For more than a century, surgeons have envisioned reshaping tissue without the use of scalpels and sutures. Recently, developments with multiple therapeutic modalities have brought this vision closer to reality through development of new procedures, minimally invasive instrumentation, and innovative devices for treating skin and other tissues;each of which exploits the ability of these modalities to alter the intrinsic material properties of the tissue. In the head and neck, cartilage tissue is of particular interest as it serves functional and structural roles, including the support of soft tissue (ear and nose), airway patency (trachea), phonation (larynx), and joint movement (i.e.,TMJ). The defects that result from cancer, trauma, or congenital malformations in these organs are currently corrected by """"""""cut and suture"""""""" surgery, which has numerous disadvantages including shape memory, donor site morbidity, and usually general anesthesia. We have developed electromechanical reshaping (EMR), a novel minimally invasive technique that combines mechanical deformation with the application of very low-current DC electric fields. In EMR cartilage is bent into a new shape by a jig, platinum needle electrodes are inserted into regions of increased internal stress, and a small current (<25 mA) is delivered. The jig is removed, and the cartilage assumes a new stable shape. EMR is a novel and compelling technology that exploits the native properties of cartilage to change its mechanical state by simply altering the electrical and chemical milieu that interacts with the charged cartilage tissue matrix. To drive this technology forward, we aim to: 1) determine the relationships between shape change, voltage, and application time during EMR;2) determine the degree of tissue damage produced during EMR as a function of voltage and application time;and 3) determine the stability, functionality, and long-term behavior of electroformed cartilage grafts in an in vivo rabbit model. As with all emerging surgical technologies, efficacy must be demonstrated in an animal model to fuel clinical interest and provide justifiable motivation to pursue more extensive basic studies focusing on both mechanisms and optimization. Knowing how cartilage heals, remodels, and maintains shape after EMR will provide impetus to further develop and investigate methods to understand, optimize, and control this process and ultimately usher in a new therapeutic surgical modality. EMR is an elegant and simple, low-cost technology, and has the potential to become a clinically useful surgical treatment modality as ubiquitous as the Bovie cautery, surgical stapler, or endoscope in reconstructive surgery.
Deformities of the ear, nose, and airway are common and surgery to correct these disorders requires general anesthesia, incisions, sutures and bleeding. The development of the technology proposed in this grant is aimed at advancing this simple, non-surgical method to reshape tissue in these organs in the face, head, and neck. This technology is potentially simpler, safer, and less expensive than current existing surgical techniques.
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