Wound Hedaling: distortion and generation of cartilage
Distortion of a cartilage structure is defined as an acute change of form in reaction to a local injury. Wound healing is restricted to the site of the le- sion (Chapter 2A). Distortion may extend to non-injured parts or even to the total structure. Injury-induced distortions have previously been reported for rib cartilage [1,2] and nasal septum cartilage [3–6]. Distortion is considered to depend on cartilage specific biophysical properties. The resilient and elas- tic quality of cartilage has been ascribed to the high content (80%) of water bound by hydrophilic proteins embedded in a 3-dimensional network of col- lagen fibres. The fibrous component determines the specific form of the structure. Interruption of the fibrous network will alter the balance between the network and the protein-bound water, and cause an immediate change of form –distortion– of the cartilage by a ‘release of interlocked stresses’ .This hypothetical mechanism has been first exploited in surgery of the na- sal septum. Straightening of a curved part of septum cartilage can be accom- plished by ‘controlled distortion’, effectuated by a few parallel incisions (scoring) on the concave side . Cricoid pathology, as observed in a few post-mortem specimens from neonates or very young children, also points to injury-induced distortion . The results from previous animal studies, focusing on the long-term effects of various types of endolaryngeal trauma, further supported the hypothesis of injury-induced distortion [8–11]. Finally, in surgical practice it is common knowledge that an anterior split of the cricoid –as a first step in larynx sur- gery– invariably leads to an immediate gap between the cut ends due to re- traction (distortion) of the cartilage on both sides. The Chapters 2B, 2C and 2D focus on injury-induced distortion and deal with the following questions: 1. Is the gap, following an anterior cricoid split, the result of an intrinsic distortion of the cartilage and/or the effect of extrinsic forces from outside the cartilage, originating in soft tissues with an insertion on the cricoid? 2. Does the distortion of a split cricoid show any changes during a long- term follow-up? 3. Is the immediate and long-term distortion of a cricoid cartilage related to age?
|Erasmus University Rotterdam|
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ten Koppel, P.G.J. (2005, June 8). Wound Hedaling: distortion and generation of cartilage. Erasmus University Rotterdam. Retrieved from http://hdl.handle.net/1765/8053
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