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。     

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。     

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。     

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。     

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     

术中即时扩张皮肤面积增加与压力和时间的量效关系

目的探讨术中即时扩张皮肤面积增加与压力、时间的量效关系。方法用6头小型猪，压力参数分别为15、20、25kPa，时间参数为60、90min，配对组成6个实验组，1个对照组，36个实验部位。在每只猪背部皮下均匀埋置100ml圆形扩张器6个，术中即时扩张皮肤，观察扩张皮肤各径线移位特点，计算面积变化。结果扩张区周边皮肤向中心蠕动和扩张器表面皮肤伸展同时存在。扩张皮肤面积扩大在一定范围内与压力、时间增加成正比，20kPa、60min组合增幅最大，此后增幅明显减少，并逐渐引发皮肤病理性改变。结论皮肤可在一定范围内通过术中即时扩张获得面积有效增加。     

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     

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.     

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。     

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%.     

Our experience with tissue expansion on a series of 50 cases in Vietnam

The authors reviewed their experience with tissue expansion from July of 1995 to December of 1999 at Hanoi Plastic Surgery Center. A total of 75 tissue expanders of various sizes were placed in 50 consecutive patients (16 men and 34 women) for the reconstruction of secondary defects (burn scars, skin graft scars, hypertrophic scars, keloids, capillary hemangioma, congenital nevi and micotia). The average age of patients was 21 years. The tissue expansion protocol was used in clinical as well as common principle. The main technical details are modified in this procedure by the authors: type of intralesional incision for expander insertion, closing of wound incision by three layers, evacuation of the liquid in the prosthesis pocket, injection with antibiotic solution and expanded flap capsulectomy. The complications rate was 10.6% (8 complications in 75 expanders). The most common complications consisted of infection, hematoma, exposure of valve, dehiscence of incision, necrosis of the distal expanded flap. The overall failure rate was 8%. Thus our modified surgical details allowed us to decrease the major complications and to achieve the best possible functional and aesthetic results.     

Five years' experience of the modified Meek technique in the management of extensive burns

BACKGROUND: The Meek technique of skin expansion is useful for covering a large open wound with a small piece of skin graft, but requires a carefully followed protocol. METHODS: Over the past 5 years, a skin graft expansion technique following the Meek principle was used to treat 37 individuals who had sustained third degree burns involving more than 40% of the body surface. A scheme was devised whereby the body was divided into six areas, in order to clarify the optimal order of wound debridements and skin grafting procedures as well as the regimen of aftercare. RESULTS: The mean body surface involvement was 72.9% and the mean area of third degree burns was 41%. The average number of operations required was 1.84. There were four deaths among in this group of patients. CONCLUSIONS: The Meek technique of skin expansion and the suggested protocol are together efficient and effective in covering an open wound, particularly where there is a paucity of skin graft donor sites.