MOLECULAR-BASIS FOR TISSUE EXPANSION - CLINICAL IMPLICATIONS FOR THE SURGEON

A wide variety of tissue expansion techniques have been used for breas t reconstruction, craniofacial surgery, and burn care in plastic recon structive surgery. However, the basic mechanism by which skill and sur rounding tissue respond to mechanical expansion remains unclear. Recen t studies have revealed the biomechanical aspects of cells subjected t o strain and various factors involved in the str etch-induced signal t ransduction pathway. In this regard, we have reported previously that mechanical force increases keratinocyte growth and protein synthesis a nd alters cell morphology. The mechanism by which strain causes an enh ancement of cellular growth appears to be a network of several integra ted cascades, implicating growth factors, cytoskeleton, and the protei n kinase family. Recently, additional evidence has accumulated that me chanical strain stimulates signal transduction pathways that could tri gger a series of cascades eventually leading to a new skin production. For example, we have evidence suggesting a key role for protein kinas e C (PKC) in mechanosignaling as PKC is activated and translocated in keratinocytes subjected to strain in an isoform-specific manner. In th is report, molecular mechanisms leading to enhancement of skin surface area are reviewed, and possible future applications are discussed.