Abstract
Significance: Continuous external tissue expansion (CETE) is a versatile tool in soft tissue injury management, and could be an addition to the traditional reconstructive ladder.Recent Advances: This critical review discusses the principles and application of CETE, covering a company-sponsored consensus meeting on this emerging technology and highlighting the DermaClose® (Synovis Micro Companies Alliance, Inc., Birmingham, AL) device's unique approach to soft tissue injury management. There is clinical evidence to support the use of CETE in the management of a number of wound types, including fasciotomy, trauma, amputation, and flap donor sites. The device can be applied to open wounds, potentially avoiding the need for a skin graft or other more complex or invasive reconstruction options. DermaClose applies constant tension without restricting blood flow and does not require repeated tightening.Critical Issues: CETE is becoming more widely used by surgeons of different specialties, and numerous reports describing its efficacy and safety in wound management have been published. Surgeons using CETE must follow the correct technique and select patients carefully to achieve optimal outcomes. However, there is no single source of information or consensus recommendations regarding CETE application.Future Directions: Prospective evidence on the efficacy and safety of CETE in clinical practice is required to communicate the best techniques and share important experiences. This will help to solidify its place in the reconstructive ladder as a valuable additional option for surgeons.
Highlights
The hierarchy of surgical techniques traditionally used by reconstructive surgeons is depicted in the ‘‘reconstructive ladder’’ (Fig. 1).[1]
The authors were selected for their experience with CETE
A company-sponsored consensus group was formed, and a literature search was performed in PubMed to identify publications concerning tissue expansion and CETE
Summary
The hierarchy of surgical techniques traditionally used by reconstructive surgeons is depicted in the ‘‘reconstructive ladder’’ (Fig. 1).[1]. Chemical agents inhibiting cellular attachment to the ECM have been shown to cause tissue expansion, indicating that extracellular forces have a role in inducing cell growth This discovery led researchers the discovery that mechanical strain affects signaling pathways in the proliferation cascade. EGF is thought to be linked to the movement of K+ ions, and may be the mechanism by which ion channels affect cell proliferation[3] Protein kinases Protein kinases, protein kinase C, are known to be involved in signal transduction pathways that stimulate tissue growth These and other protein kinases such as phospholipase C and diacylglycerol are thought to interact with extracellular components to stimulate cell proliferation under stress conditions[3] Protein synthesis Typically, protein synthesis is inversely proportional to cAMP concentration, as cAMP is consumed in the process of making new proteins.
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