伸展作用后皮肤超微结构变化.doc

伸展作用后皮肤超微结构变化摘要目的:观察伸展作用后皮肤超微结构的变化。方法:取4只体重约20kg的猪为实验动物,分别对伸展作用侧及对照侧皮肤标本进行扫描和透射电镜观察。结果:扫描电镜观察伸展皮肤的胶原纤维自身卷曲状态明显减轻,多数纤维沿着伸展力的方向排列,纤维未见断裂表现。透射电镜见伸展作用后表皮细胞层次增加,间隙增宽,真皮层胶原纤维排列整齐紧密,成纤维细胞功能活跃,胶原纤维结构未受损害。结论:皮肤伸展术是一种有效、安全的方法。 关键词 皮肤伸展术 超微结构 扫描电镜 透射电镜 周黎安,男,1964年生,1992年第四军医大学口腔医学院硕士研究生毕业,1996年在医科院整形外科医院进修,现为解放军451医院美容整形外科主治医生,兼任本刊编辑,皮肤伸展器专利发明人,获军队科技进步三等奖一项,发表论文16篇,参编书籍二本。主持空军重点科研项目一项。 THE ULTRAMICROSTRUCTURAL CHANGES OF THE STRETCHED SKIN Zhou Lian Guo Shuzhong Li Zun et al Depart of Plastic surgery, Chinese PLA 451 Hospital, (Xi?an710054) Abstract Objective: The study was designed to investigate the ultramicrostructural changes of the s retched skin. Methods: On 4 Pigs, stretched skin was compared with non-stretched control skin from the opposite side of the animal. The specimens were observed with scanning electron microscopy (SEM) and transmission electron microscopy(TEM). Results: The collagen bundles became more aligned and compact. This alignment was along the direction of the loading force applied to the skin. The collagen fiber was normal. The epidermal cell layers were increase. The distant between cells became large. More active fibroblasts with increased rough endoplasmic reticulum、 mitochodrion and intracellular pre collagen filaments were seen in stretched skin dermis. Conclusion: The skin stretching technique was a safe and useful technique in aiding the closure of large defects. Key words Skin stretching technique Ultramicrostructure Scanning electron microscopy(SEM) Transmission electron microscopy(TEM) 皮肤伸展术始于1976年,Barrer[1]等提出了固位桥装置,用于直接关闭伤口。以后陆续有人采用不同装置和方法使关闭的创面不断增大。近年来,该方法在国内、外受到普遍关注,认为是一种“有把握的关闭”(surecloser)方法[2～4]。为进一步研究皮肤伸展术的作用机理及安全性,本研究对伸展作用后皮肤超微结构的变化进行了观察,并与未伸展侧皮肤进行了比较。 1 材料与方法 1.1实验动物及伸展作用 选取4只体重20kg左右白色乳猪(第四军医大学实验动物中心提供),雌雄不限,3%戊巴比妥钠(美国Sigama公司)30mg/kg肌注麻醉后,侧胸、腹及背部肥皂水刷洗,术区皮肤常规消毒,在胸背部选择7cm×3.5cm的面积,长边为首尾方向(图1),在11.5kg力的作用下,两条短边相对牵拉至靠拢(图2),并用针固定保持5天后,在靠近短边的伸展皮肤取材,对照标本取自相应对称部位的皮肤。 2 标本制备和观察 2.1扫描电镜标本距短边0.5cm的伸展皮肤切