外用罂粟碱霜加速组织扩张的实验研究

目的　探讨外用罂粟碱霜对组织扩张效率及对扩张组织质量的影响。方法　以小型猪为实验动物 ,将罂粟碱霜用于组织扩张过程 ,分别与罂粟碱全身给药和囊内导入两种方式以及常规扩张进行对照 ,观察在扩张效率、组织微循环、组织结构和超微结构变化等方面的差异。结果　外用组完成扩张历时 (2 8 9± 4 5 )d ,导入组 (34 0± 2 6 )d ,肌注组 (37 6± 4 8)d ,常规扩张组 (38 5± 3 5 )d ,各组差异有显著性意义 (P <0 0 5 ) ;外用组扩张皮瓣成活长度平均为 (13 6 7± 1 2 8)cm ,导入组为 (11 0 7± 0 88)cm ,肌注组为 (10 79± 0 4 9)cm ,常规扩张组为 (9 4 9± 0 77)cm ,各组之间差异有非常显著性意义 (P <0 0 1) ;各组在扩张率、回缩率、皮肤各层厚度等方面差异无显著性意义 (P >0 0 5 ) ;电镜显示外用组包膜中的肌成纤维细胞功能不活跃 ,常规扩张组肌成纤维细胞功能活跃 ,其它组介于两者之间 ;外用组扩张包膜内罂粟碱的浓度为 (3 5± 1 2 ) μg g ,其它各组包膜内及各组血液中均未检测到罂粟碱。结论　外用罂粟碱霜剂能够在组织内达到有效的药物浓度 ,抑制扩张包膜中肌成纤维细胞的功能 ,从而增加平均注水量 ,缩短扩张时间 ,提高扩张效率 ,增加扩张皮瓣的成活长度。其作用连续而持久 ,不增加创伤     

带导药系统的快速扩张器的临床研究

目的探索快速组织扩张和提高皮瓣扩张质量的方法.方法对15例不同部位应用带导药(罂粟碱)系统的扩张器进行皮肤软组织扩张.结果新型扩张法(下简称NEM)和普通扩张法(下简称GEM)扩张至额定容量所需要的平均时间分别为26d和51d;全部扩张完成后两种扩张法扩张器的实际注水量超过额定容量的百分比分别为92.41%和27.12%.扩张区皮肤血流量的比较(V),NEM1.27±0.28;GEM0.64±0.11.扩张表面积即时回缩率的比较(%),NEM20.17±1.74;GEM38.26±2.01.结论采用此种方法,扩张速度快,皮瓣的即时回缩率低,血运好.     

Protective effect of theophylline on renal functions in experimental pneumoperitoneum model

Abstract

Our objective in this experimental study is to research the effect of the intra-abdominal pressure which rises following pneumoperitoneum and whether Theophylline has a possible protective activity on this situation. In our study, 24 Wistar Albino rats were used. Rats were divided into two groups. The first group was set for only pneumoperitoneum model. The second group was given 15?mg/kg of Theophylline intraperitoneally before setting pneumoperitoneum model. Then urea, creatinine, cystatin-C, tissue and serum total antioxidant capacity, total oxidant capacity and oxidative stress index in two groups were measured and compared with each other. Apoptosis and histopathological conditions in the renal tissues were examined. The differences between the groups were analyzed with the Mann–Whitney U test. Results were considered significant at p?<?0.05. No statistically significant difference was determined between tissue and serum averages in two groups in terms of TAS, TOS and OSI values (p?>?0.05). The mean value of urea were similar in pneumoperitoneum and pneumoperitoneum?+?theophylline groups (p?=?0.12). The mean cystatin-C value was 2.2?±?0.3?µg/mL in pneumoperitoneum, 1.74?±?0.33?µg/mL in pneumoperitoneum?+?theophylline (p?=?0.002). According to our study, lower cystatin-C levels in the group, where Theophylline was given, are suggestive of lower renal injury in this group. However, this opinion is interrogated as there is no difference in terms of tissue and serum TAS, TOS, OSI and urea values between the groups.     

Relaxation mechanisms of antispasmodics papaverine and thiphenamil on the human corpus cavernosum

The relaxation mechanism of the antispasmodics, papaverine and thiphenamil on isolated human corpus cavernosum (CC) was investigated. CC tissues were obtained from 12 impotent men undergoing surgery for insertion of penile prostheses. CC preparations were mounted in a tissue bath and the isometric tension was recorded. Papaverine and thiphenamil consistently inhibited high-potassium ([K])-induced contractions in a dose-dependent manner. Noradrenaline (NA)-induced contractions were inhibited by both agents in a non-competitive manner. The pD'2 values were 4.77 +/- 0.20 for papaverine and 4.58 +/- 0.13 for thiphenamil. Papaverine at 10(-4) M, the concentration at which high-[K]-induced contraction was abolished, suppressed NA-induced contraction by approximately 85%. In the Ca2(+)-free solution containing two mM EGTA, NA-induced contraction was suppressed by approximately 90%. This contraction was inhibited by papaverine or thiphenamil in a dose-dependent manner and was abolished by papaverine at 10(-4). These results suggest that papaverine and thiphenamil relax CC tissue by the inhibition of extracellular Ca2+ influx (mainly voltage-dependent Ca2+ influx) and by the inhibition of release and/or storage of intracellular stored Ca2+.     

内外双囊扩张器注药加速组织扩张的实验研究

目的 探索加速组织扩张速度、提高扩张皮瓣质量的新方法。方法 我们采用自行研制的带导药系统的内外双囊扩张顺（下简称双囊扩张器），并应用抗收缩剂罂粟碱，以豚鼠为实验动物与传统的扩张方法对比。结果 双囊扩张器能有效地将药物导入到扩张囊周围的组织中发挥药理作用，使扩张后的皮瓣血流量较常规扩张组显著提高，成活长度、长宽比例也明显增加，回缩率明显降低，表皮明显增厚，包膜较其他各组明显变薄，真皮在各种扩张组和不     

Facilitated tissue expansion with topical estriol

Tissue expansion is a helpful technique in reconstructive plastic surgery. Unfortunately, tissue expansion still needs to be improved. Twenty-four male Wistar rats were used to evaluate the effect of estriol on tissue expansion. The agents hyaluronidase, estriol, and base cream (as a control) were applied topically to separate animal groups for 5 weeks, and their effects were studied on tissue expansion. Both hyaluronidase (p < 0.05) and estriol (p < 0.001) enhanced the rate of expansion when compared with control animals. Estriol was more effective than hyaluronidase (p < 0.05). Breaking strengths were measured in the estriol and the control groups. Breaking strength was not evaluated in the hyaluronidase group because of the necrotic changes seen at the end of the fifth week. The breaking strength was higher in the control group than in the estriol group (p < 0.05). The authors suggest that topical estriol be used as an adjunctive agent to facilitate tissue expansion.     

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     

个性化护理在皮肤软组织扩张中的应用效果

目的 分析在皮肤软组织扩张中应用个性化护理的效果。方法 选取解放军联勤保障部队第 九六〇医院2020年6月-2023年6月收治的80例接受皮肤软组织扩张治疗的患者为研究对象,采用随机 数字表法分为参照组和研究组,各40例。参照组予以常规护理,研究组予以个性化护理,比较两组皮 瓣扩张量/预期量、焦虑情况、依从性、满意度及并发症发生情况。结果 研究组扩张量/预期量为 （126.80±30.70）%,高于参照组的（78.40±14.60）%（P ＜0.05）;研究组护理后SAS评分低于参照组 （P ＜0.05）;研究组依从率为95.00%,高于参照组的75.00%（P ＜0.05）;研究组满意度为97.50%,高于 参照组的77.50%（P ＜0.05）;研究组并发症发生率为2.50%,低于参照组的17.50%（P ＜0.05）。结论 在 皮肤软组织扩张中应用个性化护理可获得令人满意的效果,有助于促进皮瓣扩张,实现扩张目的,且患者 满意度及依从性较高,并发症发生几率较低,值得临床应用。     

软组织扩张术对烧伤整形患者创面愈合情况的影响

目的 探讨烧伤整形患者采用软组织扩张术对创面愈合情况的影响。方法 选取我院2019年 7月-2022年6月收治的30例烧伤整形患者为研究对象,根据随机数字表法分成研究组与对照组,每组15例。 对照组采用复合皮瓣移植术,研究组采用软组织扩张术,比较两组临床疗效、创面愈合情况、疼痛程度、 生命质量、瘢痕修复效果及并发症发生情况。结果 研究组治疗总有效率为93.33%,高于对照组的60.00% （P＜0.05）;研究组创面愈合时间、皮肤血运恢复时间短于对照组（P＜0.05）;两组术后24 h VAS评分均 低于术前,且研究组低于对照组（P＜0.05）;两组术后3个月BSHS-B评分均高于术前,且研究组高于对 照组（P＜0.05）;两组术后3个月外观、质地、弹性评分均高于术前,且研究组高于对照组（P＜0.05）;研 究组并发症总发生率为6.67%,低于对照组的46.67%（P＜0.05）。结论 对烧伤整形患者行软组织扩张术可提 高临床疗效,改善创面愈合情况,缓解疼痛程度,提高生活质量及瘢痕修复效果,减少并发症发生几率。     

Effects of antineoplastic agents on the peripheral nerves under a surgical tissue expansion procedure: an experimental study

BACKGROUND: Elongation of peripheral nerve by the use of a tissue expander is helpful to repair nerve defects. This study was designed to investigate the effects of some antineoplastic agents on the peripheral nerves under a surgical tissue expansion procedure. MATERIALS AND METHODS: Twenty-five Wistar rats were used in this study. Following the exposition of the sciatic nerve and placement of two 10/0-nylon sutures in the epineurium 20 mm apart, a tissue expander was then placed under it. Inflation of the expander was immediately accomplished by the separate percutaneous injections of 6, 6, and 8 ml for every 3 min under general anesthesia. The expander was fully deflated at the end of each 3 min The distance between two sutures was measured 1 h later to measure the rate of elongation. Rats were randomly divided into five groups (according to the administered drugs), each consisting of five rats (10 sciatic nerves). Normal saline (1 ml) in the control group (group I), cyclophosphamide (15 mg/kg) in the group II, cisplatinum (3 microg/kg) in the group III, mitomycin-C (0.5 mg/kg) in the group IV and 5-fluorouracil (10 mg/kg) in the group V were injected intravenously. Intravenous injections of drugs were performed via the tail vein 30 min before expansion, 48 and 96 h after removal of expander. The incision was reopened on the third and seventh postoperative days, and five sciatic nerves of each group were exposed and then the pinching test was performed to measure regeneration distance. Electroneurographic changes were recorded. The expanded portion of the sciatic nerve between two sutures was harvested for histological evaluation. RESULTS: There is no significant difference between the elongation rates of all groups (P < 0.05). Histologic evaluation showed that inflammatory changes, vacuolization, intraneural edema, demyelination, axonal changes in the control group, the cisplatinum group, and the mitomycin-C group. These changes were significantly decreased in the cyclophosphamide group and the 5-fluorouracil group. In the cyclophosphamide group and the 5-fluorouracil group, the amplitude of compound action potential (CAP) values were significantly higher and the latency was significantly shorter (P > 0.05). CONCLUSION: We believed that cyclophosphamide and 5-fluorouracil may be helpful in tissue expansion of peripheral nerves, by decreasing the effects of the ischemia-reperfusion injury on the expanded peripheral nerves.     

Intraoperative tissue expansion in the surgical correction of craniosynostosis

BACKGROUND:Wound healing complications can occur after calvarial vault expansion due to tension on the scalp flaps.OBJECTIVES:To compare wound healing outcomes in patients with craniosynostosis undergoing calvarial vault expansion with and without intraoperative tissue expansion of the scalp.METHODS:The present analysis was an institutional review board-approved, retrospective cohort study involving 40 consecutive patients at the University of Missouri Hospitals and Clinics (Columbia, Missouri, USA) who underwent calvarial vault expansion for nonsyndromic craniosynostosis between June 1, 2009 and June 30, 2012. Patients were divided into two sequential cohorts: the first 20 underwent calvarial vault expansion without intraoperative tissue expansion; the second 20 underwent calvarial vault expansion with intraoperative tissue expansion. The main outcome measures included presence or absence of wound healing complications (persistent scabbing or slow-healing wounds, hardware exposure, need for operative wound revision or healed but widened scars), with documented postoperative follow-up of at least three months. The primary end point was the presence of a well-healed scar; the secondary end point was the need for an operative revision.RESULTS:Patients in the intraoperative tissue expansion group had a higher percentage of well-healed scars (73.6%) than those in the nonexpansion group (42.1%) (P=0.0487). This difference was primarily due to scar widening in the nonexpansion group.CONCLUSIONS:The present study demonstrated that the use of intraoperative tissue expansion in patients with nonsyndromic craniosynostosis who underwent calvarial vault expansion resulted in a greater likelihood of a well-healed incision with a lower rate of poor scarring.     

注射壶内置和外置危险因素的分析

目的 对比注射壶内置和外置的相关危险因素,为临床手术方案的设计提供参考.方法 对821例皮肤扩张术患者,首先依据扩张方式分为普通扩张和亚急性扩张,然后再分成注射壶内置组和注射壶外置组,统计并比较各组并发症发生率.同时比较各组扩张器纤维包囊的厚度.结果 在普通扩张和亚急性扩张中,注射壶外置组的总并发症发生率,均较注射壶内置组发生率高,特别是血肿继发感染和单纯感染的发病率最为显著.另外注射壶外置者扩张器纤维包囊也显著增厚,为Ⅱ期手术带来不便.结论 注射壶外置的相关并发症比较高,应该慎用.     

复合皮移植与皮肤软组织扩张术在烧伤整形治疗中的应用效果

目的 分析复合皮移植与皮肤软组织扩张术在烧伤整形治疗中的效果。方法 选取2021年8月-2023年 8月我院收治的90例烧伤患者为研究对象,采用随机数字表法分为对照组和研究组,各45例。对照组接受 复合皮移植术治疗,研究组接受皮肤软组织扩张术治疗,比较两组临床疗效、围术期指标、并发症发生率 及患者满意度。结果 研究组治疗总有效率为91.11%,高于对照组的75.56%（P ＜0.05）;研究组创面愈合 时间、血运恢复时间及住院时间均短于对照组（P ＜0.05）;研究组并发症发生率为6.67%,低于对照组的 22.22%（P＜0.05）;研究组患者满意度为95.56%,高于对照组的82.22%（P ＜0.05）。结论 在对烧伤患者 进行整形治疗时,实施皮肤软组织扩张术的效果较好,有助于患者创面愈合及局部血运恢复,降低并发症 发生率,提高患者满意度。     

The effects of calcium channel blockers on random skin flap survival in the pig model

Summary This study was designed to evaluate the influence of two calcium channel blockers, verapamil and nifedipine, on skin flap survival. These agents were selected because they inhibit the passage of calcium through calcium selective channels in the plasma membrane, thereby blocking calcium mediated electromechanical coupling in contractile tissue and resulting in peripheral arterial vasodilation. Three groups of pigs were used in this study. All skin flaps in this study were 3 cm wide and 12 cm long. The first group (10 flaps) served as controls with no pharmacologic manipulations. Pigs in group II (15 flaps) received verapamil (80 mg orally, three times a day) for 7 days postoperatively. Pigs in group III (15 flaps) received nifedipine (10 mg orally, three times a day) for 7 days postoperatively. Statistical analysis of the results demonstrated that both verapamil and nifedipine resulted in significant enhancement of skin flap survival. The increased survival of the skin flaps produced by nifedipine as compared to verapamil was statistically significant.This study is supported in part by PHS Research Grant DE00853 from the National Institute of Dental Research     

Comparison of ultrastructural changes of skin between continuous tissue expansion and conventional tissue expansion]

OBJECTIVE: To observe the ultrastrual changes of the skin between the continuous tissue expansion and the conventional tissue expansion. METHODS: Twelve white piglets were used for this study on an animal model of tissue expansion with the continuous tissue expansion group and the conventional tissue expansion group. The tissue samples in each group were harvested and prepared for the transmission electron microscope observation. RESULTS: The interspace among basal cells and spinose cells was increasing and the numbers of cell conjunctures were decreasing in the both groups. However, these changes in the continuous tissue expansion group were more obvious than in the conventional tissue expansion group. In the dermal layer of the skin, the ultrastructure of collagen fibers were basically normal. But, the fibroblasts and capillary endothelia cells were more activated in the continuous tissue expansion group, compared with the conventional tissue expansion group. The fibroblast apoptosis and collagenolysis spots were observed in both of the groups, while the red blood cells were also found in the tissue leaked outsides from the blood vascular cavities. CONCLUSION: Tissue expansion may result in tissue growth and tissue degeneration in the same time.     

持续恒压扩张和常规间断扩张后皮肤超微结构的改变

目的：对比观察持续恒压扩张（CPTE）和常规间断扩张（CITE）后皮肤组织的超微结构改变。方法：用白色小家猪制作CPTE和CITE动物模型，切取组织样本做电镜观察。结果：CPTE组与正常皮肤和CITE组皮肤比较，皮肤基底细胞和棘细胞间距明显增大，细胞连接明显减少。两实验组扩张后的真皮中，胶原纤维结构基本正常，CPTE组成纤维细胞和血管内皮细胞的活化程度高于CITE组。两实验组中均可见到胶原溶解和成纤维细胞凋亡现象，CPTE组中表现明显。两种扩张方法均可引起毛细血管破裂出血。结论：扩张后皮肤中具有组织生长和退化的双重超微结构改变。     

Tissue expansion in the limbs: a comparative analysis of limb and non-limb sites.

We present an 8 year retrospective case-note study of 88 patients, who underwent 113 episodes of tissue expansion for a variety of indications. Overall, 31 patients underwent 42 episodes of tissue expansion in the limbs, and 57 patients underwent 71 expansions at other sites. Although the incidence of complications was higher in the limb group (43%) than in the group undergoing expansion at other sites (27%), the overall success in completing expansion was remarkably similar in both groups (86% and 83%, respectively). The indications and contraindications for tissue expansion in our cases are presented, as is the specific management in the presence of infection or exposure. Careful case selection, proper planning and meticulous surgical technique are important in minimising complication rates and ensuring both success and salvage in the case of any mishaps.     

皮肤扩张术后的组织退行性变研究

目的探讨扩张术对皮肤的损伤及退行性变作用.方法选择常规间断扩张和持续恒压扩张术各9例,在扩张皮瓣术中切取标本作组织病理学、分子生物学及透射电子显微镜观察.结果扩张可引起毛细血管出血,损伤修复纤维(网状纤维和弹力纤维)增生,微小动脉血栓形成,成纤维细胞凋亡增加,胶原纤维溶解.常规间断扩张后皮肤以退行性变为明显,持续恒压扩张后皮肤急性损伤明显.结论扩张刺激可引起组织急性损伤和退行性变,提示常规扩张时间不能过长,持续扩张不能过快.     

皮肤软组织重复扩张的微观研究

目的 探讨皮肤软组织重复扩张的微观变化，为临床应用提供理论依据。方法以6头小型猪为实验动物，并分为正常对照组、常规扩张组、重复扩张组，分别切取皮肤标本，进行光镜结构和超微结构的观察，以及碱性成纤维细胞生长因子（bFGF）含量的测定。结果重复扩张的皮肤软组织肉眼观察基本健康，其微观结构在常规扩张的基础上有进一步的变化。胶原纤维损伤明显，细胞损伤较轻并且进一步增殖和功能更加活跃。皮肤中bFGF含量进一步增高。结论重复扩张过程中，皮肤软组织虽然有进一步损伤，但通过进一步加强生长和修复功能，仍然能保持基本健康，因此，重复扩张安全可行。     

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。