LAUSR

BACKGROUND Biological cover over tissue expander prostheses has been introduced to provide soft tissue support for tissue expanders during breast reconstruction. However, its impact on mechanically induced skin growth remains unknown. This study will investigate the hypothesis that covering the tissue expander with acellular dermal matrix (ADM) affects mechanotransduction without compromising the efficacy of tissue expansion. METHODS Tissue expansion, with and without use of ADM, was performed on a porcine model. The tissue expanders were inflated twice with 45 ml of saline and the full-thickness skin biopsies were harvested from expanded and control unexpanded skin one week and 8 weeks after the final inflation. Histological evaluation, immunohistochemistry staining, and gene expression analysis were performed. Skin growth and total deformation were evaluated using isogeometric analysis (IGA). RESULTS Our results demonstrate that utilization of ADM as a biological cover during tissue expansion does not impede mechanotransduction that lead to skin growth and blood vessel formation. IGA revealed similar total deformation and growth of expanded skin with and without a biological cover, confirming that its use does not inhibit mechanically induced skin growth. In addition, we found that use of an ADM cover results in more uniform distribution of mechanical forces applied by the tissue expander. CONCLUSIONS These results suggest that ADM improves mechanically induced skin growth during tissue expansion by facilitating a more uniform distribution of mechanical forces applied by the tissue expander. Therefore, the use of a biological cover has potential to improve outcomes in tissue expansion-based reconstruction. CLINICAL RELEVANCE STATEMENT Utilization of ADM during tissue expansion results in more uniform distribution of mechanical forces applied by the tissue expander and might improve clinical outcomes in patients undergoing breast reconstruction.