title: Excess Dermal Tissue Remodeling In Vivo: Does It Settle?
abstract: BACKGROUND
  Surgical manipulation of skin may result in undesired puckering of excess tissue, which is generally assumed to settle over time. In this article, the authors address the novel question of how this excess tissue remodels.
  
  
  METHODS
  Purse-string sutures (6-0 nylon) were placed at the midline dorsum of 22 wild-type BALB/c mice in a circular pattern marked with tattoo ink. Sutures were cinched and tied under tension in the treatment group, creating an excess tissue deformity, whereas control group sutures were tied without tension. After 2 or 4 weeks, sutures were removed. The area of tattooed skin was measured up to 56 days after suture removal. Histologic analysis was performed on samples harvested 14 days after suture removal.
  
  
  RESULTS
  The majority of excess tissue deformities flattened within 2 days after suture removal. However, the sutured skin in the treatment group decreased in area by an average of 18 percent from baseline (n = 9), compared to a 1 percent increase in the control group (n = 10) at 14 days after suture removal (p < 0.05). This was similarly observed at 28 days (treatment, -11.7 percent; control, 4.5 percent; n = 5; p = 0.0243). Despite flattening, deformation with purse-string suture correlated with increased collagen content of skin, in addition to increased numbers of myofibroblasts. Change in area did not correlate with duration of suture placement.
  
  
  CONCLUSIONS
  Excess dermal tissue deformities demonstrate the ability to remodel with gross flattening of the skin, increased collagen deposition, and incomplete reexpansion to baseline area. Further studies will reveal whether our findings in this mouse model translate to humans.
authors.affiliation: Stanford, Calif.; and Boston, Mass.|From the Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Institute for Stem Cell Biology and Regenerative Medicine; and Boston University School of Medicine.
authors.forename: Tripp
authors.initials: T
authors.lastname: Leavitt
authors.affiliation: Stanford, Calif.; and Boston, Mass.|From the Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Institute for Stem Cell Biology and Regenerative Medicine; and Boston University School of Medicine.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Hu
authors.affiliation: Stanford, Calif.; and Boston, Mass.|From the Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Institute for Stem Cell Biology and Regenerative Medicine; and Boston University School of Medicine.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Zielins
authors.affiliation: Stanford, Calif.; and Boston, Mass.|From the Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Institute for Stem Cell Biology and Regenerative Medicine; and Boston University School of Medicine.
authors.forename: Leandra A
authors.initials: LA
authors.lastname: Barnes
authors.affiliation: Stanford, Calif.; and Boston, Mass.|From the Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Institute for Stem Cell Biology and Regenerative Medicine; and Boston University School of Medicine.
authors.forename: Clement D
authors.initials: CD
authors.lastname: Marshall
authors.affiliation: Stanford, Calif.; and Boston, Mass.|From the Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Institute for Stem Cell Biology and Regenerative Medicine; and Boston University School of Medicine.
authors.forename: Derrick C
authors.initials: DC
authors.lastname: Wan
authors.affiliation: Stanford, Calif.; and Boston, Mass.|From the Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Institute for Stem Cell Biology and Regenerative Medicine; and Boston University School of Medicine.
authors.forename: H Peter
authors.initials: HP
authors.lastname: Lorenz
authors.affiliation: Stanford, Calif.; and Boston, Mass.|From the Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Institute for Stem Cell Biology and Regenerative Medicine; and Boston University School of Medicine.
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Gurtner
authors.affiliation: Stanford, Calif.; and Boston, Mass.|From the Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Institute for Stem Cell Biology and Regenerative Medicine; and Boston University School of Medicine.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Longaker
mesh_terms: D000818:Animals; D062109:Dermatologic Surgical Procedures / Q000379:methods*; D051379:Mice; D008807:Mice, Inbred BALB C; D011183:Postoperative Complications / Q000517:prevention & control; D012868:Skin Abnormalities / Q000517:prevention & control; D013536:Suture Techniques