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Development of a Novel Anisotropic Self-Inflating Tissue Expander: In Vivo Submucoperiosteal Performance in the Porcine Hard Palate

Swan, Marc C. D.Phil., M.R.C.S.; Bucknall, David G. Ph.D.; Czernuszka, Jan T. Ph.D.; Pigott, David W. F.R.C.A.; Goodacre, Timothy E. E. F.R.C.S.

Plastic and Reconstructive Surgery: January 2012 - Volume 129 - Issue 1 - p 79–88
doi: 10.1097/PRS.0b013e3182362100
Experimental: Original Articles

Background: The advent of self-inflating hydrogel tissue expanders heralded a significant advance in the reconstructive potential of this technique. Their use, however, is limited by their uncontrolled isotropic (i.e., uniform in all directions) expansion.

Methods: Anisotropy (i.e., directional dependence) was achieved by annealing a hydrogel copolymer of poly(methyl methacrylate-co-vinyl pyrrolidone) under a compressive load for a specified time period. The expansion ratio is dictated by the percentage of vinyl pyrrolidone content and the degree of compression. The expansion rate is modified by incorporating the polymer within a silicone membrane. The in vivo efficacy of differing prototype devices was investigated in juvenile pigs under United Kingdom Home Office Licence. The devices were implanted within a submucoperiosteal pocket in a total of six porcine palates; all were euthanized by 6 weeks after implantation. A longitudinal volumetric assessment of the expanded tissue was conducted, in addition to postmortem analysis of the bony and mucoperiosteal palatal elements.

Results: Uncoated devices caused excessive soft-tissue expansion that resulted in mucoperiosteal ulceration, thus necessitating animal euthanasia. The silicone-coated devices produced controlled soft-tissue expansion over the 6-week study period. There was a statistically significant increase in the volume of expanded soft tissue with no evidence of a significant acute inflammatory response to the implant, although peri-implant capsule formation was observed. Attenuation of the bony palatal shelf was noted.

Conclusion: A unique anisotropic hydrogel device capable of controlled expansion has been developed that addresses a number of the shortcomings of the technology hitherto available.

Oxford, United Kingdom; and Atlanta, Ga.

From the Department of Plastic and Reconstructive Surgery, Nuffield Department of Surgery, and the Nuffield Department of Anesthesia, University of Oxford, John Radcliffe Hospital; Department of Materials, University of Oxford; and Materials Science and Engineering, Georgia Institute of Technology.

Received for publication April 3, 2011; accepted July 21, 2011.

Disclosure: M.C.S. was funded by a Royal College of Surgeons of England Surgical Research Fellowship and a Thirunavukkarasu Material Science Scholarship from Trinity College, Oxford. Further funding for this project was obtained from the Oxfordshire Health Services Research Committee and the University of Oxford Medical Research Fund. The authors have no potential conflicts of interest to declare.

Marc C. Swan, D.Phil., M.R.C.S.; Department of Plastic and Reconstructive Surgery, Nuffield Department of Surgery, John Radcliffe Hospital, Headley Way, Oxford, Oxfordshire, OX3 9DU, United Kingdom,

©2012American Society of Plastic Surgeons