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

Experimental study on enhancement of tissue expansion with papaverine cream

OBJECTIVE: To evaluate the effect of external use of papaverine cream on enhancement of tissue expansion. METHODS: 8 mini pigs were randomly divided into 4 groups. During inflation, papaverine was given externally in group A, through a delivery system in group B, though intramuscular injection in group C. Papaverine was not given in group D. The time of inflation, the expansion rate, the surviving length of expanded flaps and the papaverine concentration in the fibrous capsule in each group were examined. Histologic and electroscope examinations of the expanded tissue were made. RESULTS: The average inflation time was 28.9 +/- 4.5 days in group A, 34.0 +/- 2.6 days in group B, 37.6 +/- 4.8 days in group C and 38.5 +/- 3.5 days in group D. There was significant difference between each group(P < 0.05). The average surviving length of expanded flaps in group A was 13.67 +/- 1.28 cm, 11.07 +/- 0.88 cm in group B, 10.79 +/- 0.49 cm in group C, and 9.49 +/- 0.77 cm in group D. There was significant difference between each group (P < 0.01). Histologic examinations of the expanded tissue suggested that there were no significant differences in thickness of epidermis, derma and fibrous capsule among the four groups. Electroscope examinations of the myofibroblast in fibrous capsule showed that there were smaller nuclei, fewer microfilaments and fewer mitochondrias and rougher endoplastic reticulume in group A than those in other groups. The concentration of papaverine in fibrous capsule of group A was 3.5 +/- 1.2 micrograms/g. Papaverine was detected neither in the skin of other groups nor in the blood of all groups. CONCLUSIONS: 1. Papaverine cream can permeate through skin and maintain high concentration and continuous effect in local tissue. 2. External use of papaverine cream can inhabit the function of myofibroblast in fibrous capsule, increase inflation rate, accelerate expansion process, and improve microcirculation of the expanded skin with a result of prolongation of surviving length of expanded flaps. 3. The technique of enhancing tissue expansion with external use of papaverine has the advantages of convenient delivery, cheapness, no more injury and infection, and no side effects etc. It is a safe, effective, simple, and reliable method for accelerating tissue expansion.