Ultrastructural effects of topical dimethyl sulfoxide on collage fibers during acute skin expansion in a human ex-vivo model

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 cutaneous flaps. Methods: Specimens were obtained and ultrastructurally examined from two groups of ex vivo cutaneous flaps from the anterior thigh: group A (experimental) DMSO-treated and acutely expanded flaps, and group B (control), acutely expanded flaps. Results: A statistically significant difference was observed between 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.