Nerve

Most nerve expansion studies involve animal models. At 18 months after nerve expansion, no differences in nerve conduction velocity (NCV) and muscle contraction force between nerve grafting and nerve expansion/repair procedures were found, although muscle weight was significantly greater with grafting133; in skin that was expanded 110%, no change in nerve function was noted.134 Expanded/repair nerve compares favorably with traditional nerve repair results.119 Using electron microscope evaluation, although degenerative changes were present beginning at 8% limb lengthening up to 33% of limb lengthening, nerves in an animal model recovered normal

»References 4, 5, 63, 70, 73, 79, 106, 109, 115. References 4, 5, 78, 79, 106, 115.

structure within 2 months postexpansion.69 Another electron microscopic study found that nerves elongated by 88% retained their intraneural cytoskeleton components despite some loss of myelin.47 Expanded Wallerian degenerated nerve exhibits increased Schwann cell proliferation and increased vascularity at the expander site.57,100,101

I VASCULAR AND LYMPHATIC SYSTEMS

Most vascular volume and/or lengthening procedures involve acute intraoperative expansion. Studies on the affects of intravascular volume expansion with stents indicate that adaptive vessel remodeling occurs after stent placement with endothelial and smooth muscle cell hyperplasia taking place. Expanders have been used intraoperatively to increase arterial length.56 Studies involving influences of tissue expansion on the lymphatic system are rare. Ercocen found that the expander itself reduces lymphatic flow.

I DEVICES THAT REMODEL SOFT TISSUES

Soft tissue expansion devices may be two-dimensional or three-dimensional depending on the direction(s) of applied force. Surgery is required to insert nonin-flatable or inflatable force-transducing devices or to incorporate bone pins/screws as links to distraction frames.72 Producing more dermal thickening than three-dimensional expanders,1 two-dimensional expanders operate in one plane by pulling wound boundaries together.1 This type of expander stimulates biological tissue gain, maintains mechanical creep, prevents stretchback.1,98 Three-dimensional expanders push/compress tissue away from fixed boundaries, stretching tissues in all directions.1 Tissue gain is five times more than that for two-dimensional expanders.1 Tissue deformation, via biologic creep, assumes the configuration of the expansion device.

In contrast, splints apply noninvasive mobilization forces that are unidirectional, or sometimes bidirectional, to in vivo soft tissues surrounding three-dimensional bone and joint structures that comprise a multiarticulated open kinematic chain. Mobilization splinting to remodel soft tissues limited by adhesion, stiffness, or contracture is efficacious because splintgenerated biologic creep or tissue remodeling occurs in the plane(s) of normal joint function. It is important to remember that associated normal and abnormal anatomical structures also apply remodeling forces in addition to those applied by splints. Knowing how to effectively control and harness these multiple forces is a key factor to successful splinting outcomes (Fig. 3-26).

SUMMARY

Soft tissue remodeling is inherent to life. As we move from infancy to adulthood our soft tissue structures continuously adapt to keep pace with our lengthening skeletal frames. Through pregnancy, weight changes, skeletal pathology, disease, or injury our soft tissues continue to adapt, sometimes for the better and sometimes for the worse. It is only when life leaves that tissue remodeling ceases.

The remodeling process can be positively influenced to correct deformity caused by disease or injury through the judicious use of externally or internally applied devices that apply prolonged, sustained, controlled, gentle forces. Understanding the biomechani-cal and biochemical processes involved in tissue remodeling allows therapists and surgeons to better treat their patients. Extensive investigation into the causative factors underlying cellular growth is already well underway. We all need to be a part of this exciting and challenging frontier. Knowledge derived from other disciplines provides therapists with an important step up into the future. Splints apply forces externally and expanders apply forces internally. Each is used to affect tissue remodeling. Although an assumption of parallel influences and results is self evident, considerable splinting research is needed to conclusively connect the bridge between splinting and tissue expansion frames of knowledge.

Fig. 3-26 Index-small finger DIP extension and flexion torque transmission splint, type 3 (13)

As described by Brand in the 1950s, joints beyond the physical boundaries of a splint may be remodeled over time by controlling secondary joints and allowing active motion at primary joints. This splint encourages DIP active motion by controlling the secondary wrist, MP, and PIP joints.

REFERENCES

1. Alex JC, Bhattacharyya TK, Smyrniotis G, et al: A histologic analysis of three-dimensional versus two-dimensional tissue expansion in the porcine model, Laryngoscope 111(1):36-43, 2001.

2. Arem A, Madden J: Is there a Wolff's law for connective tissue? Surg Forum 25:512-4, 1974.

3. Arem AJ, Madden JW: Effects of stress on healing wounds: I. Intermittent noncyclical tension, J Surg Res 20(2):93-102, 1976.

4. Argenta L, Marks M, Pasyk K: Advances in tissue expansion, Clin Plast Surg 12(2):159-71, 1985.

5. Austad E, Pasyk K, McClatchey K: Histomorphologic evaluation of guinea pig skin and soft tissue after controlled tissue expansion, Plast Reconstr Surg 70:704-10, 1982.

6. Austad E, Thomas S, Pasyk K: Tissue expansion: dividend or loan? Plast Reconstr Surg 78(1):63-8, 1986.

7. Baker S, Swanson N: Clinical applications of tissue expansion in head and neck surgery, Laryngoscope 100:313-9, 1990.

8. Baker S, Swanson N: Rapid intraoperative tissue expansion in reconstruction of the head and neck, Arch Otolaryngol Head Neck Surg 116:1431-4, 1990.

9. Bauman JH, Brand PW: Measurement of pressure between foot and shoe, Lancet p. 629-32, 1963.

10. Beauchene J, et al: Biochemical, biomechanical, and physical changes in the skin in an experimental animal model of therapeutic tissue expansion, J Surg Res 47:507, 1989.

11. Bell JA: Plaster cylinder casting for contractures of the interphalangeal joints. In Hunter J, et al: Rehabilitation of the hand, ed 1, Mosby, 1978, St. Louis.

12. Bell-Krotoski J, Breger DE, Beach RB: Biomechanics and evaluation of the hand. In Mackin E, et al: Rehabilitation of the hand, ed 5, Mosby, 2002, St. Louis.

13. Bell-Krotoski JA: Plaster cylinder casting for contractures of the interphalangeal joints. In Mackin E, et al: Rehabilitation of the hand, vol 2, ed 5, Mosby, 2002, St. Louis.

14. Bennett R, Hirt M: The history of tissue expansion: concepts, controversies and complications, J Dermatol Surg Oncol 19(12):1066-73, 1993.

15. Biewener AA, Fazzalari NL, Konieczynski DD, et al: Adaptive changes in trabecular architecture in relation to functional strain patterns and disuse, Bone 19(1):1-8, 1996.

16. Boyer MI, Gelberman RH, Burns ME, et al: Intrasynovial flexor tendon repair. An experimental study comparing low and high levels of in vivo force during rehabilitation in canines, J Bone Joint Surg [Am] 83-A(6):891-9, 2001.

17. Brand PW: Clinical mechanics of the hand, Mosby, 1985, St. Louis.

18. Brand PW: Deformity in leprosy. In Cochrane RG, Devey TF: Leprosy in theory and practice, Wright & Sons, LTD, 1964, Bristol, England.

19. Brand PW: Hand rehabilitation: management by objectives. In Hunter JM, Schneider LC, Mackin E: Rehabilitation of the hand, ed 2, Mosby, 1984, St. Louis.

20. Brand PW: Lessons from hot feet: a note on tissue remodeling. In Fess E, et al: Hand and upper extremity splinting principles and methods, ed 3, Mosby, 2004, St. Louis.

21. Brand PW: Mechanical factors in joint stiffness and tissue growth, J Hand Ther 8(2):91-6, 1995.

22. Brand PW: Personal communication from Paul Brand: soft tissue remodeling for club foot deformity, 2001, Seattle, WA.

23. Brand PW: The forces of dynamic splinting: ten questions before applying a dynamic splint to the hand. In Hunter JM, Schneider LC, Mackin E: Rehabilitation of the hand, ed 2, Mosby, 1984, St. Louis.

Fig. 3-26 Index-small finger DIP extension and flexion torque transmission splint, type 3 (13)

As described by Brand in the 1950s, joints beyond the physical boundaries of a splint may be remodeled over time by controlling secondary joints and allowing active motion at primary joints. This splint encourages DIP active motion by controlling the secondary wrist, MP, and PIP joints.

24. Brand PW, Beach RB, Thompson DE: Relative tension and excursion of muscles in the forearm and hand, J Hand Surg [Am] 6(3):209-29, 1981.

25. Brand PW, Bell J, Buford Jr WL: Biomechanics of deformity and correction of the insensitive hand, annual seminar, Gilles W. Long Hansens Disease Center, 1984, Carville, LA.

26. Brand PW, Hollister A: Clinical mechanics of the hand, ed 2, Mosby, 1993, St. Louis.

27. Brand PW, Hollister A: Clinical mechanics of the hand, ed 3, Mosby, 1999, St. Louis.

28. Brand PW, Hollister A: External stress: effect at the surface. In Brand PW, Hollister A: Clinical mechanics of the hand, ed 3, Mosby, 1999, St. Louis.

29. Brand PW, Hollister A: Hand stiffness and adhesions. In Brand PW, Hollister A: Clinical mechanics of the hand, ed 3, Mosby, 1999, St. Louis.

30. Brand PW, Hollister A: Mechanics of individual muscles at individual joints. In Brand PW, Hollister A: Clinical mechanics of the hand, ed 3, Mosby, 1999, St. Louis.

31. Brand PW, Hollister A: Methods of clinical measurement in the hand. In Brand PW, Hollister A: Clinical mechanics of the hand, ed 3, Mosby, 1999, St. Louis.

32. Brand PW, Hollister A: Muscles: the motors of the hand. In Brand PW, Hollister A: Clinical mechanics of the hand, ed 3, Mosby, 1999, St. Louis.

33. Brand PW, Hollister A: Operations to restore muscle balance to the hand. In Brand PW, Hollister A: Clinical mechanics of the hand, ed 3, Mosby, 1999, St. Louis.

34. Brand PW, Hollister A, Agee JM: Transmission. In Brand PW, Hollister A: Clinical mechanics of the hand, ed 3, Mosby, 1999, St. Louis.

35. Brand PW, Hollister A, Thompson D: Mechanical resistance. In Brand PW, Hollister A: Clinical mechanics of the hand, ed 3, Mosby, 1999, St. Louis.

36. Brandy D: The principles of scalp extension, Am J Cosmetic Surg 11:245-54, 1994.

37. Breger-Lee DE, Bell-Krotoski J, Brandsma JW: Torque range of motion in the hand clinic, J Hand Ther 3:7-13, 1990.

38. Brunette DM: Mechanical stretching increases the number of epithelial cells synthesizing DNA in culture, J Cell Sci 69:35, 1984.

39. Burnett W: Yank meets native, Natl Geogr 88:105, 1945.

40. Chen C, et al: Geometric control of cell life and death, Sci 276:1425, 1997.

41. Colditz JC: Preliminary report on a new technique for casting motion to mobilize stiffness in the hand. In Proceedings, American Society of Hand Therapists 22nd annual meeting, J Hand Ther 13(1):68-73, 2000.

42. Concannon MJ, Puckett CL: Wound coverage using modified tissue expansion, Plast Reconstr Surg 102(2):377-84, 1998.

43. De Filippo RE, Atala A: Stretch and growth: the molecular and physiologic influences of tissue expansion, Plast Reconstr Surg 109(7):2450-62, 2002.

44. Duran R, et al: Management of flexor tendon lacerations in Zone 2 using controlled passive motion postoperatively. In Hunter J, Schneider L, Mackin E: Tendon surgery in the hand, Mosby, 1987, St. Louis.

45. Ehlert TK, Thomas JR: Rapid intraoperative tissue expansion for closure of facial defects, Arch Otolaryngol Head Neck Surg 117(9):1043-9, 1991.

46. Elfman H: Biomechanics of muscle, J Bone Joint Surg [Am] 48A:363-77, 1966.

47. Endo T, Nakayama Y: Histologic examination of peripheral nerves elongated by tissue expanders, Br J Plast Surg 46(5): 421-5, 1993.

48. Evans R, Thompson D: Immediate active short arc motion following tendon repair. In Hunter J, Schneider L, Mackin E: Tendon and nerve surgery in the hand, a third decade, ed 3, Mosby, 1997, St. Louis.

49. Fess EE: A history of splinting: to understand the present, view the past, J Hand Ther 15(2):97-132, 2002.

50. Fess EE, McCollum M: The influence of splinting on healing tissues, J Hand Ther 11(2):157-61, 1998.

51. Flowers K, LaStayo P: Effect of total end range time on improving passive range of motion, J Hand Ther 7(3):150-7,

1994.

52. Flowers K, Pheasant S: Use of torque angle curves in the assessment of digital joint stiffness, J Hand Ther 1(2):69-75, 1988.

53. Folkman J, Moscona A: Role of cell shape in growth control, Nature 273:345, 1978.

54. Foster JA, Scheiner AJ, Wulc AE, et al: Intraoperative tissue expansion in eyelid reconstruction, Ophthalmology 105(1): 170-5, 1998.

55. Frantz RA, Xakellis GC: Characteristics of skin blood flow over the trochanter under constant, prolonged pressure, Am J Phys Med Rehabil 68(6):272-6, 1989.

56. Freehafer AA, Peckham PH, Keith MW: Determination of muscle-tendon unit properties during tendon transfer, J Hand Surg [Am] 4(4):331-9, 1979.

57. Fujisawa K, et al: Elongation of wallerian degenerating nerve with a tissue expander: a functional, morphometrical, and immunohistochemical study, Microsurgery 16(10):684-91,

1995.

58. Garcia-Elias M, An KN, Berglund L: Extensor mechanism of the fingers. I. A quantitative geometric study, J Hand Surg [Am] 16(6):1130-6, 1991.

59. Gelberman RH, Manske PR: Factors influencing flexor tendon adhesions, Hand Clin 1(1):35-42, 1985.

60. Gibson T, Kenedi R: Biomechanical properties of skin, Surg Clin North Am 47(2):279-94, 1967.

61. Greenbaum SS: Intraoperative tissue expansion with the Foley catheter, J Dermatol Surg Oncol 19(12):1079-83, 1993.

62. Gugenheim J: The Ilizarov method: orthopedic and soft tissue applications, Clin Plast Surg 25(4):567-78, 1998.

63. Gur E, Hanna W, Andrighetti L, et al: Light and electron microscopic evaluation of the pectoralis major muscle following tissue expansion for breast reconstruction, Plast Reconstr Surg 102(4):1046-51, 1998.

64. Homma K, Ohura T, Sugihara T, et al: Prefabricated flaps using tissue expanders: an experimental study, Plast Reconstr Surg 91(6):1098-107, 1993.

65. Ilizarov G: Clinical application of a tension-stress effect for limb lengthening, Clin Orthop 250:8-26, 1990.

66. Ilizarov G: The tension-stress effect on the genesis and growth of tissue. Part I. The influence of stability of fixation and soft-tissue preservation, Clin Orthop 238:249-81, 1989.

67. Ilizarov GA, Lediaev VI, Shitin VP: [The course of compact bone reparative regeneration in distraction osteosynthesis under different conditions of bone fragment fixation (experimental study)], Eksp Khir Anesteziol 14(6):3-12, 1969.

68. Ingber D: Tensegrity: the architectural basis of cellular mechanotransduction, Annu Rev Physiol 59:573, 1997.

69. Ippolito E, et al: Histology and ultrastructure of arteries, veins, and peripheral nerves during limb lengthening, Clin Orthop (308):54-62, 1994.

70. Johanson TM, Lowe L, Brown MD, et al: Histology and physiology of tissue expansion, J Dermatol Surg Oncol 19(12):1074-8, 1993.

71. Johnson P, Kernahan D, Bauer BS: Dermal and epidermal response to soft-tissue expansion, Plast Reconstr Surg 81(3):390-7, 1988.

72. Khouri RK, Schlenz I, Murphy BJ, et al: Nonsurgical breast enlargement using an external soft-tissue expansion system, Plast Reconstr Surg 105(7):2500-12; discussion 2513-4, 2000.

73. Kim K, Hong C, Futrell J: Histomorphologic changes in expanded skeletal muscle in rats, Plast Reconstr Surg 92(4): 710-6, 1993.

74. Kleinert HE, et al: Primary repair of flexor tendons in no-man's land, J Bone Joint Surg 49A:577, 1967.

75. Kleinert HE, Kutz J, Cohen M: Primary repair of zone 2 flexor tendon lacerations. In Hunter J, Schneider L: American Academy of Orthopaedic Surgeons symposium on tendon surgery in the hand, Mosby, 1975, St. Louis.

76. Knight K, McCann J, Vanderkolk C: The redistribution of collagen in expanded pig skin, Br J Plast Surg 43(5):565-70, 1990.

77. Lailas N, Cilento B, Atala A: Progressive ureteral dilation for subsequent ureterocystoplasty, J Urol 156(3):1151-3, 1996.

78. Lantieri LA, Martin-Garcia N, Wechsler J, et al: Vascular endothelial growth factor expression in expanded tissue: a possible mechanism of angiogenesis in tissue expansion, Plast Reconstr Surg 101(2):392-8, 1998.

79. Leighton WD, Russell RC, Feller AM, et al: Experimental pretransfer expansion of free-flap donor sites: II. Physiology, histology, and clinical correlation, Plast Reconstr Surg 82(1):76-87, 1988.

80. LeVay D: The history of orthopaedics, Parthenon, 1990, Park Ridge, NJ.

81. Lew D, Fuseler J: The effect of pulsed expansion of subfascially placed expanders on the extent and duration of mitosis in the capsule and rat integument, J Oral Maxillofac Surg 51(2):154-8, 1993.

82. Lew D, Fuseler J: The effect of stepwise expansion on the mitotic activity and vascularity of subdermal tissue and induced capsule in the rat, J Oral Maxillofac Surg 49(8):848-53, 1991.

83. Liang M, Briggs P, Heckler FR, et al: Presuturing—a new technique for closing large skin defects: clinical and experimental studies, Plast Reconstr Surg 81(5):694-702, 1988.

84. Machida B, Liu-Shindo M, Sasaki G: Immediate versus chronic tissue expansion, Ann Plast Surg 26(3):227-32, 1991.

85. MacLennan SE, Corcoran JF, Neale HW: Tissue expansion in head and neck burn reconstruction, Clin Plast Surg 27(1):121-32, 2000.

86. Madden J: Wound healing: biologic and clinical features. In Sabiston J: Davis-Christopher textbook of surgery, Saunders, 1981, Philadelphia.

87. Madden J: Wound healing: the biological basis of hand surgery, Clin Plast Surg 3(1):3-13, 1976.

88. Madden J, Peacock E: Studies on the biology of collagen during wound healing: dynamic metabolism of scar collagen and remodeling of dermal wounds, Ann Surg 174(3):511-20, 1971.

89. Manske PR, Gelberman RH, Lesker PA: Flexor tendon healing, Hand Clin 1(1):25-34, 1985.

90. Manske PR, Lesker PA, Gelberman RH, et al: Intrinsic restoration of the flexor tendon surface in the nonhuman primate, J Hand Surg [Am] 10(5):632-7, 1985.

91. Marks M, Burney RE, Mackenzie JR, et al: Enhanced capillary blood flow in rapidly expanded random pattern flaps, J Trauma 26(10):913-5, 1986.

92. Mason ML, Allen HS: The rate of healing of tendons: an experimental study of tensile strength, Ann Surg 113:424-59, 1941.

93. Meland N, Smith A, Johnson C: Tissue expansion in the upper extremities, Hand Clinics 13:303, 1997.

94. Micks JE, Reswick JB: Confirmation of differential loading of lateral and central fibers of the extensor tendon, J Hand Surg [Am] 6(5):462-7, 1981.

95. Mustoe T, Bartell T, Garner W: Physical, biomechanical, histologic and biochemical effects of rapid versus conventional tissue expansion, Plast Reconstr Surg 83:687-91, 1989.

96. Neumann CG: The progressive expansion of an area of skin by progressive distention of a subcutaneous balloon, Plast Reconstr Surg 9:121, 1957.

97. Newson T, Pearcy M: Skin surface PO2 measurement and the effect of externally applied pressue, Arch Phys Med Rehabil 62(390), 1981.

98. Nordstrom R: "Stretch back" in scalp reductions for male pattern baldness, Plast Reconstr Surg 73:422-6, 1984.

99. Nordstrom R, Divine J: Scalp stretching with a tissue expander for closure of scalp defects, Plast Reconstr Surg 75:578-81, 1985.

100. Ohkaya S, Hibasam H, Hirata H, et al: Nerve expansion in nerve regeneration: effect of time on induction of ornithine decarboxylase and Schwann cell proliferation, Muscle Nerve 20(10):1314-7, 1997.

101. Ohkaya S, Hirata H, Uchida A: Repair of nerve gap with the elongation of Wallerian degenerated nerve by tissue expansion, Microsurgery 20(3):126-30, 2000.

102. Olenius M, Dalsgaard C, Wickman M: Mitotic activity in expanded human skin, Plast Reconstr Surg 91:213, 1993.

103. Osol G: Mechanotransduction by vascular smooth muscle, J Vasc Res 32:275, 1995.

104. Pasyk K, Argenta L, Hassett C: Quantitative analysis of the thickness of human skin and subcutaneous tissue following controlled expansion with a silicone implant, Plast Reconstr Surg 81:516, 1988.

105. Pasyk K, Austad E, Cherry G: Intracellular collagen fiber in capsule around silicone expanders in guinea pigs, J Surg Res 36:125, 1984.

106. Pasyk K, Austad E, McClatchey K: Electron microscopic evaluation of guinea pig skin and soft tissues expanded with a self-inflating silicone implant, Plast Reconstr Surg 70:37-45, 1982.

107. Radovan C: Adjacent flap development using expandable silatic implant, Presented at the Annual Meeting of the American Society of Plastic and Reconstructive Surgeons, 1976, Boston.

108. Radovan C: Breast reconstruction after mastectomy using a temporary expander, Plast Reconstr Surg 69:195-206, 1982.

109. Rowsell A, Godfrey A, Richards M: The thinned latissimus dorsi free flap: a case report, Br J Plast Surg 39:210, 1986.

110. Ruoslahti E: Stretching is good for a cell, Science 276:1345, 1997.

111. Russell R, Khouri RK, Upton J, et al: The expanded scapular flap, Plast Reconstr Surg 96(4):884-95, 1995.

112. Sachs F: Biophysics of mechanoreception, Membr Biochem 6:173, 1986.

113. Sarrafian S, et al: Strain variations in the components of the extensor apparatus of the finger during flexion and extension, J Bone Joint Surg [Am] 52A(5):980-90, 1970.

114. Sasaki G: Intraoperative sustained limited expansion as immediate reconstructive technique, Clin Plast Surg 14:63-573, 1975.

115. Sasaki G: Tissue expansion in reconstructive and aesthetic surgery, Mosby, 1998, St. Louis.

116. Satar N, Yoo JJ, Atala A: Progressive dilation for bladder tissue expansion, J Urol 162(3 Pt 1):829-31, 1999.

117. Sato M, Ochi T, Nakase T, et al: Mechanical tension-stress induces expression of bone morphogenetic protein (BMP)-2 and BMP-4, but not BMP-6, BMP-7, and GDF-5 MRNA, during distraction osteogenesis, J Bone Miner Res 14(7):1084-95, 1999.

118. Silfverskiold KL, May EJ: Flexor tendon repair in zone II with a new suture technique and an early mobilization program combining passive and active flexion, J Hand Surg [Am] 19(1):53-60, 1994.

119. Skoulis TG, Lovice D, von Fricken K, et al: Nerve expansion. The optimal answer for the short nerve gap. Behavioral analysis, Clin Orthop 314:84-94, 1995.

120. Slavin SA: Nonsurgical breast enlargement using an external soft-tissue expansion system, Plast Reconstr Surg 105(7): 2513-4, 2000.

121. Squier C: The stretching of mouse skin in vivo: effect on epidermal proliferation and thickness, J Invest Dermatol 74:68, 1980.

122. Strickland JW, Gettle K: Flexor tendon repair: the Indianapolis method. In Hunter J, Schneider L, Mackin E: Tendon and nerve surgery in the hand—a third decade, Mosby, 1997, St. Louis.

123. Takei T, Rivas-Gotz C, Delling CA, et al: The effect of strain on human keratinocytes in vitro, J Cell Physiol 173(1):64-72, 1997.

124. Tsuchiya H, Tomita K, Shinokawa Y, et al: The Ilizarov method in the management of giant cell tumors of the proximal tibia, J Bone Joint Surg Br 78(2):264-9, 1996.

125. Twigg SM, Chen MM, Joly AH, et al: Advanced glycosylation end products up-regulate connective tissue growth factor (insulin-like growth factor-binding protein-related protein 2) in human fibroblasts: a potential mechanism for expansion of extracellular matrix in diabetes mellitus, Endocrinology 142(5):1760-9, 2001.

126. Weeks G: Into the heart of Africa, Natl Geogr 110:257, 1956.

127. Weeks PM, Wray RC: The management of acute hand injuries: a biological approach, Mosby, 1973, St. Louis.

128. Wieslander J, Wieslander M: Prefabricated (expander) capsule-lined transposition and advancement flaps in reconstruction of lower eyelid and oral defects: an experimental study, Plast Reconstr Surg 105:1399, 2000.

129. Wilson E, Mai Q, Sudhir K, et al: Mechanical strain induces growth of vascular smooth muscle cells via autocrine action of PDGF, J Cell Biol 123(3):741-7, 1993.

130. Wilson J: Serial excision, Br J Plast Surg 1:117-8, 1948.

131. Withington E: Hippocrates, vol III, Harvard University Press, 1999, Cambridge, MA.

132. Wollina U, Berger U, Stolle C, et al: Tissue expansion in pig skin: a histochemical approach, Anat Hist Embryol 21(2):101-11, 1992.

133. Wood RJ, Adson MH, VanBeek AL, et al: Controlled expansion of peripheral nerves: comparison of nerve grafting and nerve expansion/repair for canine sciatic nerve defects, J Trauma 31(5):686-90, 1991.

134. Wood FM, McMahon SB: The response of the peripheral nerve field to controlled soft tissue expansion, Br J Plast Surg 42(6):682-6, 1989.

135. Xakellis GC, Frantz RA, Arteaga M, et al: A comparison of changes in the transcutaneous oxygen tension and capillary blood flow in the skin with increasing compressive weights, Am J Phys Med Rehabil 70(4):172-7, 1991.

136. Yashi N, Kojimoto H, Shimomura Y: The effect of distraction upon bone, muscle, and periosteum, Orthop Clin North Am 22:563, 1991.

137. Zambacos GJ, Shroff N, Newman PL, et al: Massive prepatellar bursa: a case of natural tissue expansion: anatomic and histologic implications, Plast Reconstr Surg 108(1):267-8, 2001.

Was this article helpful?

0 0
Arthritis Joint Pain

Arthritis Joint Pain

Arthritis is a general term which is commonly associated with a number of painful conditions affecting the joints and bones. The term arthritis literally translates to joint inflammation.

Get My Free Ebook


Post a comment