定向与非定向皮肤扩张的临床应用及组织学改变*☆

背景：研究表明皮肤扩张术应用逐渐广泛，但非定向、定向扩张器扩张后皮瓣回缩趋势及对基底压迫影响至今少有报道。 目的：通过比较非定向、定向扩张器扩张后皮瓣回缩趋势，观察其疗效，评价定向扩张器临床应用的安全性及有效性。 方法：对应用皮肤扩张术治疗面颈部病灶的患者126 例进行回顾性分析，比较非定向、定向扩张的临床效果及并发症的差异，观察非定向、定向两种扩张方法的皮肤组织学改变。 结果与结论：两种扩张方式使扩张器表面皮肤表皮细胞及纤维包膜组织增殖；部分成纤维细胞在真皮层可转化为具有收缩功能的肌成纤维细胞。定向扩张组相对于非定向扩张组具有扩张时间短、扩张次数少、疗效好等优点。两种扩张术对皮肤软组织的病理组织结构改变相似，未发现定向扩张术因单向扩张对皮肤软组织造成更严重损伤及扩张越快挛缩越严重的病理组织学表现。结果提示，临床中定向扩张器相对于非定向扩张器扩张效率高、对基底压迫小、疗程短，是一种安全、有效的修复面颈部体表病变的治疗方法。

Clinical application and histological changes of the directional and non-directional skin expansion

BACKGROUND: In recent years, clinical studies have shown that skin expansion had been widely used. However, the flap retraction trends and pressure on basal of directional and non-directional skin expansion had rarely reported. OBJECTIVE: To compare the trend retraction in the flap between directional and non-directional skin expansion, and to investigate the safety and effectiveness of skin expansion applying in clinic. METHODS: Totally 126 patients with faciocervical disease treated by skin expansion were reviewed retrospectively. The differences in clinical effects and complication of directional and non-directional skin expansion were compared, and histological changes of skins using two expansions were observed. RESULTS AND CONCLUSION: Both epidermal cells and the fibrous capsules located on the surface of expansion proliferated in two groups. Part of fibroblasts changed into myofibroblasts in derma. Compared with non-directional skin expansion, directional skin expansion could decrease the expanding duration and frequency, as well as reduce complication. The results showed that histomorphological changes of soft tissues in two groups were similar. There was no histological manifestation that directional expansion had much more serious damage to the skin tissues than non-directional skin expansion and faster expansion led to much more serious retraction. Compared with the non-directional skin expansion, the clinical application of directional skin expansion is characterized by more efficient in expanding skin, less compressive on the basal layer of epidermis, and shorten treatment duration. The therapeutic efficacy shows that directional skin expansion is really a safe and effective method in treating faciocervical disease.