Complications of tissue expansion in the head and neck

Azzi, Jayson Lee; Thabet, Chloé; Azzi, Alain J.; Gilardino, Mirko S.

doi:10.1002/hed.26017

Cited by 19 publications

(18 citation statements)

References 67 publications

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“…Importantly, the biomechanical properties of stretched skin remain unchanged 26 and, as we previously reported, the initial increase in epidermal thickness normalizes over time 27 . Although TE is broadly used in clinical settings 28 – 30 , complications are still very common 31 – 33 and molecular mechanisms involved in mechanically-induced skin growth are not well understood. Subsequently, this medical procedure does not include any approved skin pretreatment and the procedural technique is highly dependent on the experience and subjective assessment of the surgeon.…”

Section: Introductionmentioning

confidence: 99%

Transcriptomic analysis reveals dynamic molecular changes in skin induced by mechanical forces secondary to tissue expansion

Ledwon

Kelsey

Vaca

et al. 2020

Sci Rep

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Tissue expansion procedures (TE) utilize mechanical forces to induce skin growth and regeneration. While the impact of quick mechanical stimulation on molecular changes in cells has been studied extensively, there is a clear gap in knowledge about sequential biological processes activated during long-term stimulation of skin in vivo. Here, we present the first genome-wide study of transcriptional changes in skin during TE, starting from 1 h to 7 days of expansion. Our results indicate that mechanical forces from a tissue expander induce broad molecular changes in gene expression, and that these changes are time-dependent. We revealed hierarchical changes in skin cell biology, including activation of an immune response, a switch in cell metabolism and processes related to muscle contraction and cytoskeleton organization. In addition to known mechanoresponsive genes (TNC, MMPs), we have identified novel candidate genes (SFRP2, SPP1, CCR1, C2, MSR1, C4A, PLA2G2F, HBB), which might play crucial roles in stretched-induced skin growth. Understanding which biological processes are affected by mechanical forces in TE is important for the development of skin treatments to maximize the efficacy and minimize the risk of complications during expansion procedures.

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Section: Introductionmentioning

confidence: 99%

Transcriptomic analysis reveals dynamic molecular changes in skin induced by mechanical forces secondary to tissue expansion

Ledwon

Kelsey

Vaca

et al. 2020

Sci Rep

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“…However, the selection of the anatomical donor sites for skin expansion can vary considerably depending on different preoperative diagnoses and various operative procedures ( Huang et al, 2011 ; Azzi et al, 2020 ). Because of the distinct transcriptional programming varied by the anatomical sites ( Cheng et al, 2018 ), it is relatively challenging to exploit a common strategy to enhance the regenerative competency for long-term expansion therapy.…”

Section: Discussionmentioning

confidence: 99%

Single-Cell Transcriptomics Uncover Key Regulators of Skin Regeneration in Human Long-Term Mechanical Stretch-Mediated Expansion Therapy

Sun

et al. 2022

Front. Cell Dev. Biol.

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Tissue expansion is a commonly performed therapy to grow extra skin invivo for reconstruction. While mechanical stretch-induced epidermal changes have been extensively studied in rodents and cell culture, little is known about the mechanobiology of the human epidermis in vivo. Here, we employed single-cell RNA sequencing to interrogate the changes in the human epidermis during long-term tissue expansion therapy in clinical settings. We also verified the main findings at the protein level by immunofluorescence analysis of independent clinical samples. Our data show that the expanding human skin epidermis maintained a cellular composition and lineage trajectory that are similar to its non-expanding neighbor, suggesting the cellular heterogeneity of long-term expanded samples differs from the early response to the expansion. Also, a decrease in proliferative cells due to the decayed regenerative competency was detected. On the other hand, profound transcriptional changes are detected for epidermal stem cells in the expanding skin versus their non-expanding peers. These include significantly enriched signatures of C-FOS, EMT, and mTOR pathways and upregulation of AREG and SERPINB2 genes. CellChat associated ligand-receptor pairs and signaling pathways were revealed. Together, our data present a single-cell atlas of human epidermal changes in long-term tissue expansion therapy, suggesting that transcriptional change in epidermal stem cells is the major mechanism underlying long-term human skin expansion therapy. We also identified novel therapeutic targets to promote human skin expansion efficiency in the future.

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“…The reduction of donor-site morbidity can also be achieved ( 6 ). However, it also has some significant disadvantages, including the lengthy duration of TE, the need for multiple-staged operations, and temporary discomfort ( 7 ). Moreover, for patients with large defects, the amount of skin provided by internal TE is often insufficient because of the limited regenerative capacity of skin ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

Tissue expansion techniques in reconstructive surgery: a 10-year bibliometric analysis

Wu¹,

Chen²,

Gao³

et al. 2023

Ann Transl Med

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Background Tissue expansion (TE) has attracted significant attention from researchers over the past decade. However, there are currently no bibliometric analyses in this field. We aimed to quantitatively and visually analyze the literature to explore the hotspots and frontiers in TE research. Methods We extracted all the documents on this topic published from the Web of Science Core Citation (WOSCC) database between 2012 and 2021. CiteSpace (version 5.8 R3) and VOSviewer (version 1.6.18) were used to perform the visualization analysis. Results A total of 1,085 documents were included in the analysis. The publication trend fluctuated over time. The United States led the research, and Harvard University was the most productive institution. Plastic and Reconstructive Surgery published the largest number of documents and had the most citations. Kim JYS was the most prolific and most cited author. The high-frequency keywords were “complications”, “breast reconstruction”, “outcomes”, “tissue expander”, “mastectomy”, and “acellular dermal matrix” (ADM). “Surgical site infection”, “tissue expander/implant”, “bilateral prophylactic mastectomy”, and “activated controlled expansion” were the keywords with the strongest citation bursts until 2021. Conclusions This study provided a complete analysis of the research on TE. The effect of ADM on the complication rates after breast reconstruction is the current hotspot of TE research in surgery. Patient-activated controlled expansion might be a promising future research direction for TE.

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Complications of tissue expansion in the head and neck

Cited by 19 publications

References 67 publications

Transcriptomic analysis reveals dynamic molecular changes in skin induced by mechanical forces secondary to tissue expansion

Transcriptomic analysis reveals dynamic molecular changes in skin induced by mechanical forces secondary to tissue expansion

Single-Cell Transcriptomics Uncover Key Regulators of Skin Regeneration in Human Long-Term Mechanical Stretch-Mediated Expansion Therapy

Tissue expansion techniques in reconstructive surgery: a 10-year bibliometric analysis

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