Abstract
Electromechanical reshaping (EMR) involves reshaping cartilage by mechanical deformation and delivering electric current to the area around the bend axis, causing local stress relaxation and permanent shape change. The mechanism of EMR is currently unclear, although preliminary studies suggest that voltage and application time are directly related to the concentration and diffusion of acid-base products within the treated tissue with little heat generation. This study aims to characterize local tissue pH changes following EMR and to demonstrate that local tissue pH changes are correlated with tissue damage and shape change. Ex vivo animal study involving EMR of rabbit nasal septal cartilage and biochemical estimation of tissue pH changes. The magnitude and diffusion of acid-base chemical products in control (0V, 2 minutes), shape change (4V, 4 minutes; 6V, 1, 2, 4 minutes; 8V, 1, 2 minutes), and tissue damage (8V, 4, 5 minutes; 10V, 4, 5 minutes) parameters following EMR are approximated by analyzing local pH changes after pH indicator application. There is a direct relationship between total charge transfer and extent of acid-base product diffusion (P <0.05). A "pH transition zone" is seen surrounding the bend apex above 8V, 2 minutes. Colorimetric analysis suggests that small local pH changes (10(-8) hydrogen ions) are at least partly implicated in clinically efficacious EMR. These results provide additional insight into the translational applications of EMR, particularly the relationship among pH changes, shape change, and tissue injury, and are integral in optimizing this promising technology for clinical use.
Highlights
Congenital, iatrogenic, inflammatory, and traumatic defects often damage cartilage in head, neck, and upper airway, resulting in significant functional and aesthetic consequences
Colorimetric analysis suggests that small local pH changes (10−8 hydrogen ions) are at least partly implicated in clinically efficacious electromechanical reshaping (EMR)
These results provide additional insight into the translational applications of EMR, the relationship among pH changes, shape change, and tissue injury, and are integral in optimizing this promising technology for clinical use
Summary
Congenital, iatrogenic, inflammatory, and traumatic defects often damage cartilage in head, neck, and upper airway, resulting in significant functional and aesthetic consequences. EMR is the latest emerging cartilage reshaping modality.[7,8,9] EMR provides multiple advantages over traditional techniques and LCR, including its minimally invasive nature, dependence on voltage and application time[8] as well as electrode geometry,[9] and dependence on a nonthermal electrochemical mechanism.[7] Component costs are inexpensive, on par with sutures It is speculated, at least as part of the mechanism of EMR, that oxidation-reduction (redox) reactions occur at the tissue–electrode interface, producing H+ and OH− ions at the anode and cathode ends, respectively, that interact with ionic bonds within the cartilage matrix and result in permanent changes in tissue biomechanics.[10,11]
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