不同扩张方式对皮肤组织结构和回缩率的影响

目的研究反复快速扩张、单纯快速扩张及常规张对皮肤组织结构和回缩率的影响,以探讨适合于临床的最佳皮肤扩张方式。方法用兔制备动物模型,随机将动物分为反复快速扩张组(A组)、单纯快速扩张组(B组)、常规扩张组(C组)、植入不扩组(D组)和正常对照组(E组),扩张后分别维持1周、2周、3周、4周和6周,光镜下观察扩张皮肤组织结构的变化,分格测量法计算回缩率。结果 A、C两组在不同维持期的组织学表现较接近,表现为表皮层厚度增加,胶原纤维断裂较少。B组在维持2周过程中有大量胶原纤维断裂,且表皮层厚度增加不明显。A、B及C组维持4周时,组织结构基本恢复至正常。D组与E组的组织学表现近似。A、B、C及D组在相同扩张维持期,回缩率均高于E组。A、B、C组回缩率随时间延长均呈下降趋势。A、C组与B组比较,维持1、2、3和4周,回缩率均下降。A组与C组比较,维持1和2周,回缩率增加。结论采用反复快速扩张方式,能获取与常规扩张相同回缩率及质量的皮肤,并可缩短疗程。

Effect of different expansion on the structure and contraction rate of skin flap

Objective To investigate the effect of different expansion on the structure and contraction rate of skin flap. Methods New Zealand white rabbits were used and randomly divided into five groups, the repeatedly rapid expansion （group A）, the rapid expansion （group B）, conventional expansion （group C）, embedding but no expansion （group D） and the control group （ group E）. After the expansion for 1,2, 3, 4 and 6 weeks, the changes of structure of the expanded skin was observed under light microscope, and the contraction rate was calculated by sub-grid method. Results Group A and C showed similar histological features at different periods, demonstrating increased thickness of the epidermis and less fiber breakage. There were a lot of fiber breakage at two weeks in group B and the thickness of the epidermis did not change. At 4-week period, the skin structure returned to normal in group A, B and C. Group D and E showed similar histological features. The contraction rates of group A, B, C and D were higher than that of group E （ P 〈 0. 05 ）. The contraction rates of group A, B and C presented a trend of decrease with time. At maintaining period for 1,2,3,4 weeks, the contraction rates of group A and C were lower than that of Group B （ P 〈 0. 05 ）. At maintaining period for 1 and 2 weeks, the contraction rate of group C was lower than that of Group A （ P 〈 0. 05 ）. Conclusion Repeatedly rapid expansion may acquire the same contraction rate and quality of skin flap as the conventional expansion.