title: Growth factors expression in hyaluronic acid fat graft myringoplasty.
abstract: OBJECTIVE
  To investigate the effect of hyaluronic acid (HA) associated to fat graft on growth factors expression during the healing process of tympanic membrane (TM) perforations in guinea pigs using the hyaluronic acid fat graft myringoplasty (HAFGM) technique.
  
  
  METHODS
  Prospective randomized animal study.
  
  
  METHODS
  Thirty guinea pigs were divided equally into three groups: group I (control group), group II (fat graft myringoplasty technique), and group III (HAFGM technique). TMs were perforated on day 1 and then sampled on days 0, 3, 8, and 21 and tested for the expression of: epidermal growth factor (EGF), insulin-like growth factor (IGF), tumor necrosis factor α (TNF α), vascular endothelial growth factor (VEGF), and keratinocyte growth factor (KGF). Five perforated TMs were taken at day 0 from group I to serve as a reference level.
  
  
  RESULTS
  Group III showed an increased expression of all tested growth factors, except for KGF. EGF was highest in the early healing process; then IGF peaked at day 8 with statistically significant increase compared to groups I and II. TNF α in group III was significantly higher than group I throughout the study, with a peak level at day 21. VEGF was significantly higher in group III compared to group I at days 3 and 21. Neovascularization and scarless TM closure was obtained in group III, while spontaneous closure was associated with thin-layered and scarred TM in group I.
  
  
  CONCLUSIONS
  HA association to fat graft in perforated TM increases the expression of the endogenous growth factors, suggesting that such an association is advantageous for healing.
  
  
  METHODS
  N/A.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Issam
authors.initials: I
authors.lastname: Saliba
authors.forename: Musaed
authors.initials: M
authors.lastname: Alzahrani
authors.forename: Tang
authors.initials: T
authors.lastname: Zhu
authors.forename: Sylvain
authors.initials: S
authors.lastname: Chemtob
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000818:Animals; D015415:Biomarkers / Q000032:analysis; D004195:Disease Models, Animal; D004815:Epidermal Growth Factor / Q000032:analysis; D006085:Graft Survival; D006168:Guinea Pigs; D006820:Hyaluronic Acid / Q000494:pharmacology*; D036341:Intercellular Signaling Peptides and Proteins / Q000032:analysis*; D008297:Male; D009225:Myringoplasty / Q000009:adverse effects / Q000379:methods*; D018919:Neovascularization, Physiologic / Q000502:physiology; D038781:Otoscopy / Q000379:methods; D011897:Random Allocation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013002:Somatomedins / Q000032:analysis; D013524:Surgical Flaps / Q000098:blood supply; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis; D014432:Tympanic Membrane / Q000187:drug effects; D018058:Tympanic Membrane Perforation / Q000378:metabolism / Q000601:surgery*; D042461:Vascular Endothelial Growth Factor A / Q000032:analysis; D014945:Wound Healing / Q000502:physiology
chemical_list: D015415:Biomarkers; D036341:Intercellular Signaling Peptides and Proteins; D013002:Somatomedins; D014409:Tumor Necrosis Factor-alpha; D042461:Vascular Endothelial Growth Factor A; D004815:Epidermal Growth Factor; D006820:Hyaluronic Acid
keywords: HAFGM; Tympanic membrane; fat graft; growth factors; hyaluronic acid; myringoplasty