bFGF和硫糖铝加速组织扩张实验方法的建立

目的研究碱性成纤维细胞生长因子(bFGF)和硫糖铝加速组织扩张的可行性和机理.方法用猪作为实验动物,制作持续恒压扩张模型,实验Ⅰ组在扩张器与组织之间注入bFGF和硫糖铝,实验Ⅱ组注入bFGF和生理盐水,对照组注入生理盐水,2次/日,持续用药7天;扩张完成后3天行组织学检查,皮肤即时回缩率的测量,制作皮瓣.结果实验Ⅰ组扩张器内注液量为(143±15.22)ml,实验Ⅱ组为(122±18.7)ml,对照组(121±20.09)ml,统计分析发现实验Ⅰ组与实验Ⅱ组、对照组间有显著差别(P＜0.05).实验Ⅰ组扩张器表面组织表皮层增厚,成纤维细胞和毛细血管密度显著增高,实验Ⅱ组、对照组变化较弱.扩张后皮肤组织即时回缩率实验Ⅰ组明显小于对照组(P＜0.05),实验Ⅱ组稍小于对照组,无统计学意义(P＞0.05).皮瓣形成术后4周实验Ⅰ组皮瓣伸展程度较对照组高,基本恢复正常(P＜0.05),8周实验Ⅰ组皮瓣有增宽趋势;实验Ⅱ组与对照组差别无统计学意义.结论 bFGF和硫糖铝局部应用与持续恒压扩张术结合可以促进扩张组织增生,加速扩张,该动物实验方法简单,效果可靠.     

bFGF和硫糖铝加速组织扩张实验方法的建立

目的　研究碱性成纤维细胞生长因子 (bFGF)和硫糖铝加速组织扩张的可行性和机理。方法　用猪作为实验动物 ,制作持续恒压扩张模型 ,实验Ⅰ组在扩张器与组织之间注入bFGF和硫糖铝 ,实验Ⅱ组注入bFGF和生理盐水 ,对照组注入生理盐水 ,2次 /日 ,持续用药 7天 ;扩张完成后 3天行组织学检查 ,皮肤即时回缩率的测量 ,制作皮瓣。结果　实验Ⅰ组扩张器内注液量为 (1 4 3± 1 5 .2 2 )ml,实验Ⅱ组为 (1 2 2± 1 8.7)ml,对照组 (1 2 1± 2 0 .0 9)ml,统计分析发现实验Ⅰ组与实验Ⅱ组、对照组间有显著差别 (P <0 .0 5)。实验Ⅰ组扩张器表面组织表皮层增厚 ,成纤维细胞和毛细血管密度显著增高 ,实验Ⅱ组、对照组变化较弱。扩张后皮肤组织即时回缩率实验Ⅰ组明显小于对照组(P <0 .0 5) ,实验Ⅱ组稍小于对照组 ,无统计学意义 (P >0 .0 5)。皮瓣形成术后 4周实验Ⅰ组皮瓣伸展程度较对照组高 ,基本恢复正常 (P <0 .0 5) ,8周实验Ⅰ组皮瓣有增宽趋势 ;实验Ⅱ组与对照组差别无统计学意义。结论　bFGF和硫糖铝局部应用与持续恒压扩张术结合可以促进扩张组织增生 ,加速扩张 ,该动物实验方法简单 ,效果可靠     

bFGF和硫糖铝在持续恒压扩张术中局部联合应用对组织细胞增殖的影响

目的 研究bFGF和硫糖铝在扩张术中局部应用对细胞增殖的影响。方法 白色小猪9只，自身对照，分为实验Ⅰ、Ⅱ、Ⅲ组，对照组，扩张术中分别注入bFGF和硫糖铝、bFGF、硫糖铝、生理盐水。各动物于术后第1～14天取出扩张器后6周取材作免疫组织化学检查。结果 持续恒压扩张术同时加用bFGF和硫糖铝后，表皮层基底细胞增殖更早更明显，尤其以第3天最为显著，14d基底细胞增殖指数最低但也高于对照组（持续恒压扩张组）；真皮层成纤维细胞，毛细血管内皮细胞，毛囊上皮细胞，汗腺上皮细胞增殖更明显，早于对照组，7d达高峰，14d明显减少但仍高于对照组，6周基本恢复正常。实验Ⅱ、Ⅲ组与对照组差异无显著性意义。结论 bFGF和硫糖铝联合局部应用于扩张术，促细胞增殖作用强，从而在扩张早期有效地诱导皮肤细胞分裂增殖，促进皮肤软组织生物性生长。     

组织扩张术囊上皮肤来源、扩张率和回缩率研究

目的探讨恒压持续快速扩张的可行性。方法用白色小家猪１２只（１７．５±２．７１ｋｇ）、长方形硅胶扩张器（１８０ｍｌ）２４只作持续快速扩张术（ＣＴＥ）和常规间断扩张术（ＩＴＥ）对比研究。结果ＣＴＥ组６天完成扩张，ＩＴＥ组２７天完成扩张，两组扩张囊内平均实际液体量、扩张囊外皮肤总面积和皮肤回缩率相同（Ｐ＞０．０５）。ＣＴＥ组的皮肤净增面积和皮肤组织扩张率小于ＩＴＥ组（Ｐ＜０．０１）；ＣＴＥ组皮肤移行面积明显大于ＩＴＥ组（Ｐ＜０．０１）。结论恒压持续扩张术具有速度快的优势和某些与ＩＴＥ相似的性质，可用于局部皮肤病变或缺损的修复，但广泛性皮肤病的治疗仍应选择常规间断扩张术     

碱性成纤维细胞生长因子和硫糖铝联合局部应用对扩张皮肤组织结构的影响

目的　探讨碱性成纤维细胞生长因子 (b FGF)和硫糖铝对扩张皮肤组织结构的影响。方法　白色小猪 9只 ,自身对照。在猪两侧侧胸埋置皮肤扩张器。持续恒压扩张同时实验 组注入 b FGF和硫糖铝 ,实验 组注入b FGF和生理盐水 ,实验 组注入硫糖铝 ,对照组注入生理盐水共 7天。各组完成扩张后第 3天及取出扩张器后 6周取材行组织学检查。结果　实验 组皮肤表皮层增厚更明显 ,颗粒和棘细胞层次更多 ,基底细胞数目增多 ,细胞核肥大 ,染色质变浓 ,排列密集 ,表皮钉突增多 ,呈粗长发育成巨大钉突 ;真皮层厚度变化较轻 ,胶原纤维束粗而密 ,平行于皮面排列 ,弹力纤维明显增加 ;成纤维细胞和毛细血管密度更高 (P<0 .0 5 )。对照组表皮层和真皮层有相应的变化均弱于实验 组 ,术后 3天、6周胶原纤维可见断裂。实验 、 组表皮层和真皮层组织改变与对照组差异无统计学意义 (P>0 .0 5 )。各组纤维包膜厚度近似。结论　在持续恒压扩张同时扩张囊周围注入外源性 b FGF和硫糖铝 ,能更有效地刺激皮肤生物性生长 ,促进扩张速率 ,缩短扩张时间     

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。     

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。     

皮肤软组织快速扩张的实验研究

以白色乳猪为实验动物，分为常规扩张组（ＣＥＧ），快速扩张组（ＲＥＧ）和对照组（ＣＯＮ）。在囊内压及皮肤血流的监测下定期扩张。扩张结束后分别进行皮肤血流动力学、物理学、组织学及超微结构的观察、测量。结果表明：快速扩张后皮肤即时回缩率较常规扩张重。快速扩张可致组织增生，但增生的程度与扩张的间隔时间有关。快速扩张不损害皮肤胶原纤维的结构。因此，在充分估计缺损区大小及即时回缩重的情况下，临床上可考虑采用。     

联合性快速皮肤软组织扩张法的研究

目的　观察联合性快速扩张法应用于皮肤软组织扩张术的效果 ,并探讨其机制。方法　在 8头小猪脊柱两侧设计 48块扩张区域 ,分为 :联合组 :耗时 1周。常规组 :耗时 3周。对照组分别测定扩张前囊内压 ;测量扩张毕皮肤表面积增加幅度、皮肤即时回缩率。结果　联合组扩张后皮肤即时回缩率 (3 6.2 3± 1.0 7) %与常规组 (3 5 .89± 0 .90 ) %比较 ,差异无显著性 (P >0 .0 5 ) ;与对照组相比 ,联合组表皮层厚度显著增厚 (P <0 .0 1) ,真皮层显著变薄 (P <0 .0 1) ,真皮层内胶原纤维密度明显减低 (P <0 .0 1)。结论　联合性快速扩张法能获得额外皮肤组织 ,对皮肤超微结构无明显影响 ,具有扩张速度快 ,并发症少的优点。     

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。     

持续扩张后任意皮瓣的活力及回缩的动态观察

目的　观察持续扩张后皮瓣的活力及近期修复效果。方法　用小家猪和恒压灌注仪制作持续扩张动物模型 ,A组动物用 180ml扩张器 ,B组动物用 2 10ml扩张器。完成扩张后 3d制作扩张区皮瓣和正常区任意皮瓣 (对照组 )。结果　A组和B组皮瓣的存活长度比正常任意皮瓣分别增加 92 60 %和 91 96% ,A、B两组差别不明显 (P >0 0 5 )。术后早期扩张后皮瓣有明显回缩 ,术后两个月皮瓣的宽度恢复到正常任意皮瓣水平 (P >0 0 5 )。结论　持续快速扩张后皮瓣的存活能力和修复效果可靠 ,可在临床使用。利用大容量扩张器不能进一步增加皮瓣的存活能力。     

Subperiosteal tissue expansion: an experimental study

Periosteal flaps have been used to cover bone defects. There are no sufficient data on whether expanded periosteum can be used to repair bone defects after subperiosteal tissue expansion. In this experimental study, 14 male dogs, which were 2 years-old and weighed 14.5–16.0 kg, were used to investigate the repair of bony defects with expanded periosteum. Rectangular tissue expanders, measuring 50 mm in width, 70 mm in length, and 20 mm in height (volume: 20 ml) were used. The dogs were divided into two groups each of seven dogs: one control group and one experimental group. In each dog, a pocket, 50×70 mm in size, was prepared in parietal area, and a periosteal area, 30×40 mm in size, was marked out. A rectangular tissue expander was inserted into the pocket. In the control group, the tissue expanders were not inflated. On the seventh postoperative day, the tissue expander inflation with normal saline (5 ml per 2 days) was started in the experimental group. After 15 days, the previously marked out periosteal area was measured. A specimen was taken from this periosteal tissue for histopathological evaluation. A bone defect, 20×20 mm in size, was created beneath expanded periosteal tissue, and this defect was covered with the expanded periosteal tissue. After 15 days, a histopathological evaluation was carried out. Statistical analysis was carried out using the Mann–Whitney U-test. The area of periosteum expanded was more in the experimental group than that of the control group (p>0.05). After removal of the tissue expander, both in the control and subperiosteal tissue expansion group, osteoblastic lining of the expanded periosteum, increased vascularity, and granulation tissue was noted. Following 15 days, woven and lamellated bone tissue was formed both in the control and subperiosteal expansion group. In the subperiosteal expansion group, there was greater bone formation, the expanded periosteum was thickened, and thickened lamellated bone was covered by active osteoblasts. It is concluded that subperiosteal tissue expansion may be worthwhile to provide large periosteal flaps for the repair of large bone defects, by increasing osteogenic capacity.     

The effect of skin expansion on acellular dermis in an experimental model

Objective: Although acellular dermis is widely used in prosthesis-based breast reconstruction, there is no study evaluating its expandability and histological, ultra-structural related changes. The purpose of this study is to determine whether acellular dermis could be expanded and whether the histological changes occurring in the skin with tissue expansion is different from normal when acellular dermis is used.

Methods: Twenty-two male Wistar rats were used in this study. In group 1 (n?=?6), a rectangular-shaped tissue expander with final volume of 35?ml was placed subcutaneously. In group 2 (n?=?6) tissue expander was placed submuscularly. In group 3 (n?=?6), a 4?×?5?cm, acellular dermis was inserted and sutured in place, tissue expander was placed underneath acellular dermis. Group 4 (n?=?4) was control, no procedure was done after creation of a pocket. After day 30, tissue expanders were inflated with 2?ml every 2 days with saline solution. On day 66, midvertical, midhorizontal surface expansion measurements were recorded. Samples were examined macroscopically. Biopsies were taken from mid-point of the expanded full-thickness flap. Histological evaluation, total skin thickness, epidermal thickness, and the amount of vascularisation were measured.

Results: There was no expansion noted on the acellular dermis; however, acellular dermis increased vascularity and decreased the thinning of the overlying skin and thickening of the epidermis when compared to other groups.

Conclusion: Acellular dermis use can be beneficial in implant-based breast reconstruction in terms of morbidity and its tissue support.     

短程持续组织扩张技术的临床应用

目的：研究住院周期最短的理想快速扩张法。方法：选择１１７例皮肤瘢痕患者,分成间断快速扩张组（ＩＦＴＥ）和短疗程持续扩张组（ＳＰＴＥ）。ＩＦＴＥ组采用平行切口埋植扩张器,术后１０天开始作间断快速扩张。ＳＰＴＥ组经垂直小切口埋植扩张器,术中大量注水扩张,术后持续扩张。结果：所有患者均顺利完成快速扩张并获得满意治疗效果。ＩＦＴＥ组平均扩张时间１６．８天,平均住院时间为４５．３天。ＳＰＴＥ组平均扩张时间为