The effect of skin expansion on acellular dermis in an experimental model

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. CONCLUSION: Acellular dermis use can be beneficial in implant-based breast reconstruction in terms of morbidity and its tissue support.