Barwinska Daria, Garner John, Davidson Darrell D, Cook Todd G, Eckert George J, Tholpady Sunil S, March Keith L, Park Kinam, Barco Clark T
Department of Cellular and Integrative Physiology, Indiana University, Indianapolis, Ind. Indiana Center for Vascular Biology and Medicine, Indiana University, Indianapolis, Ind.; VC-CAST Signature Center, Indiana University, Indianapolis, Ind.; Regenerative Medicine Division, Roudebush Veteran Affairs Medical Center, Indianapolis, Ind.; Akina, Inc. West Lafayette, Ind.; Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Ind.; Department of Biostatistics, Indiana University, Indianapolis, Ind.; Plastic Surgery Division, Roudebush Veteran Affairs Medical Center, Indianapolis, Ind.; Division of Cardiology, Department of Medicine, Indiana University, Indianapolis, Ind.; Department of Biomedical Engineering, Purdue University, West Lafayette, Ind.; Roudebush Veterans Affairs Medical Center, Dental Service, Indianapolis, Ind.
Plast Reconstr Surg Glob Open. 2017 Aug 28;5(8):e1449. doi: 10.1097/GOX.0000000000001449. eCollection 2017 Aug.
There are few methods for expanding oral mucosa, and these often cause complications such as tissue necrosis and expander eruption. This study examines mucosal blood perfusion following insertion of a novel shapeable hydrogel tissue expander (HTE). The canine model used subgingival insertion of HTE following tooth extraction and alveolar bone reduction. The primary goal of this study was to gain understanding of epithelial perfusion and reparative responses of gingival mucosa during HTE expansion.
Nine Beagle dogs underwent bilateral premolar maxillary and mandibular tooth extraction. Three to four months later, HTE-contoured inserts were implanted submucosally under the buccal surface of the alveolar ridge. After removal and following a 6- to 7-month period of healing, new HTE implants were inserted at the same sites. The area was assessed weekly for tissue perfusion and volume of expansion. Biopsies for histological analysis were performed at the time of expander removal.
Within 2 weeks following the second insertion, blood flow returned to baseline (defined as the values of perfusion measurements at the presurgery assessment) and remained normal until hydrogel full expansion and removal. Volume expansion analysis revealed that the hydrogel doubled in volume. Histological assessment showed no macrophage or inflammatory infiltration of the mucosa. No superficial fibrosis, decreased vascularity, or mucosal change was seen.
Maintenance of adequate tissue perfusion is a clinically important aspect of tissue expander performance to reduce risk of device loss or injury to the patient, particularly for areas with a history of previous surgeries.
用于扩张口腔黏膜的方法较少，且这些方法常常会引发诸如组织坏死和扩张器外露等并发症。本研究检测了一种新型可塑形水凝胶组织扩张器（HTE）植入后的黏膜血流灌注情况。犬类模型采用拔牙及牙槽骨减量后龈下植入HTE。本研究的主要目的是了解HTE扩张过程中牙龈黏膜的上皮灌注及修复反应。
9只比格犬接受双侧上颌和下颌前磨牙拔牙术。三到四个月后，将塑形好符合HTE的植入物黏膜下植入牙槽嵴颊侧表面。取出后，经过6至7个月愈合期，在相同部位植入新的HTE植入物。每周评估该区域的组织灌注及扩张体积。在取出扩张器时进行活检以做组织学分析。
第二次植入后2周内血流恢复至基线水平（定义为术前评估时的灌注测量值），并在水凝胶完全扩张及取出前保持正常。体积扩张分析显示水凝胶体积增加了一倍。组织学评估显示黏膜无巨噬细胞或炎性浸润。未见表面纤维化、血管减少或黏膜改变。
维持充足组织灌注是组织扩张器性能的一个临床重要方面，可降低器械丢失或对患者造成损伤的风险，尤其对于有既往手术史部位。
