Improving tissue expansion protocols through computational modeling.
Improving tissue expansion protocols through computational modeling.
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DOI：
10.1016/j.jmbbm.2018.03.034
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发表时间：
2018-06
影响因子：
3.9
通讯作者：
Tepole AB
中科院分区：
文献类型：
--
作者：
Lee T;Vaca EE;Ledwon JK;Bae H;Topczewska JM;Turin SY;Kuhl E;Gosain AK;Tepole AB
组织扩张是用于在体内生长皮肤以矫正大缺损的重建手术中的常用技术。尽管它很受欢迎，但缺乏对拉伸如何导致新皮肤生长的定量了解。这导致了几种任意的扩张方案，这些方案依赖于外科医生的个人培训和经验，而不是准确的预测模型。例如，选择缓慢或快速扩张，或小或大的通货膨胀量仍然存在争议。在此，我们通过系统地改变猪模型中的充盈体积和方案持续时间来探索四种组织扩张方案。定量分析结合三维摄影，等几何运动学，有限增长理论。引人注目的是，所有四种方案都产生类似的峰值拉伸，但不同的生长模式：每次充气30 ml的较小填充体积对于短方案和长方案都没有导致显著的扩张剂诱导的生长;每次充气60 ml的较大填充体积触发皮肤适应，在较大拉伸区域中具有较大的扩张器诱导的生长，并且与10天扩增方案相比，14天扩增剂诱导的生长更多。我们的研究结果表明，膨胀剂诱导的增长并不是由局部拉伸单独触发的。虽然拉伸显然是增长的驱动力，但给定点的局部拉伸不足以预测该位置处的膨胀剂诱导的增长。从临床的角度来看，我们的研究表明，需要更长的扩张方案，以确保足够的增长相当大的皮肤补丁。
Tissue expansion is a common technique in reconstructive surgery used to grow skin in vivo for correction of large defects. Despite its popularity, there is a lack of quantitative understanding of how stretch leads to growth of new skin. This has resulted in several arbitrary expansion protocols that rely on the surgeon’s personal training and experience rather than on accurate predictive models. For example, choosing between slow or rapid expansion, or small or large inflation volumes remains controversial. Here we explore four tissue expansion protocols by systematically varying the inflation volume and the protocol duration in a porcine model. The quantitative analysis combines three-dimensional photography, isogeometric kinematics, and finite growth theory. Strikingly, all four protocols generate similar peak stretches, but different growth patterns: Smaller filling volumes of 30 ml per inflation did not result in notable expander-induced growth neither for the short nor for the long protocol; larger filling volumes of 60 ml per inflation trigger skin adaptation, with larger expander-induced growth in regions of larger stretch, and more expander-induced growth for the 14-day compared to the 10-day expansion protocol. Our results suggest that expander-induced growth is not triggered by the local stretch alone. While stretch is clearly a driver for growth, the local stretch at a given point is not enough to predict the expander-induced growth at that location. From a clinical perspective, our study suggests that longer expansion protocols are needed to ensure sufficient growth of sizable skin patches.
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影响因子：
3.6
作者：
AUSTAD, ED;PASYK, KA;CHERRY, GW
通讯作者：
CHERRY, GW
影响因子：
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Khalatbari, Behzad;Bakhshaeekia, Alireza
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3.5
作者：
Rezakhaniha, R.;Agianniotis, A.;Stergiopulos, N.
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作者：
Rausch MK;Kuhl E
通讯作者：
Kuhl E
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作者：
RADOVAN, C
通讯作者：
RADOVAN, C