维持扩张期对扩张皮肤张力和即时回缩率影响的研究

目的：研究维持扩张期对扩张皮肤在体张力和即时回缩率的影响，并以此指导临床。方法：以狗为动物模型，在6只成年大狗的背侧，对称设计6个区域。实验分为注水2周组、6周组、实验对照组和空白对照组。分析比较各组的在体张力和即时回缩率（包括有包膜和去包膜）。结果：皮肤在体张力和即时回缩率随着维持期的延长逐渐缩小，而注水期的长短对其影响不大；去除包膜后皮肤的在体张力和即时回缩率明显降低。在此基础上，临床应用16例23个扩张器的效果较好。结论：在皮肤软组织扩张术中，可以通过缩短注水期（2周左右）、适当延长维持期（4周）以及去包膜的方法，可以达到减少扩张皮肤的在体张力和即时回缩率，增加扩张皮肤面积的目的。     

皮肤软组织重复扩张的生物力学

目的探讨皮肤软组织重复扩张的生物力学规律，为应用和推广皮肤软组织重复扩张术提供理论基础。方法以6只小型猪为实验动物，实验分为正常对照组、常规扩张组、重复扩张组，分别切取皮肤试件，进行应力应变、应力松弛、极限抗拉强度各项生物力学指标的测定。结果常规扩张组和重复扩张组每个试件的应力应变曲线、应力松弛曲线较正常对照组均有偏离，其极限抗拉强度较之也有明显降低；其中重复扩张组的应力应变曲线、应力松弛曲线的偏离最大，其极限抗拉强度的降低也最显著。结论常规扩张的皮肤软组织的黏弹性较正常皮肤软组织有降低的趋势，重复扩张的皮肤软组织的黏弹性较常规扩张的皮肤软组织有进一步降低的趋势。初步明确了皮肤软组织重复扩张的的生物力学特性及其变化规律，对临床工作有一定的参考意义。     

Quantitative benefits provided by acute tissue expansion: a biomechanical study in human cadavers.

The aim of this study was to test the ex vivo biomechanical properties of acutely expanded cutaneous flaps to quantitatively assess the efficacy of intraoperative tissue expansion. A total of 14 fresh male cadavers were used for the study. In each cadaver, a rectangular (15 x 8 cm), proximally based flap was designed on each side of the body, in three different locations: lateral arm, anterior thorax, anterior thigh. In each cadaver, one randomly selected flap per each body region underwent acute-intermittent expansion, whereas the contralateral flap served as control. The biomechanical properties (stress/strain ratio, mean stiffness) of both expanded and control flaps were then assessed by means of a dynamometer and a force-transducer. The obtained data showed that the biomechanical benefits provided by acute tissue expansion were statistically different (P< 0.05) from those obtained by simple subcutaneous undermining. While no changes of length have been observed in the acutely expanded skin flaps as compared to control cutaneous flaps, a statistically significant gain in the compliance of the former has been recorded as compared to the biomechanical behaviour of the latter.     

每次反复注水快速皮肤扩张法的实验研究

目的　探讨最佳的皮肤扩张法,了解每次反复注水快速皮肤扩张法的效果及机理。方法　白色乳猪4只,在脊柱两侧各设计3个皮瓣组,分别为每次反复注水快速扩张组、常规扩张组、对照组,在监测囊内压的情况下定期扩张,扩张结束后分别测定和比较扩张总面积、时间、皮肤的即时回缩率以及囊内压的变化,并进行组织学及超微结构的观察。结果　每次反复注水快速扩张组扩张后总面积明显大于常规扩张组（P＜0.05）,皮肤即时回缩率与常规扩张组间无明显差异（P＞0.05）,扩张总时间短于常规扩张组,扩张前囊内压在每次反复注水快速扩张组与常规扩张组间差异无显著性（P＞0.05）,每次反复注水快速扩张组扩张后皮肤的超微结构及功能与常规扩张组无明显区别。结论　每次反复注水快速皮肤扩张法是一种有效的、安全的方法,可在临床上推广应用。     

Intraoperative expansion of scalp flaps. Quantitative assessment

BACKGROUND: The aim of this study was to test the ex-vivo biomechanical properties of acutely expanded scalp flaps, in order to quantitatively assess the efficacy of acute scalp expansion. METHODS: A total of 14 fresh male cadavers were used for the study. In each cadaver, a rectangular (4 x 10 cm), laterally-based flap was designed on each side of the scalp, starting from the superior margin of the external auditory canal. One randomly-selected flap per each scalp underwent acute-intermittent expansion (3-minute expansion-3-minute rest cycle per three times with the maximal expansion achievable), while the contralateral flap served as control. After the expansion process, the acutely-expanded flaps were measured to assess if the applied biomechanical stress have determined any changes in their dimensions. The biomechanical properties (stress/strain ratio, mean stiffness) of both expanded and control flaps were then assessed by means of a dynamometer and a force-transducer. RESULTS: The obtained data showed that the biomechanical benefits provided by acute scalp expansion were not statistically different (p < 0.05) from those obtained by simple subgaleal undermining. Neither any change of length nor any gain in the compliance have been observed in the acutely-expanded flaps as compared to control scalp flaps. CONCLUSIONS: In our opinion, a possible explanation (to be further validated) for the lack of effect of acute scalp expansion might be that inelastic galea aponeurotica did not allow the mechanical creep to exploit the inherent elastic properties of the overlying scalp skin.     

他莫昔芬对扩张皮瓣即时回缩率及纤维包膜组织学的影响

目的探讨他莫昔芬对扩张皮瓣回缩率及纤维包膜组织结构的影响和作用机制。方法以灰兔为实验动物,分为实验组(A组)和对照组(B组),将软组织扩张器置入灰兔皮下扩张,B组普通饲料喂养,A组加喂他莫昔芬。分别观察扩张皮瓣即时回缩率和纤维包膜的厚度,通过HE、VG染色观察两组扩张后10d和20d扩张皮瓣和纤维包膜成纤维细胞、胶原纤维含量。结果①A组的即时回缩率和纤维包膜厚度均小于B组(P<0.05)。②A组扩张皮瓣中成纤维细胞、胶原纤维与B组比较差异无显著意义(P>0.05),而在纤维包膜中明显少于B组(P<0.05)。结论在动物体内,他莫昔芬可以有效地减少扩张皮瓣即时回缩率,明显抑制扩张皮瓣纤维包膜中成纤维细胞和胶原纤维的增生。     

bFGF和硫糖铝在组织扩张术中的应用

目的：探索碱性居纤维细胞生长因子（bFGF）和硫糖铝在扩张术中的临床应用方法与效果。方法：皮肤瘢痕及鼻尖缺损患者共12例，经病变外边缘垂直切口埋置扩张器23个，持续恒免疫组化检测。结果：术后1－3d即可开始持续扩张，平均扩张时间为8．9d；第一、二期手术间隔平均13．5d，平均住院时间为28．4d。扩张后皮肤软组织即时回缩率平均25．7％，皮瓣全部皮活。组织学、PCNA检测显示表皮层明显增厚、细胞层数增加，胶原纤维排列较密，弹力纤维、成纤维细胞、毛细血管密度增高；增生期基底细胞增多，分布广泛。结论：采用此法扩张速度快，能明显缩知疗程，提高皮瓣质量，改善治疗效果。     

扩张皮肤移植后的生物力学变化

目的:探讨扩张皮肤移植后的生物力学变化。方法:成年狗8只,每只背部置入4个150ml扩张器,两个不扩张作为对照。注水8周取出扩张器,扩张组:切取标本后形成和基底大小一致的皮瓣原位移植;对照组:一侧切取标本,另一侧取出扩张器后皮瓣原位缝合,以作远期观察。然后随机将8只狗平均分为4组,皮瓣移植后3周、6周、3个月、6个月时在实验部位取1cm×4cm大小的皮肤3块,分别进行应力-应变、应力松弛、极限抗拉强度测定。结果:扩张后皮肤的粘弹性及强度均下降,前者于移植后半年恢复,后者恢复较慢,移植后6个月仍未完全恢复。结论:皮肤扩张后的改变是一种暂时的现象,扩张皮肤于移植后6个月物理特性基本恢复正常。     

Biomechanical and histomorphological changes in expanded rabbit skin

In 12 rabbits, biomechanical and histomorphological properties were determined in expanded, sham-operated and non-operated control skin. Results were evaluated in paired fashion. Both expanded and sham-operated skin showed a significant loss of stiffness of 60% and 35% respectively (rho less than 0.001 and rho less than 0.05). In addition, maximum stiffness in expanded skin was reached at a shorter extensibility than in sham-operated or non-operated control skin. Histomorphological examination revealed thickened dermal collagen bundles with loosened packing of collagen fibrils in both expanded and sham-operated skin. It is concluded that the surgical procedure of balloon implantation is responsible for a significant part of the reported biomechanical and histomorphological findings. Wound healing, in addition to the delay phenomenon, may therefore be a mechanism involved in skin expansion.     

高压氧对快速扩张皮肤血流影响的实验研究

目的：探讨高压氧对快速扩张皮肤血流量的影响。方法：以新西兰大白兔为动物模型,实验分为3组：①高压氧治疗快速扩张组（A组）;②单纯快速扩张组（B组）;③仅埋置扩张器不扩张的对照组（C组）。测量各组术前、术后、注射盐水前后及高压氧治疗结束后即刻血流量及皮肤温度的变化,进行比较和统计学分析。结果：术前A组扩张区域皮肤血流量为93.32±11.93pu,B组为96.35±14.31pu,扩张前两天,两组血流量无显著性差异（P〉0.05）,扩张第四天至扩张结束A组扩张皮肤血流量较B组多（P〈0.01）,扩张最后一天,注水前A组扩张皮肤血流量为130.63±16.68pu,B组为35.05±4.89pu;在扩张前7天,A组与B组注水前后皮肤温度均下降约0.6℃,从第8天开始至扩张期结束,A组注水前后皮温仅轻微下降,而B组下降约0.6℃。结论：在本实验条件下,将高压氧疗法应用于快速扩张术中可有效增加扩张皮肤血流灌注量,对扩大组织扩张术的应用范围、减少并发症、提高手术效果有一定的参考价值。     

重复皮肤组织扩张术的临床、生物力学及病理观察

目的 总结重复皮肤扩张的经验,探讨其组织学和生物力学变化,为在临床的应用提供理论基础和实践经验.方法 对已扩张的皮肤进行重复扩张,分次修复缺损,首次扩张与重复扩张的时间间隔平均为8个月.将31例分为儿童组和成人组,对重复扩张术的治疗经验进行总结,测量首次和重复扩张后皮瓣的增长率,并做生物力学特性检测和病理观察,进行两组间的比较.结果 共治疗31例,第1、2次扩张过程中的并发症发生率分别为10%、17%,随访6～12个月,大部分治疗效果满意.重复扩张后两组的皮瓣增长率均下降、应力-松弛特性和断裂强度减弱、表皮增殖减少,尤以成人组较为显著.结论 皮肤重复扩张术是临床可行的手术方法,在儿童可取得比成人更加满意的手术效果,但因其风险增大、皮瓣质量下降,应用时应小心慎重.     

THE EFFECTS OF TISSUE EXPANSION ON SKIN LYMPH FLOW AND LYMPHATICS: AN EXPERIMENTAL STUDY IN RABBITS

Histomorphological, physiological, and biomechanical changes of the skin and 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 and lymphatics may be influenced during tissue expansion, and also to study different pattern of vascular supply of skin on lymph flow during tissue expansion. The skin lymph flow was quantitatively assessed by 99mTc-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 distension in both expanded and non-expanded skin. There were no quantitative differences in the number of lymphatic vessels compared with control skin. We did not see any lymphatic capillaries in the subdermal capsule of either expanded or non-expanded skin. These results show that lymphostasis has an obstructive (mechanical) aetiology, and the tissue expander itself reduces the lymph flow regardless of expansion, and interferes with the formation of new lymphatic vessels.     

吻合血管游离皮瓣移植后皮肤再扩张的实验研究

在应用耳后皮肤扩张行耳廓再造的手术中，为了解决耳后皮肤不正常，如烧伤后耳后有瘢痕不能行皮肤扩张的问题，我们设计了吻合血管游离皮瓣移植后皮肤再扩张的手术方式，为证实手术设计的可行性，在兔体上进行此术式的动物实验。用兔双侧胸背部皮肤，一侧作原位吻合血管游离皮瓣移植后，再扩张；另一侧作常规的皮肤扩张。从扩张容量、扩张中有无并发症、皮肤血管的变化和组织学观察等方面比较两组之间均无显著性差异（Ｐ＞０．０５）。表明，在兔体上吻合血管游离皮瓣移植后再皮肤扩张对皮肤扩张无明显不良影响，为临床应用提供参考。     

扩张皮肤移植后生物学转归的实验研究

目的 研究扩张皮肤移植后的远期生物学转归。方法 于狗扩张皮肤移植时和移植后3，6周及3，6个月分别观测其面积、组织学、电镜、胶原含量、皮肤力学、和免疫组化染色等项的变化。结果 各项指标在3－6个月时均恢复至对照组水平，接近正常。结论 扩张皮肤的生物学变化在移植后3个月依然存在，3－6个月逐渐恢复正常，表现为一个创伤愈合过程。     

磷酸化ERK在扩张皮肤组织中的分布和表达

目的：观察细胞外信号调节激酶（ERK1／2）在扩张皮肤表皮中的分布情况，探讨皮肤扩张机理。方法：利用免疫组织化学技术ABC法，对人不同扩张区皮肤和正常皮肤磷酸化ERK的分布和表达进行定性测定，并对结果进行图像分析。结果：（1）扩张皮肤和正常皮肤表皮基底层都有磷酸化ERK的表达和分布，但扩张皮肤中的磷酸化ERK的分布和表达较明显，染色较深且密，部分阳性细胞呈多层排列，有散在的增殖闭区；（2）扩张皮肤的顶部和侧部差别不十分明显，而侧部和顶部与基底部有一定的差别，基底部染色较深，多为细胞核着色。（3）经图像分析不同部位的正常皮肤和扩张皮肤以及扩张皮肤的不同部分的相对灰度值和阳性细胞密度，进一步证实了上述观察结果。结论：扩张皮肤表皮细胞磷酸化ERK增加，推测磷酸化ERK可能在扩张皮肤细胞增殖过程中发挥一定的作用，在扩张刺激的作用下，表皮细胞内的ERK被大量激活，随即激活下游分子，进而引起细胞的增殖，最终实现皮肤的扩张。     

Enhanced capillary blood flow in rapidly expanded random pattern flaps

We have quantitatively examined the effect of rapid sequential skin expansion on capillary blood flow in the porcine random flap model in order to determine the relation between the increased survivability of expanded random flaps and capillary blood flow. Three 6 X 20 cm random flaps were tattooed on the backs of six small (20-kg) pigs. One flap was not manipulated (control). A 450-ml expander was inserted at the base of the second flap and left in place (sham). At the base of the third flap a 450-ml expander was inserted and each day for 5 days sequentially filled to the limits of skin viability as determined by vital dye staining (expanded). Capillary blood flow was measured on day 8 by measurement of radioactivity after injection of 15-microns radiolabeled microspheres. Samples were taken at 4-cm intervals from the base of each flap. Rapid expansion led to significant increases in capillary blood flow in expanded skin and to enhanced preservation of capillary flow after elevation of random pattern flaps based on expanded skin compared to sham and to control tissues. This correlates with and explains at least in part our previous observation of improved length of survival of flaps raised on expanded skin.     

扩张后皮肤挛缩动力环境的实验研究

目的　研究皮肤扩张后真皮内环境的变化及其与挛缩过程的关系。方法　采用兔头部扩张模型进行皮肤扩张实验,通过免疫组化、放射免疫测定等方法研究了真皮Ⅰ、Ⅲ型胶原以及透明质酸的变化。结果　Ⅰ型胶原在皮肤扩张后出现破坏和修复的现象,而Ⅲ型胶原有一过性增多。透明质酸的含量在皮肤扩张后由30ng/ml增加到80ng/ml,而且在相当长时间内呈增高状态,快速扩张变化较常规扩张明显。结论　扩张后真皮中的胶原结构发生重组,透明质酸的增加为扩张后皮肤挛缩提供重要的动力环境基础,快速扩张产生透明质酸多因此更易发生挛缩。     

皮肤定量扩张法在耳廓再造中的应用及并发症的处理

目的 探讨皮肤扩张器的定量扩张法在在耳廓再造中的应用,并对所发生的并发症进行处理.方法 选择50 ml肾形扩张器埋置于残耳后乳突区无毛发皮下,术后3 d拔除引流管,10d拆除缝线.术后7 d进行常规注水,每周3次,每次注水约5 ml,注水总量为60 ml左右.注水完毕后维持扩张1个月.结果 1992年1月至2006年12月共收治先天性小耳畸形患者5 248例,完成50ml肾形扩张器埋置6 252只.扩张器维持扩张完毕后可见扩张皮肤质薄、血管丰富.并发症有血肿、扩张器外露、创口裂开、感染等,发生率较低,约为7.79%.结论 皮肤定量扩张法操作简单、并发症较少,为耳廓再造提供了良好的无毛发、质薄、血供丰富可靠的皮肤.     

皮肤定量扩张法在耳廓再造中的应用及并发症的处理

目的 探讨皮肤扩张器的定量扩张法在在耳廓再造中的应用,并对所发生的并发症进行处理.方法 选择50 ml肾形扩张器埋置于残耳后乳突区无毛发皮下,术后3 d拔除引流管,10d拆除缝线.术后7 d进行常规注水,每周3次,每次注水约5 ml,注水总量为60 ml左右.注水完毕后维持扩张1个月.结果 1992年1月至2006年12月共收治先天性小耳畸形患者5 248例,完成50ml肾形扩张器埋置6 252只.扩张器维持扩张完毕后可见扩张皮肤质薄、血管丰富.并发症有血肿、扩张器外露、创口裂开、感染等,发生率较低,约为7.79%.结论 皮肤定量扩张法操作简单、并发症较少,为耳廓再造提供了良好的无毛发、质薄、血供丰富可靠的皮肤.     

皮肤定量扩张法在耳廓再造中的应用及并发症的处理

目的 探讨皮肤扩张器的定量扩张法在在耳廓再造中的应用,并对所发生的并发症进行处理.方法 选择50 ml肾形扩张器埋置于残耳后乳突区无毛发皮下,术后3 d拔除引流管,10d拆除缝线.术后7 d进行常规注水,每周3次,每次注水约5 ml,注水总量为60 ml左右.注水完毕后维持扩张1个月.结果 1992年1月至2006年12月共收治先天性小耳畸形患者5 248例,完成50ml肾形扩张器埋置6 252只.扩张器维持扩张完毕后可见扩张皮肤质薄、血管丰富.并发症有血肿、扩张器外露、创口裂开、感染等,发生率较低,约为7.79%.结论 皮肤定量扩张法操作简单、并发症较少,为耳廓再造提供了良好的无毛发、质薄、血供丰富可靠的皮肤.