The Effects of Negative Pressure by External Tissue Expansion Device on Epithelial Cell Proliferation, Neo-Vascularization and Hair Growth in a Porcine Model.

While pre-treating a fat transplant recipient site with negative pressure has shown promise for increasing the fat survival rate, the underlying mechanisms have not been investigated, partly due to challenges related to immobilization of vacuum domes on large animal subjects. The aim of this study was to examine the effect of negative pressure treatment by External Tissue Expansion Device (ETED) on fat grating recipient sites in a porcine model. The ETED was designed to provide negative pressure on the dorsum of swine. Pressure treatment (-70 mmHg) was applied for 1 or 3 hours every other day for 10 and 20 treatments. The treated areas (3.5 cm in diameter) were harvested and examined for histological changes, vessel density, cell proliferation (Ki67) and growth factor expression (FGF-1, VEGF and PDGB-bb). The application of the ETED increased epidermis thickness even after 1-hour treatments repeated 10 times. The results of Ki67 analysis suggested that the increasing thickness was due to cell proliferation in the epidermis. There was a more than two-fold increase in the vessel density, indicating that the ETED promotes vascularization. Unexpectedly, the treatment also increased the number of hair follicles. Negative pressure provided by the ETED increases the thickness of epidermis section of tissue, cell proliferation and vessel density. The porcine model provides a better representation of the effect of the ETED on skin tissue compared to small animal models and provides an environment for studying the mechanisms underlying the clinical benefits of negative pressure treatment.