Proteoglycan synthesis in porcine nasal cartilage grafts following Nd:YAG (lambda = 1.32 microns) laser-mediated reshaping

Bipolar Radiofrequency Plasma-Mediated Ablation of Porcine Nasal Septal Cartilage: A Pilot Investigation

Background

The objectives of this pilot study were to (1) determine whether bipolar radiofrequency plasma-mediated ablation (PMA) can efficiently remove nasal septal cartilage and (2) calculate the ablation rate as a function of device power, probe force, and translation velocity using ex vivo porcine tissue.

Methods

Specimens were secured to a linear translation stage and were subjected to varying translation velocities (4, 7, and 12 cm/s), probe forces (140, 200, and 225 g), and bipolar radiofrequency generator (Coblator ENTec power settings, 38–58, 77–115, and 129–193 Watts root mean squared. Specimen mass loss and depth of ablation were measured using an analytic balance and dissection microscope, respectively.

Results

Visual and microscopic inspection revealed little char. Mass loss increased with decreasing translation velocity and increasing generator setting. Increasing probe force also influenced mass loss and increased crater depth. Depth of ablation did not correlate with translation velocity or generator setting.

Conclusion

PMA effectively ablates nasal septal cartilage and may be able to reduce or contour cartilaginous deformities and framework structures in the head and neck.

Laser surface modification of decellularized extracellular cartilage matrix for cartilage tissue engineering

The implantation of autologous cartilage as the gold standard operative procedure for the reconstruction of cartilage defects in the head and neck region unfortunately implicates a variety of negative effects at the donor site. Tissue-engineered cartilage appears to be a promising alternative. However, due to the complex requirements, the optimal material is yet to be determined. As demonstrated previously, decellularized porcine cartilage (DECM) might be a good option to engineer vital cartilage. As the dense structure of DECM limits cellular infiltration, we investigated surface modifications of the scaffolds by carbon dioxide (CO₂) and Er:YAG laser application to facilitate the migration of chondrocytes inside the scaffold. After laser treatment, the scaffolds were seeded with human nasal septal chondrocytes and analyzed with respect to cell migration and formation of new extracellular matrix proteins. Histology, immunohistochemistry, SEM, and TEM examination revealed an increase of the scaffolds' surface area with proliferation of cell numbers on the scaffolds for both laser types. The lack of cytotoxic effects was demonstrated by standard cytotoxicity testing. However, a thermal denaturation area seemed to hinder the migration of the chondrocytes inside the scaffolds, even more so after CO₂ laser treatment. Therefore, the Er:YAG laser seemed to be better suitable. Further modifications of the laser adjustments or the use of alternative laser systems might be advantageous for surface enlargement and to facilitate migration of chondrocytes into the scaffold in one step.

Laser-induced micropore formation and modification of cartilage structure in osteoarthritis healing

Pores are vital for functioning of avascular tissues. Laser-induced pores play an important role in the process of cartilage regeneration. The aim of any treatment for osteoarthritis is to repair hyaline-type cartilage. The aims of this study are to answer two questions: (1) How do laser-assisted pores affect the cartilaginous cells to synthesize hyaline cartilage (HC)? and (2) How can the size distribution of pores arising in the course of laser radiation be controlled? We have shown that in cartilage, the pores arise predominately near chondrocytes, which promote nutrition of cells and signal molecular transfer that activates regeneration of cartilage. In vivo laser treatment of damaged cartilage of miniature pig joints provides cellular transformation and formation of HC. We propose a simple model of pore formation in biopolymers that paves the way for going beyond the trial-and-error approach when choosing an optimal laser treatment regime. Our findings support the approach toward laser healing of osteoarthritis.

Thermoforming of tracheal cartilage: viability, shape change, and mechanical behavior

BACKGROUND AND OBJECTIVES

Trauma, emergent tracheostomy, and prolonged intubation are common causes of severe deformation and narrowing of the trachea. Laser technology may be used to reshape tracheal cartilage using minimally invasive methods. The objectives of this study were to determine: (1) the dependence of tracheal cartilage shape change on temperature and laser dosimetry using heated saline bath immersion and laser irradiation, respectively, (2) the effect of temperature on the mechanical behavior of cartilage, and (3) tissue viability as a function of laser dosimetry.

MATERIALS AND METHODS

Ex vivo rabbit trachea cartilage specimens were bent and secured around a cylinder (6 mm), and then immersed in a saline bath (45 and 72 degrees C) for 5-100 seconds. In separate experiments, tracheal specimens were irradiated with a diode laser (lambda = 1.45 microm, 220-400 J/cm(2)). Mechanical analysis was then used to determine the elastic modulus in tension after irradiation. Fluorescent viability assays combined with laser scanning confocal microscopy (LSCM) were employed to image and identify thermal injury regions.

RESULTS

Shape change transition zones, between 62 and 66 degrees C in the saline heating bath and above power densities of 350 J/cm(2) (peak temperatures 65+/-10 degrees C) for laser irradiation were identified. Above these zones, the elastic moduli were higher (8.2+/-4 MPa) than at lower temperatures (4.5+/-3 MPa). LSCM identified significant loss of viable chondrocytes within the laser-irradiation zones.

CONCLUSION

Our results indicate a change in mechanical properties occurs with laser irradiation and further demonstrates that significant thermal damage is concurrent with clinically relevant shape change in the elastic cartilage tissues of the rabbit trachea using the present laser and dosimetry parameters.

Minimizing superficial thermal injury using bilateral cryogen spray cooling during laser reshaping of composite cartilage grafts

Composite cartilage grafts were excised from New Zealand rabbit ears. Flat composite grafts (of cartilage and overlying skin graft on both surfaces) were obtained from each ear and cut into a rectangle measuring 50 mm by 25 mm (x by y) with an average thickness of approximately 1.3 mm (z), skin included. Specimens were manually deformed with a jig and maintained in this new position during laser illumination. The composite cartilage grafts were illuminated on the concave surface with an Nd:YAG laser (1,064 nm, 3 mm spot) at 10 W, 20 W, 30 W, 40 W, 50 W. Cryogen spray cooling (CSC) was applied to both exterior (convex) and interior (concave) surfaces of the tissue to reduce thermal injury to the grafts. CSC was delivered: (1) in controlled applications (cryogen released when surface reached 40 degrees C, and (2) receiving only laser at above wattage, no CSC [representing the control group]. The specimens were maintained in a deformation for 15 minutes after illumination and serially examined for 14 days. The control group with no CSC caused injury to all specimens, ranging from minor to full thickness epidermal thermal injury. Although most levels of laser and CSC yielded a high degree of reshaping over an acute time period, after 14 days specimens exposed to 30 W, 40 W, 50 W retained shape better than those treated at 10 W and 20 W. The specimens exposed to 50 W with controlled CSC retained its new shape to the highest degree over all others, and thermal injury was minimal. In conclusion, combinations of laser and CSC parameters were effective and practical for the reshaping of composite cartilage grafts.

Shape retention in porcine and rabbit nasal septal cartilage using saline bath immersion and Nd:YAG laser irradiation

BACKGROUND AND OBJECTIVES

The process of altering the shape of cartilage using heat has been referred to as thermoforming, and presents certain clinical benefits in reconstructive surgical procedures within the head and neck. Thermoforming allows cartilage in the upper airway and face to be reshaped without the use of classic surgical maneuvers such as carving, morselizing, or suturing. The goal of this study was to determine the dependence of cartilage shape change on both temperature and laser dosimetry using two thermoforming methods: saline bath immersion and laser irradiation.

STUDY DESIGN/MATERIALS AND METHODS

Ex-vivo rabbit and porcine nasal septal cartilages were mechanically deformed and reshaped using the two thermoforming methods. With saline bath immersion using rabbit cartilage, each specimen was deformed by securing it to a small copper tube (outer diameter 8 mm) using dental bands. For porcine cartilage immersed in a saline bath, each sample was mechanically deformed between two pieces of wire mesh attached to a semicircular acrylic block. With both porcine and rabbit cartilage, the specimen and apparatus were then immersed in a hot saline bath for time intervals varying from 20 and 320 seconds and at constant temperatures between 62 and 74 degrees C. In laser reshaping, the cartilage specimens were mechanically deformed on a jig and consecutively irradiated with an Nd:YAG laser (lambda = 1.32 microm) in several spots for 6-16 seconds and irradiances of 10.2-40.7 W/cm2 per spot. After either saline bath heating or irradiation, cartilage specimens were immersed in room temperature saline for 15 minutes, then upon removal from the jig the length between the ends of each specimen was measured in order to calculate the resulting bend angle.

RESULTS

The transition zone for cartilage reshaping was defined as where a significant increase in bend angle was observed between consecutive times of immersion/irradiation at the same temperature/irradiance. For the saline bath experiments, the transition zone was observed between 59-68 degrees C and 62-68 degrees C for porcine and rabbit cartilage, respectively. Similar transition zones occurred with laser irradiation below irradiances of 20.4 W/cm2 for both porcine and rabbit cartilage. In addition, the dosimetry pairs in the transition zones produce peak temperatures below the thresholds determined from the saline bath immersion studies.

CONCLUSIONS

The critical transition temperature region was determined by the sharp increase in bend angle at consecutive times of immersion at the same temperature. This range was determined to be 59-68 degrees C and 62-68 degrees C for porcine and rabbit cartilage, respectively. Similar transition zones for dosimetry occurred below 20.4 W/cm2 during cartilage irradiation in both species.

Laser cartilage reshaping in an in vivo rabbit model using a 1.54 ?m Er:Glass laser

BACKGROUND AND OBJECTIVES

The potential applications for facial laser cartilage reshaping (LCR) have generated increasing clinical interest. This study aimed to evaluate in vivo LCR of the rabbit ear using a 1.54 micro m Er:Glass laser in combination with contact cooling.

STUDY DESIGN/MATERIALS AND METHODS

LCR was performed in vivo on 12 rabbit ears using a 1.54 micro m Er:Glass laser (Aramis, Quantel Medical, Clermont Ferrand, France) connected to a 4 mm chilled (+5 degrees C) handpiece placed in contact to the skin. Ear curvature was predetermined using a perforated cylindrical guide also used to standardize laser beam delivery. The treatment consisted of 15 spots (3 millisecond, 7 pulses, 12 J/cm(2), 2 Hz, 84/cm(2) cumulative fluence) applied on 10 contiguous parallel rows along the ear. After irradiation, the aluminum jig was replaced by a holder (10 mm diameter plastic tube) maintaining the curvature. This holder was secured with sutures and covered by an adhesive gauze bandage dressing to keep new form during 7 days. In order to assess thermal damage, biopsies were taken on irradiated areas and 1 week, 3 weeks and 6 weeks and studied using haematoxylin-erythrosin-safran (HES) and orcein staining and PCNA to detect cells in cycle.

RESULTS

Using the laser with the parameters given above, no immediate visible effects were observed on the skin (no swelling, no bleaching). There were also no late visible side effects like crusting, or blistering. The laser treatment produced changes in the shape of every ear after the dressing was removed. A slight tendency to recover its initial shape was observed for each ear. However, the curvature was stabilized after 10 days and the average shape retention was 64+/-4% at 6 weeks, with a curvature radius of 7.25+/-0.75 mm, instead of 5 mm initially. Histological examination of the laser irradiated side at 1 week showed an intact epidermis. A reduced inflammation process was seen in the dermis. A modification of half of the layer of cartilage was observed at the opposite side where the laser irradiation was applied and proliferative cells were detected inside. At 3 weeks, an important chondroblastic proliferation was observed around the area of contracted cartilage. At 6 weeks, significant thickening of the cartilage layer was observed (from 300 to 490 micro m) and new chondrocytes were clearly seen.

CONCLUSIONS

Rabbit ear cartilage can be reshaped with an Er:Glass laser. This technique could offer exciting possibilities that may help patients whose cartilage-lined joints have been affected by disease or trauma. This technique could be certainly utilized to correct alar cartilage deformities and septum deviation of cleft lips.

Measurement of the elastic modulus of rabbit nasal septal cartilage during Nd:YAG (lambda = 1.32 microm) laser irradiation

BACKGROUND AND OBJECTIVES

The objective of this study was to quantitatively measure changes in the elastic moduli of rabbit nasal septal cartilage during laser heating. While the efficacy of laser cartilage reshaping has been established for use in nasal surgery, few studies have investigated the temperature-dependent viscoelastic behavior of cartilage.

STUDY DESIGN/MATERIALS AND METHODS

Cyclic force versus displacement curves were generated during the Nd:YAG laser (lambda = 1.32 microm, 10 second exposure time, 21.22 W/cm2) irradiation of cartilage specimens secured in cantilevered geometry. Samples were irradiated three times with 30 second cooling intervals between each laser exposure. Measurements were recorded before, during, and after laser irradiation, and then following complete rehydration in normal saline (NS) for 1 hour at 25 degrees C. Elastic modulus was calculated assuming linear viscoelastic behavior.

RESULTS

The elastic modulus in native tissue decreased during and after successive laser exposures from about 6 to 3.5 MPa. After rehydration, the modulus returned to near-baseline value. Surface temperature reached a maximum of 65 degrees C.

CONCLUSIONS

The laser irradiation of cartilage using parameters similar to those used in reshaping does not produce significant irreversible changes in the mechanical properties of the tissue. Measurement of the elastic modulus is an effective means of characterizing alterations in cartilage mechanical behavior during and after laser heating.

Quantitative assessment of chondrocyte viability after laser mediated reshaping: a novel application of flow cytometry

BACKGROUND AND OBJECTIVES

Lasers can be used to reshape cartilage by accelerating mechanical stress relaxation. In this study, fluorescent differential cell viability staining and flow cytometry were used to determine chondrocyte viability following laser heating.

STUDY DESIGN/MATERIALS AND METHODS

Porcine septal cartilages were irradiated with an Nd:YAG laser (lambda = 1.32 microm, 25 W/cm(2)) while surface temperature, stress relaxation, and diffuse reflectance were recorded. Each slab received one, two, or three laser exposures (respective exposure times of 6.7, 7.2, 10 seconds). Irradiated samples were then divided into two groups analyzed immediately and at 5 days following laser exposure. Chondrocytes were isolated following serial enzymatic digestion, and stained using SYTO/DEAD Red (Molecular Probes, Eugene, OR). A flow cytometer was then used to detect differential cell fluorescence; size; granularity; and the number of live cells, dead cells, and post-irradiation debris in each treatment population.

RESULTS

Nearly 60% of chondrocytes from reshaped cartilage samples isolated shortly after one irradiation, were viable while non-irradiated controls were 100% viable. Specimens irradiated two or three times demonstrated increasing amounts of cellular debris along with a reduction in chondrocyte viability: 31 and 16% after two and three exposures, respectively. In those samples maintained in culture medium and assayed 5 days after irradiation, viability was reduced by 28-88%, with the least amount of deterioration in untreated and singly irradiated samples.

CONCLUSIONS

Functional fluorescent dyes combined with flow cytometric analysis successfully determines the effect of laser irradiation on the viability of reshaped cartilage.

Radiofrequency cartilage reshaping: efficacy, biophysical measurements, and tissue viability

OBJECTIVES

To assess the feasibility of reshaping cartilage using radiofrequency (RF) heating, and to examine the effects of this process on tissue biophysical properties (optical and thermal) and cellular viability.

METHODS

Mechanically deformed porcine septal cartilage was reshaped using 2 RF-generating devices. We performed dynamic measurements of tissue thermal and optical properties while heating cartilage with one of these devices. Cellular viability was assessed immediately and 7 days after treatment.

RESULTS

A characteristic change in the diffuse transmittance of light through the cartilage occurred during heating. Change in transmittance has been shown to accompany the onset of stress relaxation in cartilage. Peak radiometric surface temperature during heating was 88.6 degrees C. Specimens retained their user-specified curved shape for the observed period of 14 days. Chondrocyte viability in RF-heated tissue was 19% and 14% of that in untreated control specimens at days 0 and 7 after treatment, respectively.

CONCLUSIONS

Radiofrequency heating has been shown to effectively reshape cartilage while maintaining cellular viability, illustrating a novel application for a widely used technology.

Shape retention in porcine-septal cartilage following Nd:YAG (lambda = 1.32 microm) laser-mediated reshaping

BACKGROUND AND OBJECTIVE

Photothermal heating of mechanically deformed cartilage accelerates stress relaxation and results in sustained shape change. In this study, shape retention was measured in Nd:YAG laser reshaped porcine septal cartilage.

MATERIALS AND METHODS

Specimens were laser reshaped either 4 (Group I) or 28 hours (Group II) following extraction from the crania. Specimens were bent into approximately semicircular shapes and irradiated half way between the endpoints of the semicircle. Resultant bend angle was calculated based on linear measurements. Shape retention was calculated by comparing resultant curvature with pre-irradiation measurements.

RESULTS

Mechanical deformation alone resulted in initial bend angles varying from 188 degrees to 229 degrees. Resultant bend angles varied from 84 degrees to 194 degrees corresponding to shape retention varying from 58 to 75%. Non-irradiated cartilage retained less than 46% of the original bend. Shape retention was greater in Group II, compared to Group I. In Group I, no cephalocranial difference in shape retention was observed, though in Group II greater shape retention was observed in rostral specimens.

CONCLUSION

While laser heating does significantly reshape cartilage, clinical use of this technology will require "overbending" of the cartilage graft to compensate for this memory effect. The degree of overbending is likely to vary with cartilage type and location.

Laser-mediated cartilage reshaping with feedback-controlled cryogen spray cooling: biophysical properties and viability

BACKGROUND AND OBJECTIVE

Recent studies have indicated that chondrocyte viability decreases with prolonged or repeated laser irradiation. To optimize laser-mediated cartilage reshaping, the heating process must be finely controlled. In this study, we use high-power Nd:YAG laser irradiation (lambda = 1.32 microm) combined with cryogen spray cooling (CSC) in an attempt to reshape porcine septal cartilage while enhancing chondrocyte viability.

STUDY DESIGN/MATERIALS AND METHODS

Chondrocyte viability was determined after high-power (50 W/cm2) Nd:YAG-mediated cartilage reshaping with and without cryogen spray cooling (CSC) and correlated with dynamic measurements of tissue optical and thermal properties.

RESULTS

After 1.5 to 2.0 seconds of laser exposure, characteristic changes in diffuse reflectance (indicating the onset of accelerated stress relaxation) was observed in both laser only and laser with CSC specimens. After 2 seconds of laser exposure, specimens in both groups retained the curved shape for up to 14 days. After one laser exposure, chondrocyte viability was 94.35 +/- 6.1% with CSC and 68.77 +/- 20.1% (P < 0.05) without CSC. After two laser exposures, a similar trend was observed with CSC (70.18 +/- 16.44%) opposed to without CSC (28 +/- 45%; P < 0.05).

CONCLUSION

CSC during high-power laser irradiation allows rapid heating while minimizing extreme front surface temperature elevations and axial thermal gradients. Laser irradiation with CSC can be used to effectively reshape cartilage tissue with the additional advantage of increasing chondrocyte viability.

The porcine and lagomorph septal cartilages: models for tissue engineering and morphologic cartilage research

Interest in reconstruction and modification of the facial cartilaginous frameworks using advanced technology and instrumentation is growing rapidly. Despite this maturing interest, no animal model has been established to provide morphologic cartilage tissue with similar characteristics to human septum in suitable quantities. The objective of this study was to characterize porcine and lagomorph (rabbit) nasal septal cartilage tissue. Both models share great similarity with their human counterpart and provide a low-cost, high-volume, and easily obtained source of bulk cartilage tissue. We present a technique for harvesting intact septal cartilages from these species, and characterize select cellular, metabolic, and physical properties using pulse-chase radiolabeling, flow cytometry, and mechanical analysis. Our selective evaluation of key tissue properties establishes these species as appropriate animal models for nasal septal cartilaginous surgery.