Effects of hyperbaric oxygen therapy on fibrovascular ingrowth in porous polyethylene blocks implanted under burn scar tissue: An experimental study
Introduction
Burn patients in the long term may require challenging restorations for facial deformities caused by severe burn scars. There have been numerous reconstructive procedures described to solve these burn related challenging deformities, most failed to achieve a full-satisfactory result [1], [2]. Allografting procedures are occasionally utilized for skeletal modifications and soft tissue augmentations. Among the allograft materials, porous polyethylene (PP) has been reported to be one of the best alternatives to autogenous tissues particularly in the head and neck region reconstructions [3], [4], [5]. There are reports describing safe placement of PP beneath facial burns scar tissue particularly for ear and nose reconstruction with good results [3], [4], [5].
On the other hand, use of PP has been unusually challenging in poorly vascularized hypoxic tissues of burn scars due to high risks of infection, extrusion, exposure and migration for which removal is not uncommon [3], [6], [7]. Adjunctive agents such as blood clot, recombinant human bFGF and sucralfate were experimentally investigated elsewhere in order to overcome these problems via enrichment of fibrovascular ingrowth (FVI) into porous polyethylene [8], [9], [10], [11]. The results were promising with positive enhancement in endothelial cell proliferation and FVI was shown to be one of the key factors in biointegration of PP. It was also clinically noted that PPs can be successfully covered with skin grafts when they are exposed provided that FVI and capsule formation is good enough [4], [5]. Hence, FVI is of paramount importance for the integration of this useful material into surrounding burn scar tissues and it is obvious that an accelerated and reinforced FVI will encourage prosthetic reconstructions in burn scar tissues.
An adjuvant clinical method demonstrated to accelerate and promote wound healing and fibrovascular tissue proliferation in ischemic areas is hyperbaric oxygen (HBO) therapy [12], [13]. It improves tissue oxygenation while stimulating neoangiogenesis, and collagen synthesis. Based on these beneficial effects, soft tissue integration of PP materials placed in hypoxic burn scar areas might be reinforced by HBO therapy leading to a superior and faster outcome and hence, possible complications can be diminished to an optimum level. To the best of our knowledge, there has been no previous study searching of this hypothesis.
An experimental study was designed to determine the effects of HBO therapy on tissue integration of PP implanted beneath normal skin and burn scar tissue.
Section snippets
Materials and methods
Eighty Sprague–Dawley male rats weighing 200–350 g were utilized for the study after an ethic committee approval (AEK/107/8 Project No.: 73). All animals were fed with tap water and food ad libitum and were treated according to the Animal Research Laboratory guidelines. Four different groups were established with 20 rats in each group:
Group One (n = 20): Porous polyethylene block beneath dorsal burn scar with HBO therapy.
Group Two (n = 20): Porous polyethylene block beneath dorsal burn scar without
Results
After scald burn, one rat was lost due to anesthetic complications and two rats died because of burn shock in the first 24 h. They were excluded from the study and replaced by new animals. None of the animals were lost due to complications of HBO therapy. In Group Two, PP block was partially exposed in one rat, which responded to topical care and fully recovered in 1 week with surrounding burn scar tissue. There was seroma formation in one rat in each burn scar group, which was successfully
Discussion
High-density porous polyethylene (PP) has been commonly used in various fields of reconstructive surgery including burns reconstructive surgery due to its well-known advantages over autogenous tissues [19]. However, most plastic surgeons still prefer autogenous tissue because of high costs and risks of infection, exposure, extrusion and migration [20], [21].
One of the main features of PP is its interconnected porous structure, which allows a fibrovascular ingrowth (FVI) originating from
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