The effects of tissue expansion on skin lymph flow and lymphatics: An experimental study in rabbits

Histomorphological, physiological, and biomechanical changes of the skin an d tissue that are being expanded have been extensively studied in the past. The purpose of this study was to investigate whether the skin lymph flow a nd lymphatics may be influenced during tissue expansion, and also to study different pattern of vascular supply of skin on lymph flow during tissue ex pansion. The skin lymph flow was quantitatively assessed by Tc-99m-dextran lymphoscintigraphy, and the structure of dermal lymphatics was evaluated by histological examination in 12 rabbits. Lymphoscintigraphic results showed that lymph flow is significantly reduced both in expanded and non-expanded (sham-operated) skin. Histologically, we saw widespread lymphatic distensi on in both expanded and non-expanded skin. There were no quantitative diffe rences in the number of lymphatic vessels compared with control skin. We di d not see any lymphatic capillaries in the subdermal capsule of either expa nded or non-expanded skin. These results show that lymphostasis has an obst ructive (mechanical) aetiology, and the tissue expander itself reduces the lymph flow regardless of expansion, and interferes with the formation of ne w lymphatic vessels.