of achieving excess tissue that predominantly seems to be prerequisite for ridge augmentation which can be reasonably followed by successful placement of endosseous fixtures.
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Affiliation(s)
- Prasad Vijayrao Dhadse
- Department of Periodontics, Sharad Pawar Dental College (DMIMSU), Sawangi (M), Wardha, Maharashtra, India
| | | | - Manohar Laxmanrao Bhongade
- Department of Periodontics, Sharad Pawar Dental College (DMIMSU), Sawangi (M), Wardha, Maharashtra, India
| | - Sunil Dattuji Pendor
- Department of Periodontics, Sharad Pawar Dental College (DMIMSU), Sawangi (M), Wardha, Maharashtra, India
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Second generation self-inflating tissue expanders: a two-year experience. PLASTIC SURGERY INTERNATIONAL 2014; 2014:457205. [PMID: 24587902 PMCID: PMC3920852 DOI: 10.1155/2014/457205] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 12/07/2013] [Accepted: 12/10/2013] [Indexed: 11/18/2022]
Abstract
Background. Tissue expansion is a well-established surgical technique that produces an additional amount of normal skin to cover a defect. This technique is appealing because the skin quality and color are from the patient's own. The widely used injectable expanders are of great reliability but carry the disadvantage of being painful during injection and most of the time require multiple clinic visits. So the idea of self-inflation became attractive and hydrogel expanders were developed and became widely known for being painless during clinic visit and decrease number of visits. The first generation expanders were modified by adding an enclosing plastic shell to decrease the unopposed expansion that occurred in the first generation expanders, which lead to pressure necrosis of the skin flaps. This made it an attractive option for tissue expansion in children and some adult patients. Patients, Materials, and Methods. Charts of 17 patients were retrospectively reviewed, all of them had second generation self-inflating expanders implanted over a 2-year period for one of two purposes, the treatment of giant nevi or burn scars. Results. Fifteen patients were females and 2 were males. The indication was large burn scar in 14 cases (14/17), in which 47/55 expanders were implanted, and giant nevus in 3/17 cases in which 8/55 expanders were implanted. Extrusion of the expander occurred in 8/55 expanders (14.5%), which occurred in 6/14 patients. The highest percentage of extrusion occurred in the neck in which two out of three expanders extruded; otherwise this complication does not seem to be related to the indication, gender, nor age of the patients. It seems to be that it is technical in nature. The patients did not have to get any injections to fill the tissue expanders, which made the expansion process less painful and more convenient. Conclusion. This seems to be currently the largest published review in which second generation expanders were used. Those expanders seem to offer a desirable advantage of being painless for children, also they do not require repeated visits to the surgeon's clinic, which is of great value for patients living in the periphery.
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Park SH, Choi SK, Jang JH, Kim JW, Kim JY, Kim MR, Kim SJ. Self-inflating oral tissue expander for ridge augmentation in the severely atrophic mandible. J Korean Assoc Oral Maxillofac Surg 2013; 39:31-4. [PMID: 24471015 PMCID: PMC3858160 DOI: 10.5125/jkaoms.2013.39.1.31] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 05/18/2012] [Indexed: 11/28/2022] Open
Abstract
In dentistry, tissue expanders have been used to obtain sufficient soft tissue for alveolar bone augmentation in the severely atrophic ridge. Herein, we review two cases of soft tissue augmentation using a self-inflating tissue expander in patients in the Department of Oral and Maxillofacial Surgery at Ewha Womans University Mokdong Hospital for bone graft and implant operations. The results of each patient were presented using pre-operative and post-operative radiographs and clinical exams. The results of our study indicate successful bone graft and implant surgery using a self-inflating tissue expander.
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Affiliation(s)
- Sung-Ho Park
- Department of Oral and Maxillofacial Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Sung-Keun Choi
- Department of Oral and Maxillofacial Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Jin-Hyun Jang
- Department of Oral and Maxillofacial Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Jin-Woo Kim
- Department of Oral and Maxillofacial Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Ji-Youn Kim
- Department of Oral and Maxillofacial Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Myung-Rae Kim
- Department of Oral and Maxillofacial Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Sun-Jong Kim
- Department of Oral and Maxillofacial Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
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25
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Dong CL, Li SY, Wang Y, Dong Y, Tang JZ, Chen JC, Chen GQ. The cytocompatability of polyhydroxyalkanoates coated with a fusion protein of PHA repressor protein (PhaR) and Lys-Gln-Ala-Gly-Asp-Val (KQAGDV) polypeptide. Biomaterials 2012; 33:2593-9. [DOI: 10.1016/j.biomaterials.2011.12.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 12/09/2011] [Indexed: 12/20/2022]
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Wollina U, Bayyoud Y. Reconstruction of a large scalp defect by the sequential use of dermal substitute, self-filling osmotic tissue expander and rotational flap. J Cutan Aesthet Surg 2011; 3:106-10. [PMID: 21031071 PMCID: PMC2956951 DOI: 10.4103/0974-2077.69023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Large scalp defects pose a challenge for the surgeon. Here, we present a 31-year-old male patient with a soft tissue defect on the temple with exposed bone. To allow reconstruction, we placed a self-filling osmotic expander in the subgaleal pocket for 12 weeks. The final volume of the tissue expander was 300 mL. In the last step, a rotational flap was created after removal of the tissue expander from its pocket. Thereby, a tension-free suturing was possible. The post-surgical healing was uncomplicated. Osmotic tissue expanders are a valuable tool for the closure of large tissue defects without the necessity of repeated filling procedures.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Section of Neurosurgery, Reconstructive and Hand Surgery, Hospital Dresden-Friedrichstadt, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
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Swan MC, Bucknall DG, Goodacre TEE, Czernuszka JT. Synthesis and properties of a novel anisotropic self-inflating hydrogel tissue expander. Acta Biomater 2011; 7:1126-32. [PMID: 20971218 DOI: 10.1016/j.actbio.2010.10.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Revised: 10/11/2010] [Accepted: 10/19/2010] [Indexed: 11/19/2022]
Abstract
The advent of self-inflating hydrogel tissue expanders heralded a significant advance in the reconstructive techniques available for the surgical restoration of a wide variety of soft tissue defects. However, their use in specific applications such as cleft palate surgery is limited on account of their isotropic expansion. An anisotropic self-inflating hydrogel tissue expander has been developed which markedly increases the potential indications for which this restorative tool may be employed. These include complex pediatric soft tissue reconstructions of the palate, nose, ear and digits. Anisotropic expansion in a hydrogel polymer network composed of methyl methacrylate and vinylpyrrolidone has been achieved by annealing the xerogel under a compressive load for a specified time period. By controlling the anisotropic processing conditions and composition we have been able to accurately tailor the ultimate expansion ratio up to 1500%. The expansion rate of the xerogel has also been significantly reduced by encapsulating the polymer within a semi-permeable silicone membrane. The structure and properties of the novel anisotropic hydrogel were characterized by attenuated total reflectance infrared spectroscopy, differential scanning calorimetry, thermogravimetric analysis and small-angle neutron scattering.
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Affiliation(s)
- M C Swan
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK.
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28
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Kaner D, Friedmann A. Soft tissue expansion with self-filling osmotic tissue expanders before vertical ridge augmentation: a proof of principle study. J Clin Periodontol 2010; 38:95-101. [DOI: 10.1111/j.1600-051x.2010.01630.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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29
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Xu M, Qiu J, Lin Y, Shi X, Chen H, Xiao T. Surface biocompatible modification of polypropylene by entrapment of polypropylene-block-poly(vinylpyrrolidone). Colloids Surf B Biointerfaces 2010; 80:200-5. [DOI: 10.1016/j.colsurfb.2010.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 06/02/2010] [Accepted: 06/06/2010] [Indexed: 11/17/2022]
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Uijlenbroek HJJ, Liu Y, He JF, Visscher C, van Waas MAJ, Wismeyer D. Expanding soft tissue with Osmed tissue expanders in the goat maxilla. Clin Oral Implants Res 2010; 22:121-8. [PMID: 20678133 DOI: 10.1111/j.1600-0501.2010.01972.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES soft tissue limitations are encountered in implant dentistry, due to the loss of alveolar bone. The aim of this study is to compare the outcome of soft tissue preparation using Osmed self-inflating soft tissue expanders with different in situ times in two implantation techniques. MATERIAL AND METHODS Osmed self-inflating soft tissue expanders were implanted in goats using a tunnel approach and a flap approach. The animals were sacrificed after 1h (controls) and 40 days (treated). A tattoo technique for stereographic measurements was used to look for soft tissue surface gain. Histological and histomorphometric analyses were performed to quantify and compare the changes in soft tissue volume and bone volume after 1h and 40 days of implantation. RESULTS after 40 days, the expansion was visible and none of the goats had shown any inflammation. The space between the soft tissue and the bone was filled by the completely expanded expander and surrounding connective tissue. Between the test groups and the control groups, there was no histological difference in the structure of the soft tissue. CONCLUSIONS all the tissue expanders expanded to their maximum size (2.8 times) and were a reliable product for creating a space between soft tissue and bone. The overlying soft tissue remained in excellent shape. There was no difference in the soft tissue volume and the bone volume between the tunnel and the flap approach after 40 days.
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Affiliation(s)
- Henri J J Uijlenbroek
- Department of Oral Function and Restorative Dentistry, Section of Oral Implantology and Prosthodontic Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), VU University Amsterdam.
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von See C, Rücker M, Bormann KH, Gellrich NC. Using a novel self-inflating hydrogel expander for intraoral gingival tissue expansion prior to bone augmentation. Br J Oral Maxillofac Surg 2010; 48:e5-6. [DOI: 10.1016/j.bjoms.2009.10.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2009] [Accepted: 10/29/2009] [Indexed: 11/26/2022]
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von See C, Gellrich NC, Jachmann U, Laschke MW, Bormann KH, Rücker M. Bone augmentation after soft-tissue expansion using hydrogel expanders: effects on microcirculation and osseointegration. Clin Oral Implants Res 2010; 21:842-7. [PMID: 20345382 DOI: 10.1111/j.1600-0501.2009.01847.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The success of bone augmentation, for example of the alveolar ridge, might be endangered by dehiscence of the soft tissue that covers the augmented bone. Soft-tissue coverage can be achieved without tension through pre-augmentation tissue expansion with hydrogel expanders. We used a periosteal chamber to study the influence of tissue expansion on microcirculation and osseointegration in an in vivo animal model. MATERIAL AND METHODS Sixteen isogeneic Lewis rats were randomised into two groups. Additional eight animals served as donors of isogeneic bone grafts (Group 3, n=8). The bone grafts were harvested and implanted into Group 1 animals (n=8) (without tissue expansion) and Group 2 animals (after tissue expansion). In Group 2 (n=8), hydrogel expanders were inserted subperiosteally at the site to be augmented for 21 days. We used intravital microscopy to monitor microcirculation in vivo for 19 days after implantation. Specimens from both groups were evaluated histologically. RESULTS During the entire study period, functional microvessel density in the region above the augmentation material was significantly higher after previous tissue expansion (P>0.05). Both groups showed physiological microcirculation around the augmentation material. Histology revealed bone osseointegration of the bone graft in the group with tissue expansion and the presence of connective and granulation tissue in the group without tissue expansion. CONCLUSIONS Pre-augmentation soft-tissue expansion with hydrogel expanders leads to higher functional microvessel density in the tissue above the augmentation material and thus, to more rapid osseointegration. The use of hydrogel expanders appears to increase the probability of success, especially of pre-implant bone augmentation.
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Affiliation(s)
- Constantin von See
- Department of Oral and Maxillofacial Surgery, Centre for Dentistry, Oral and Orthodontic Surgery, Hannover Medical School, Hannover, Germany.
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Osseous alterations at the interface of hydrogel expanders and underlying bone. J Craniomaxillofac Surg 2009; 37:258-62. [DOI: 10.1016/j.jcms.2009.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 01/21/2009] [Accepted: 01/22/2009] [Indexed: 11/21/2022] Open
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The expression of cross-linked elastin by rabbit blood vessel smooth muscle cells cultured in polyhydroxyalkanoate scaffolds. Biomaterials 2008; 29:4187-94. [DOI: 10.1016/j.biomaterials.2008.07.022] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Accepted: 07/15/2008] [Indexed: 11/23/2022]
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Obdeijn MC, Nicolai JPA, Werker PMN. The osmotic tissue expander: a three-year clinical experience. J Plast Reconstr Aesthet Surg 2008; 62:1219-22. [PMID: 18755643 DOI: 10.1016/j.bjps.2007.12.088] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Accepted: 12/21/2007] [Indexed: 11/19/2022]
Abstract
Closure of defects after trauma or excision of neoplasms is a basic skill in plastic surgery. Local, regional and distant flaps lead to additional scars. Skin recruitment by serial excision or skin expansion is a less damaging option for defects that must be closed. Advantages of tissue expansion include good colour and texture match. Disadvantages are the need for a second operation, use of an implant with the attendant risk of infection, time needed for inflation of the device, repeat visits to the clinic, and punctures to inflate the expander. To overcome the last disadvantage, an osmotic expander was developed in Germany in 1999 by OSMED GmbH (Ilmenau).
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Affiliation(s)
- Miryam C Obdeijn
- University Medical Center Groningen, University of Groningen, Department of Plastic Surgery, Groningen, The Netherlands.
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Lee JH, Bucknall DG. Swelling behavior and network structure of hydrogels synthesized using controlled UV-initiated free radical polymerization. ACTA ACUST UNITED AC 2008. [DOI: 10.1002/polb.21481] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Anwander T, Schneider M, Gloger W, Reich RH, Appel T, Martini M, Wenghoefer M, Merkx M, Bergé S. Investigation of the Expansion Properties of Osmotic Expanders with and without Silicone Shell in Animals. Plast Reconstr Surg 2007; 120:590-595. [PMID: 17700108 DOI: 10.1097/01.prs.0000270297.58498.18] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Particularly in clinical studies, it has been found that rapid swelling of tissue expanders leads to high-pressure peaks that can cause hypoxia in the tissue and thus also skin damage. For this reason, the present study in animals investigated whether an osmotic expander with silicone shell is capable of expanding in tissue and bringing about useful tissue expansion without complications. It was also examined whether and what quantitative and qualitative differences there are between conventional osmotic expanders and the new expanders with silicone shell. METHODS The expansion of osmotic expanders with silicone shell was compared with that of osmotic expanders without silicone shell in four mini pigs. The expander type used was an M1 rectangle with an initial volume of 6 ml. Five expanders were implanted in each pig, meaning that 20 expanders were measured. The volume of the expanders was measured directly after explantation. Indirect volume determination was performed by producing plaster casts for subsequent laser optical measurement. RESULTS Comparison of the two curve profiles showed a much flatter profile for the expanders with silicone shell. The absolute values for the volumes of the expanders with silicone shell were likewise substantially lower. CONCLUSIONS Controlled skin expansion is a technique of providing localized donor tissue for reconstructive surgery. The new expanders could be in a position to lower the rate of complications in tissue expansion.
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Affiliation(s)
- Thomas Anwander
- Bonn, Düsseldorf, and Munich, Germany; and Nijmegen, The Netherlands From the Departments of Oral and Maxillofacial Surgery of Friedrich Wilhelm University, University of Düsseldorf, and Radboud University Nijmegen, Medical Center, and the University of Munich
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Mischkowski RA, Kübler AC. Correction of congenital nasal hypoplasia associated with Kallmann syndrome using self-inflating injectable tissue expander pellets. Plast Reconstr Surg 2006; 118:1447-1452. [PMID: 17051117 DOI: 10.1097/01.prs.0000239601.13560.88] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Robert A Mischkowski
- Cologne, Germany. From the Department of Craniomaxillofacial and Plastic Surgery, University of Cologne
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Mazzoli RA, Raymond WR, Ainbinder DJ, Hansen EA. Use of self-expanding, hydrophilic osmotic expanders (hydrogel) in the reconstruction of congenital clinical anophthalmos. Curr Opin Ophthalmol 2004; 15:426-31. [PMID: 15625905 DOI: 10.1097/01.icu.0000138618.61059.4c] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Rehabilitation of the congenitally anophthalmic orbit is frustrating to both the parents and physician. Traditional methods involve using progressively enlarging static acrylic conformers to expand the conjunctival socket, followed by placement of conventional static spherical orbital implants, dermis-fat grafts, or inflatable balloon expanders for orbital enlargement. Limitations of these methods typically result in less-than-optimal cosmetic outcomes, with retardation of bony orbital and overlying soft tissue growth adversely affecting midfacial growth and symmetry. Recent advances in tissue expansion technology may offer additional, novel alternatives to conventional therapies. RECENT FINDINGS Hydrogel tissue expanders were recently adapted for use in congenital anophthalmia. The expanders are placed in their dry, contracted states, and expand gradually to their full size via osmosis of surrounding tissue fluid, with up to a 10-fold increase in volume. Offering the benefit of predictable and controllable self-expansion, hydrogel expanders may offer yet another alternative or adjunctive therapy to the early rehabilitation of the contracted socket. Separate appliances are used for conjunctival and orbital reconstruction. Initial results appear promising. Tempering the enthusiasm for their use, however-particularly in terms of implanted orbital expanders-is the recent spate of long-term complications reported from previous uses of hydrogels as scleral buckling material. SUMMARY Self-expanding hydrogel tissue expanders appear to offer an intriguing reconstructive alternative to the frustrating condition of congenital anophthalmia. Long-term safety of the material as an orbital implant has not yet been demonstrated, but early results are promising.
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Affiliation(s)
- Robert A Mazzoli
- Department of Ophthalmology, Madigan Army Medical Center, Tacoma, WA 98431, USA.
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Hydrogels based on PAAm network with PNIPAAm included: hydrophilic–hydrophobic transition measured by the partition of Orange II and Methylene Blue in water. POLYMER 2003. [DOI: 10.1016/s0032-3861(03)00370-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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