Cellular and Molecular Responses to Mechanical Expansion of Tissue

Abstract

The increased use of tissue expander in the past decades and its potential market values in near future give enough reasons to sum up the consequences of tissue expansion. Furthermore, the patients have the right to know underlying mechanisms of adaptation of inserted biomimetic, its bioinspired materials and probable complications. The mechanical strains during tissue expansion are related to several biological phenomena. Tissue remodeling during the expansion is highly regulated and depends on the signal transduction. Any alteration may lead to tumor formation, necrosis and/or apoptosis. In this review, stretch induced cell proliferation, apoptosis, the roles of growth factors, stretch induced ion channels, and roles of second messengers are organized. It is expected that readers from any background can understand and make a decision about tissue expansion.

Macrophages are necessary for skin regeneration during tissue expansion

“…It has been six decades since the tissue expansion technique was first described [1]. However, the precise mechanism of how the skin regenerates during the expansion remains ill-defined and the application of this technique is still limited for a few of donor sites such as neck and face [15]. Therefore, a better understanding of the cellular and molecular mechanism underlying the structural remodeling of the expanded skin may help therapeutic modulation to enhance skin regeneration.…”

Pemphigus vulgaris possibly associated with application of a tissue expander in a patient with Crohn’s disease and primary sclerosing cholangitis

“…In its typical form, the method consists of the surgical insertion of a biomimetic inflatable balloon beneath the skin that exerts progressively increased stretch, achieved by the periodic injection of saline solution into it. Infections and tumor or scar formation are the most significant side effects of the method (21,22). Prolonged skin stretching by expander gives rise to multiple and complex morphological and functional changes at the molecular and cellular level and leads to the production and release of growth factors such as epidermal growth factor (EGF), transforming growth factor β (TGF-β), fibroblast growth factor (FGF), vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), connective tissue growth factor (CTGF), and interleukins (IL), which play a pivotal role in the regulation of stress-induced cell growth.…”

“…Prolonged skin stretching by expander gives rise to multiple and complex morphological and functional changes at the molecular and cellular level and leads to the production and release of growth factors such as epidermal growth factor (EGF), transforming growth factor β (TGF-β), fibroblast growth factor (FGF), vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), connective tissue growth factor (CTGF), and interleukins (IL), which play a pivotal role in the regulation of stress-induced cell growth. Moreover, mechanical stretching of the skin is capable of activating various signaling pathways that can promote cell proliferation or induce apoptosis (22,23).…”

The Use of Self-Inflating Hygroscopic Tissue Expanders to Facilitate Osteosarcoma Removal in a Massasauga Rattlesnake (Sistrurus catenatus)

“…Reportedly, proliferation occurs through both cellular and molecular mechanisms resulting in increased skin surface area over time. Compared to skin stretching, the benefits of tissue expansion include the production of new skin, better tissue compliance, and improved blood flow via angiogenesis [21].…”