Ultrastructural effects of topical dimethyl sulfoxide on collage
fibers during acute skin expansion in a human ex-vivo model
Received: 7 December 2016 /Accepted: 9 March 2017 /Published online: 31 March 2017
#Springer-Verlag Berlin Heidelberg 2017
Background Despite some studies confirming the effectiveness
of dimethyl sulfoxide (DMSO) on acute skin expansion, the
precise mechanism through which it quickens tissue expansion
is yet unknown. No studies have been carried out to date to
thoroughly investigate the ultrastructural effects of DMSO on
intraoperative tissue expansion. The aim of the present study
was to test the ex vivo ultrastructural effects of topical 60%
DMSO on dermal collagen fibers of acutely expanded human
Methods Specimens were obtained and ultrastructurally exam-
ined from two groups of ex vivo cutaneous flaps from the an-
terior thigh: group A (experimental) DMSO-treated and acutely
expanded flaps, and group B (control), acutely expanded flaps.
Results A statistically significant difference was observed be-
tween groups A and B, with respect to the width of dermal
collagen fibers, distance between dermal collagen fibers, and
percentage of area not occupied by collagen fibers.
Conclusions These findings demonstrate how DMSO affects
collagen cross-linkage in the surrounding dermis, decreasing the
mechanical resistance of the acutely expanded skin in this ex-vivo
model, supporting its use in intra-operative tissue expansion.
Level of Evidence: Not ratable.
Keywords Acute skin expansion .Dimethyl sulfoxide .
Since the introduction of intraoperative tissue expansion by Sasaki
in 1987 [1,2], several authors have reported successful soft-tissue
reconstruction using this technique [3–16], and controlled studies
using animal models have confirmed its effectiveness [17,18].
A wide range of substances have been tested with the hope
of reducing some of the major drawbacks associated with
tissue expansion, i.e., the expander pressure and the length
of the procedure . Dimethyl sulfoxide [(CH
(DMSO) is an amphipathic molecule frequently used as a
solvent in biological studies and as a vehicle for drug therapy
system . As we have reported in previous studies, DMSO
has many interesting features especially with respect to plastic
surgery, from its ability to increase perfusion decreasing ische-
mia in cutaneous flaps to significant enhancement of intraop-
erative tissue expansion during breast reconstruction [21,22].
Tissue expansion exploits the skin’s ability to adapt to con-
tinuous changes. Its overall mechanical properties are largely
determined by the dermis and the amount/distribution of col-
lagen fibers that, when stretched, became oriented in a direc-
tion parallel to the stretching forces, enabling them to resist
further extension [23–30]. The use of drugs affecting collagen
cross-linkage in the surrounding dermis might be of some
value in decreasing the mechanical resistance of the acutely
expanded skin. In this regard, despite some studies that have
been carried out to confirm the effectiveness of DMSO on
acute skin expansion [31,32], the precise mechanism through
which it quickens tissue expansion is yet unknown. In partic-
ular, to the best of our knowledge, no studies have been car-
ried out to date to investigate thoroughly the ultrastructural
effects of DMSO on intraoperative tissue expansion. The
aim of the present study was to test the ex vivo ultrastructural
effects of topical DMSO on dermal collagen fibers of acutely
expanded human cutaneous flaps.
Department of Surgical Sciences, Plastic Surgery Division,
University of Parma, Via Gramsci 14, 43126 Parma, Italy
Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit,
Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
Eur J Plast Surg (2017) 40:271–276