title: The effect of skin expansion on acellular dermis in an experimental model.
abstract: OBJECTIVE
  Although acellular dermis is widely used in prosthesis-based breast reconstruction, there is no study evaluating its expandability and histological, ultra-structural related changes. The purpose of this study is to determine whether acellular dermis could be expanded and whether the histological changes occurring in the skin with tissue expansion is different from normal when acellular dermis is used.
  
  
  METHODS
  Twenty-two male Wistar rats were used in this study. In group 1 (n = 6), a rectangular-shaped tissue expander with final volume of 35 ml was placed subcutaneously. In group 2 (n = 6) tissue expander was placed submuscularly. In group 3 (n = 6), a 4 × 5 cm, acellular dermis was inserted and sutured in place, tissue expander was placed underneath acellular dermis. Group 4 (n = 4) was control, no procedure was done after creation of a pocket. After day 30, tissue expanders were inflated with 2 ml every 2 days with saline solution. On day 66, midvertical, midhorizontal surface expansion measurements were recorded. Samples were examined macroscopically. Biopsies were taken from mid-point of the expanded full-thickness flap. Histological evaluation, total skin thickness, epidermal thickness, and the amount of vascularisation were measured.
  
  
  RESULTS
  There was no expansion noted on the acellular dermis; however, acellular dermis increased vascularity and decreased the thinning of the overlying skin and thickening of the epidermis when compared to other groups.
  
  
  CONCLUSIONS
  Acellular dermis use can be beneficial in implant-based breast reconstruction in terms of morbidity and its tissue support.
authors.affiliation: a Department of Plastic Surgery , Yıldırım Beyazıt University, Yenimahalle Research and Training Hospital , Ankara , Turkiye.
authors.forename: Tuba
authors.initials: T
authors.lastname: Güçlü Karadağ
authors.affiliation: a Department of Plastic Surgery , Yıldırım Beyazıt University, Yenimahalle Research and Training Hospital , Ankara , Turkiye.
authors.forename: Ali Mübin
authors.initials: AM
authors.lastname: Aral
authors.affiliation: b Faculty of Medicine, Department of Plastic and Reconstructive Surgery , Gazi University , Ankara , Turkiye.
authors.forename: Serhan
authors.initials: S
authors.lastname: Tuncer
authors.affiliation: c Bagcilar Research and Training Hospital , Istanbul , Turkiye.
authors.forename: Ayşe
authors.initials: A
authors.lastname: Şencan
authors.affiliation: d Faculty of Medicine, Department of Histology , Gazi University , Ankara , Turkiye.
authors.forename: Çiğdem
authors.initials: Ç
authors.lastname: Elmas
mesh_terms: D062088:Acellular Dermis; D000818:Animals; D017208:Rats, Wistar; D012867:Skin / Q000033:anatomy & histology*; D016038:Skin Transplantation; D015626:Tissue Expansion; D015625:Tissue Expansion Devices
keywords: Acellular dermis; breast reconstruction; expander