Effect of Mechanical Load in Wound Healing

Langrana, Noshir A.; Alexander, Hattie E.; Strauchler, I; Metha, A; Ricci, John

doi:10.1097/00000637-198303000-00005

Cited by 35 publications

(10 citation statements)

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“…The anterolateral incision is curvilinear and parallel to the lines of Langer, generating less tension during mobilization of the knee. This may facilitate wound healing [29], and thus, could reduce the risk of wound problems. Johnson et al [23] reported that after a TKA using a medial skin incision, vascularization of the lateral skin flap was more precarious than that of the medial skin flap [21].…”

Section: Discussionmentioning

confidence: 99%

Hypesthesia after Anterolateral versus Midline Skin Incision in TKA: A Randomized Study

Laffosse

Potapov

Malo

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background The anterior midline skin incision in a TKA provides excellent surgical exposure. However, it usually requires sectioning the infrapatellar branch of the saphenous nerve which may be associated with lateral cutaneous hypesthesia and neuroma formation.Questions/purposes We asked whether an anterolateral skin incision to the knee would decrease the area of skin hypesthesia and associated postoperative discomfort. Patients and Methods We randomized 69 knees to receive a TKA through either a midline or an anterolateral skin incision. We assessed skin sensitivity by application of the Semmes-Weinstein monofilament at 13 reference points at 6 weeks and 6 and 12 months postoperatively.

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Section: Discussionmentioning

confidence: 99%

Hypesthesia after Anterolateral versus Midline Skin Incision in TKA: A Randomized Study

Laffosse

Potapov

Malo

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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“…65,71–73 This principle was demonstrated by Langrana et al, who found that episodic and sequential tissue expansion of a surgical incision beginning 1 week after surgery was not only tolerated but resulted in significantly greater tensile strength at each time point compared with controls. 74 Similarly, van Royen et al found that joint rotation initiated 1 week after surgery in rabbits significantly increased the tensile strength of healing wounds compared with immobilized controls. 66 …”

Section: Mechanical Stress and Wound Healingmentioning

confidence: 94%

“…Langrana et al found that in episodically expanded surgical incisions, scar formation was significantly reduced on both gross and microscopic levels. 74 Other histologic studies have found earlier and more uniform alignment of collagen in wounds subject to controlled mechanical stress. 16,87,101–109 On a molecular level, a recent study found that CTGF was significantly downregulated after 24 hours of cyclically stretching fibroblasts in culture.…”

Section: Mechanical Stress and Scarringmentioning

confidence: 94%

The Role of Wound Healing and Its Everyday Application in Plastic Surgery

Ireton

Unger

Rohrich

2013

Plastic and Reconstructive Surgery Global Open

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Background:After surgery it is often recommended that patients should refrain from strenuous physical activity for 4–6 weeks. This recommendation is based on the time course of wound healing. Here, we present an overview of incisional wound healing with a focus on 2 principles that guide our postoperative recommendations: the gain of tensile strength of a wound over time and the effect of mechanical stress on wound healing.Methods:A systematic search of the English literature was conducted using OVID, Cochrane databases, and PubMed. Inclusion criteria consisted of articles discussing the dynamics of incisional wound healing, and exclusion criteria consisted of articles discussing nonincisional wounds.Results:Experiments as early as 1929 laid the groundwork for our postoperative activity recommendations. Research using animal models has shown that the gain in tensile strength of a surgical wound is sigmoidal in trajectory, reaching maximal strength approximately 6 weeks postoperatively. Although human and clinical data are limited, the principles gained from laboratory investigation have provided important insights into the relationship among mechanical stress, collagen dynamics, and the time course of wound healing.Conclusion:Our postoperative activity recommendations are based on a series of animal studies. Clinical research supporting these recommendations is minimal, with the most relevant clinical data stemming from early motion protocols in the orthopedic literature. We must seek to establish clinical data to support our postoperative activity recommendations so that we can maximize the physiologic relationships between wound healing and mechanical stress.

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“…Dynamic splints, serial casting, z-plasty, massage, ambulation, range of motion exercises, and stretching techniques are commonly utilized to alter the appearance and properties of scars (Hardy, 1989). Furthermore, numerous animal studies have shown that stretching healing wounds results in a reduction in contracture and thickness and an increase in compliance and tensile strength of the scar (Brunius et al, 1967;Langrana et al, 1983;Sussman, 1966; Thorngate and Ferguson, 1958). Conversely, clinically undesirable results have also been attributed to the application of stretch including hypertrophic scarring, edema, and scar lengthening and widening (Arem and Madden, 1976;Sommerlad and Creasey, 1978).…”

Section: Introductionmentioning

confidence: 99%

“…We hypothesize that cyclic stretch stimulates dermal fibroblasts to increase their synthesis and crosslinking of collagen and to rapidly condense the surrounding matrix. To minimize the confounding effects of in-plane fibril alignment on the mechanics of the matrix, our initial approach utilizes equibiaxial stretch, a technique that has been shown previously to result in a relatively uniform angular distribution of collagen fibers in vivo (Langrana et al, 1983). Cyclic stretch is therefore expected to result in a more compact and stronger tissue, even without the contribution of fiber alignment.…”

Section: Introductionmentioning

confidence: 99%