三维表面取模后转换成二维平面测量扩张皮肤面积

目的探求可靠实用的测量扩张皮肤面积的方法。方法先将三维表面上的扩张皮肤通过表面取模后，分剪成二维平面。通过扫描仪直接输入后，利用计算机处理累计其像素点，从而客观测量出扩张皮肤面积。同法测量扩张基底面积和缺损面积后，能确定扩张后额外皮肤面积是否能满足修复需要。结果经初步论证，其最大误差小于３％。结论这一技术可望在临床和动物实验研究中提供扩张皮肤面积测量的可靠指标。     

三维表面取模后转换成二维平面测量扩张皮肤面积

目的 探求可靠实用的测量扩张皮肤面积的方法。方法 先将三维表面上的扩张皮肤通过表面取模后，分剪成二维平面。通过扫描仪直接输入后，利用计算机处理累计其像素点，从 而客观预测出扩张皮肤面积。同法测量扩张基底面积和缺损面积后，能确定扩张后额外皮肤面积是否能满足修复需要。结果 经初步论证，其最大误差小于３％。结论 这一技术可望在临床和动物实验研究中提供扩张皮肤面积可靠指标。     

扩张皮肤三维图像及面积、体积测量软件的开发和应用

目的 介绍用于测量扩张皮肤面积和体积,并形成三维图像的专用软件。方法 通过输入扩张皮肤的基底面、正中横截面和纵截面作为基本参数,扩张皮肤表面的其它部位三维坐标经过图形平滑过渡（插值计算）获得。软件是用Ｃ语言编制,运行在Ｗｉｎｄｏｗｓ下。结果据此测量面积和体积并形成三维图像。经初步验证其最大误差小于４％。结论 结合以往的三维表面转换成平面测量扩张面积的方法,该软件为测量扩张皮肤提供了一种可行的方法     

皮肤软组织扩张器注水量与扩张面积的关系

目的　通过测量皮肤软组织扩张器注水量与相应的扩张面积，初步探讨两者间的相互关系。方法　本组7例病人分别于面、肩、胸、臀部埋入7个不同容量的扩张器，将每次注水扩张后的皮肤三维表面取模后转换成二维平面，应用计算机图象处理软件测定每次注水量与相对应的扩张面积。结果　随扩张器内注水量的增加，其皮肤扩张面积也随之增加，但注水量达扩张器额定容积的130％～180％时，扩张面积即不再增加，趋向一个平台期。结论　扩张器注水扩张并非没有限制，最多达设计容量的130％～180％时，即使再增加注水量，也不会增加皮肤的扩张面积。     

头皮扩张面积与缺损面积的测算

作者报道采用形态计量方法对头皮扩张面积与缺损面积进行测量与计算。经临床试用证明，这一方法可帮助医生在术前更充分地了解皮肤扩张中供与求的科学比例关系。作者认为通过该计算方法能为头部皮肤扩张术提供科学的依据。     

bFGF和硫糖铝局部应用促组织扩张实验研究

目的：探讨bFGF和硫糖铝在持续恒压扩张术中局部应用的可行性。方法：以白色小家猪为实验动物,自身对照,分为3个实验和对照组,扩张同时分别注入bFGF加硫糖铝、bFGF、硫糖铝、生理盐水。扩张结束后第3天分别进行扩张器上总面积、皮肤净增面积、周围组织移行面积和皮肤即时回缩率的测量。结果：实验I组所获得的扩张皮肤面积、皮肤净增面积大于对照组（P＜0．05）;实验Ⅱ、Ⅲ组与对照组无统计学差别。结论：bFGF和硫糖铝用于持续恒压扩张术中,能有效地促进皮肤增殖扩展,扩张局部面积增加,皮肤即时回缩率降低,从而促进组织扩张。     

皮肤扩张术及其临床应用(文献综述)

皮肤扩张术是近年来开展的修复皮肤缺损的新技术.它通过外科的方法,将由硅胶预制的扩张器置入相邻病损的正常皮肤内.嗣后,经皮肤把生理盐水注入扩张器内,使其逐渐膨胀,从而导致其表面的皮肤也随之膨胀扩张而面积增加,为修复皮肤缺损提供新     

表皮生长因子导入治疗在皮肤扩张器中的应用研究

目的:探讨使用导入仪导入重组人表皮生长因子(rhEGF)促进皮肤扩张的临床效果。方法:自2013年1月~2013年5月入选38例患者,共将76个扩张器进行埋置,按照随机原则,分为常规注水对照组(36个扩张器)与导入仪导入治疗组(36个扩张器)。治疗组的扩张器在每次注水扩张的第二天进行导入仪治疗,在被扩张的皮肤表面涂抹rhEGF并使用导入按摩仪进行按摩导入。对照组的扩张器仅进行常规的注水。测量两组扩张器扩张致额定容量所花费的时间、皮肤扩张比率及扩张皮肤即刻回缩比率,采用自身对照的方法进行比较分析。进行胶原含量,I/III型胶原比率(%)的测定和病理HE染色分析。结果:注水后第二天进行rhEGF导入治疗能使扩张器扩张致额定容量所花费的时间明显缩短,皮肤扩张比率则明显增加,扩张皮肤即刻回缩比率减少,有效减小皮辨的即时回缩率。治疗组胶原纤维束粗而密,I/III型胶原比例降低。结论:注水后第二天通过使用导入仪将rhEGF导入扩张皮肤治疗能缩短扩张时程,促进皮肤的面积增加,降低皮瓣回缩的比率,提高皮瓣质量,改善治疗效果。     

扩张皮肤生物学转归的临床观察

目的：研究人体扩张皮肤移植后的转归。方法：采用一般观察、切口瘢痕宽度测量、皮瓣面积 算及组织学检查等对行皮肤扩张术的患者进行３个月～２年的随访。结果：①扩张皮瓣移植后３个月内松动性与弹性较差。一年后皮肤的色泽、质地、弹性等可恢复正常；②扩张部位切口瘢痕有增宽现象，主要发生于术后前３个月；③扩张皮瓣移植后有不同程度的面积缩小；④组织学结构一年后可恢复正常。结论：扩张皮肤于移植后一年左右其色泽、质地及     

皮肤扩张术临床应用的经验

皮肤扩张术是将皮肤软组织扩张器置入正常皮肤下方，通过注射壶向扩张囊内注射液体增加扩张器容量，对表面皮肤产生压力，通过生长和弹性扩张增加“额外”皮肤的面积，转移新增的皮肤进行组织修复和器官再造的一种方法。我国从1985年引进此技术以来取得了非常好的治疗效果，现已逐渐普及，适应证范围不断拓宽。但其发展相当不平衡，故很有必要进行总结和交流。     

Fundamentals of expanded tissue

The relatively recent advent of tissue expansion for medical purposes precludes the availability of extensive knowledge concerning the physiologic and histologic changes that occur during controlled expansion of the skin. This paper reviews the basic science and clinical research that has been conducted to investigate the changes and summarizes the findings. It can be concluded that flaps harvested from skin previously expanded have an improved survival rate compared to similar flaps developed in nonexpanded skin. Increased vascularity to either the skin, the capsule that forms around the expander, or both probably in some way accounts for the improved survival. Controlled expansion of the skin results in the creation of additional new skin at the expense of thinning the dermis and subcutis. This thinning is associated with an overall decrease in tensile strength of the expanded skin. The increase in surface area gained from skin expansion probably varies according to the type of skin expanded and the underlying tissues that serve as a foundation for the expander.     

In vitro skin expansion: Wound healing assessment

For treatments requiring split‐thickness skin grafts, it is preferable to mesh the grafts. This reduces the amount of excised skin and covers more wound area. The mesh technique, however, destroys surface continuity, which results in scarring. Strain‐based bioreactors, on the other hand, have successfully expanded split‐thickness skin grafts in vitro within a 7‐day period, increasing graft coverage. After in vitro expansion, the expanded skin grafts were tested in a porcine full‐thickness excisional wound model. Expanded graft take rate was 100%. Volumetric, histologic, and mechanical assessments indicated that expanded grafts were comparable to unexpanded grafts (positive control). While there was considerable variation in expansion (31% to ?3.1%), this technique has the potential to enhance the coverage area of skin grafts while reducing or eliminating scarring.     

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.     

Biomechanical comparison between conventional and rapid expansion of skin.

This study was designed to investigate the effects of different surgical expansion regimens on the biomechanical features of expanded skin. Two hundred and forty millilitres expanders were implanted on the backs of six adult dogs. Six flaps were designed on the dorsum of each dog. After serial expansion, the expander was left beneath the skin for a certain period of time, which is called the maintaining period. Rapid expansion and conventional expansion with various maintaining periods were compared. The experimental result shows that the area gain of expanded skin surface had no significant difference between the rapid and conventional expansion. Both the tension in vivo and the instant stretch-back ratio increased during the expansion, but fell almost to control values after four weeks' maintaining period. Biomechanical properties in vitro, such as tensile strength, stress-strain, stress-relaxation, and creep were tested by INSTRON material testing machine. Results show that the biomechanical properties of expanded specimens differ significantly from those of their controls immediately after expansion. However, the difference reduces with prolongation of maintaining time. With the same maintaining period, the biomechanical properties of rapidly expanded skin are similar to conventionally expanded skin. We conclude that rapid skin expansion did not demonstrate any deleterious effect when compared with the conventional expansion. Extension of the maintaining period can improve the biomechanical properties of expanded skin and effectively reduce the stretch-back ratio. Therefore, rapid expansion with an extended maintaining period is acceptable in clinical practice.     

The response of the peripheral nerve field to controlled soft tissue expansion

The aim of the study was to investigate the effect of controlled soft tissue expansion on the peripheral nerve field. The rat model was used with single neurone recordings at the dorsal root level related to areas of skin previously expanded over a period of 2-4 weeks. Parameters measured were: stimulation threshold, receptive field size, conduction velocity and afferent disconnection. Results indicated a sparing of neural function despite an expansion in skin area of 110%.     

On expander pressure and skin blood flow during tissue expansion in the pig

The structural and circulatory dynamics of expanded skin in connection with expander fillings were assessed in pigs following 7, 14, and 21 days of expansion by measuring the pressure of te fluid in the expander (Pexp) and the dermal blood flow. The results differed consistently on thoracic and abdominal sites. It was suggested that the stimulus to expansion be defined as the relative increase in extensible surface area of the expander. When plotting this value against Pexp, as measured at the end of injection, there was a good fit to an exponential curve. The area/Pexp relation was used to assess the connective tissue reaction around the expander; the reaction was most pronounced at 21 days. The decrease in Pexp after injection of fluid to 100 mm Hg showed that the tissue adapted rapidly during the first hour. Blood flow in the skin covering the expander was lower than on adjacent normal skin, and there was no increase during the three weeks of expansion. The decreases in blood flow were moderate even after injection of fluid until Pexp reached 100 mm Hg. It was suggested that the connective tissue capsule might protect the dermis from flow decrease.