Dmitriy E. Protsenko

Electromechanical reshaping of septal cartilage

Objectives: This study describes the process of tissue electroforming and how shape changes in cartilage can be produced by the application of direct current (DC). The dependence of shape change on voltage and application time is explored. Study Design: Basic investigation using ex vivo porcine septal cartilage grafts and electromechanical cartilage deformation focused on development of a new surgical technique. Methods: Uniform flat porcine nasal septal cartilage specimens were mechanically deformed between two semicircular aluminum electrodes. DC current was applied to establish charge separation and electrical streaming potential. Voltage (0–3.5 V) and application time (0–5 minutes) were varied. Shape change was measured, and shape retention was calculated using analytic representation. The effect of the direction of applied current on shape change was evaluated by switching the polarities of electrodes and using parameters of 0 to 5.5 V and 5 minutes. Temperature during reshaping was monitored with a thermocouple, and surface features were evaluated using light microscopy. Results: Reshaped specimen demonstrated mechanical stability similar to native cartilage tissue. Shape retention strongly correlated with increasing voltage and application time. Only a small current (<0.1 A) through the tissue was measured. Temperature change was less than 2°C during electroforming, suggesting that electroforming likely results from some nonthermal mechanisms. Surface features indicated that electrodeposition may occur depending on electrode material and magnitude of the applied voltage. Conclusions: These findings demonstrate that cartilage can be reshaped through the process we have described as “electroforming” by generating intrinsic differences in charge separation with negligible heat production.

Needle-Electrode-Based Electromechanical Reshaping of Rabbit Septal Cartilage: A Systematic Evaluation

Electromechanical reshaping (EMR) provides a means of producing shape change in the cartilage by initiating oxidation-reduction reactions in mechanically deformed specimens. This paper evaluates the effect of voltage and application time on specimen shape change using needle electrodes. Rabbit septal cartilage specimens (20 mm × 8 mm × 1 mm, n = 200) were bent 90° in a precision-machined plastic jig. Optimal electrode placement and the range of applied voltages were estimated using numerical modeling of the initial electric field within the cartilage sample. A geometric configuration of three platinum needle electrodes 2 mm apart from each other and inserted 6 mm from the bend axis on opposite ends was selected. One row of electrodes served as the anode and the other as the cathode. Constant voltage was applied at 1, 2, 4, 6, and 8 V for 1, 2, and 4 min, followed by rehydration in phosphate buffered saline. Samples were then removed from the jig and bend angle was measured. In accordance with previous studies, bend angle increased with increasing voltage and application time. Below a voltage threshold of 4 V, 4 min, no clinically significant reshaping was observed. The maximum bend angle obtained was 35.7 ± 1.7° at 8 V, 4 min.

Temperature Dependent Change in Equilibrium Elastic Modulus After Thermally Induced Stress Relaxation in Porcine Septal Cartilage

Laser cartilage reshaping (LCR) is a promising method for the in situ treatment of structural deformities in the nasal septum, external ear and trachea. Laser heating leads to changes in cartilage mechanical properties and produces relaxation of internal stress allowing formation of a new stable shape. While some animal and preliminary human studies have demonstrated clinical feasibility of LCR, application of the method outside specialized centers requires a better understanding of the evolution of cartilage mechanical properties with temperature. The purpose of this study was to (1) develop a method for reliable evaluation of mechanical changes in the porcine septal cartilage undergoing stress relaxation during laser heating and (2) model the mechanical changes in cartilage at steady state following laser heating.

Nasal tip support: A finite element analysis of the role of the caudal septum during tip depression

Although minor and major tip support mechanisms have been described in detail, no quantitative models exist to provide support for the relative contributions of the structural properties of the major alar cartilage, the fibrous attachments to surrounding structures, and the rigid support structures in an objective manner.

Mechanical Analysis of the Effects of Cephalic Trim on Lower Lateral Cartilage Stability

OBJECTIVE To determine how mechanical stability changes in the lower lateral cartilage (LLC) after varying degrees of cephalic resection in a porcine cartilage nasal tip model. METHODS Alar cartilage was harvested from fresh porcine crania (n = 14) and sectioned to precisely emulate a human LLC in size and dimension. Flexural mechanical analysis was performed both before and after cephalic trims of 0 (control), 4, and 6 mm. Cantilever deformation tests were performed on the LLC models at 3 locations (4, 6, and 8 mm from the midline), and the integrated reaction force was measured. An equivalent elastic modulus of the crura was calculated assuming that the geometry of the LLC model approximated a modified single cantilever beam. A 3-dimensional finite element model was used to model the stress distribution of the prescribed loading conditions for each of the 3 types of LLC widths. RESULTS A statistically significant decrease (P = .02) in the equivalent elastic modulus of the LLC model was noted at the most lateral point at 8 mm and only when 4 mm of the strut remained (P = .05). The finite element model revealed that the greatest internal stresses was at the tip of the nose when tissue was flexed 8 mm from the midline. CONCLUSION Our results provide the mechanical basis for suggested clinical guidelines stating that a residual strut of less than 6 mm can lead to suboptimal cosmetic results owing to poor structural support of the overlying skin soft-tissue envelope by an overly resected LLC.

Rethinking nasal tip support: A finite element analysis

We employ a nasal tip finite element model (FEM) to evaluate contributions of two of the three major tip support mechanisms: attachments between the upper and lower lateral cartilages and attachment of the medial crura to the caudal septum.

Thermoforming of Tracheal Cartilage: Viability, Shape Change, and Mechanical Behavior

Trauma, emergent tracheostomy, and prolonged intubation are common causes of severe deformation and narrowing of the trachea. Laser technology may be used to reshape tracheal cartilage using minimally invasive methods. The objectives of this study were to determine: (1) the dependence of tracheal cartilage shape change on temperature and laser dosimetry using heated saline bath immersion and laser irradiation, respectively, (2) the effect of temperature on the mechanical behavior of cartilage, and (3) tissue viability as a function of laser dosimetry.

Electromechanical Reshaping of Costal Cartilage Grafts: A New Surgical Treatment Modality

Needle electrode‐based electromechanical reshaping (EMR) is a novel, ultra‐low‐cost nascent surgical technology to reshape cartilage with low morbidity. EMR uses direct current to induce mechanical relaxation in cartilage that is first deformed into a required geometry, which in turn leads to permanent shape change. The objective of this study was to determine the effect of EMR voltage and time on the shape change of costal cartilage grafts.

In vivo electromechanical reshaping of ear cartilage in a rabbit model: a minimally invasive approach for otoplasty.

OBJECTIVE To report the first successful study to date of in vivo electromechanical reshaping of ear cartilage in a rabbit model. METHODS Ears of New Zealand white rabbits were reshaped using percutaneous needle electrode electromechanical reshaping (5 V for 4 minutes) and were then bolstered for 4 weeks. Ten ears were treated, with 2 undergoing sham procedures and serving as controls. The treatment was performed using a platinum array of electrodes consisting of 4 parallel rows of needles inserted across the region of flexures in the ear. After 4 weeks, the animals were killed, and the ears were photographed and sectioned for conventional light microscopy and confocal microscopy (live-dead fluorescent assays). RESULTS Significant shape change was noted in all the treated ears (mean, 102.4°; range, 87°-122°). Control ears showed minimal shape retention (mean, 14.5°; range, 4°-25°). Epidermis and adnexal structures were preserved in reshaped ears, and neochondrogenesis was noted in all the specimens. Confocal microscopy demonstrated a localized zone of nonviable chondrocytes (<2.0 mm in diameter) surrounding needle sites in all the treated ears. CONCLUSIONS Electromechanical reshaping can alter the shape of the rabbit auricle, providing good creation and retention of shape, with limited skin and cartilage injury. Needle electrode electromechanical reshaping is a viable technique for minimally invasive tissue reshaping, with potential applications in otoplasty, septoplasty, and rhinoplasty. Further studies to refine dosimetry parameters will be required before clinical trials.

A Finite Element Model to Simulate Formation of the Inverted-V Deformity

IMPORTANCE Computational modeling can be used to mimic the forces acting on the nasal framework that lead to the inverted-V deformity (IVD) after surgery and potentially determine long-range outcomes. OBJECTIVE To demonstrate the use of the finite element method (FEM) to predict the formation of the IVD after separation of the upper lateral cartilages (ULCs) from the nasal septum. DESIGN, SETTING, AND PARTICIPANTS A computer model of a nose was derived from human computed tomographic data. The septum and upper and lower lateral cartilages were designed to fit within the soft-tissue envelope using computer-aided design software. Mechanical properties were obtained from the literature. The 3 simulations created included (1) partial fusion of the ULCs to the septum, (2) separation of the ULCs from the septum, and (3) a fully connected model to serve as a control. Forces caused by wound healing were prescribed at the junction of the disarticulated ULCs and septum. Using FEM software, equilibrium stress and strain were calculated. Displacement of the soft tissue along the nasal dorsum was measured and evaluated for evidence of morphologic change consistent with the IVD. MAIN OUTCOME AND MEASURES Morphologic changes on the computer models in response to each simulation. RESULTS When a posteroinferior force vector was applied along the nasal dorsum, the areas of highest stress were along the medial edge of the ULCs and at the junction of the ULCs and the nasal bones. With full detachment of ULCs and the dorsal septum, the characteristic IVD was observed. Both separation FEMs produced a peak depression of 0.3 mm along the nasal dorsum. CONCLUSIONS AND RELEVANCE The FEM can be used to simulate the long-term structural complications of a surgical maneuver in rhinoplasty, such as the IVD. When applied to other rhinoplasty maneuvers, the use of FEMs may be useful to simulate the long-term outcomes, particularly when long-term clinical results are not available. In the future, use of FEMs may simulate rhinoplasty results beyond simply morphing the outer contours of the nose and allow estimation of potentially long-term clinical outcomes that may not be readily apparent. LEVEL OF EVIDENCE NA.