Friedrich R E, Bartel-Friedrich S, Plambeck K
Department of Oral and Maxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Germany.
J Oral Maxillofac Surg. 2000 Oct;58(10):1125-8. doi: 10.1053/joms.2000.9572.
This study investigated the distribution of collagen III and IV in experimental microvascular anastomoses and correlated the findings with the quality of the healing process.
A previously excised and reanastomosed section of the left common carotid artery of 21 female Wistar rats were explanted 4 weeks after surgery. Collagens III and IV were identified in perfusion-fixed specimens by immunohistochemistry.
The identification and distribution of collagens reflected the quality of each suturing procedure. A myointimal hyperplasia was present, extending into the vascular lumen, and was closely related to the ends of the vessel segments. The extent of myointimal hyperplasia was dependent on the length and the vitality of the vessel segments. The media was the weakest part of the tissue layers with regard to regenerative potential in the axial direction. The marked cuff of the adventitia around the anastomosis was rich in collagen III-positive vasa vasorum. Collagen IV was distributed in net-like patterns in the media. The distribution pattern in the media was not observed in anastomoses with incomplete approximation and necrotic segment ends. The collagen IV-positive subendothelial basal membrane was incomplete in the aneurysms because of partial necrosis.
The experimental findings support the need for atraumatic suturing in microvascular surgery. Immunohistochemical detection of collagens can be a valuable tool for studying the basic processes of wound healing and the integration of microvascular flaps into their recipient sites.
本研究调查了实验性微血管吻合术中III型和IV型胶原蛋白的分布情况，并将研究结果与愈合过程的质量相关联。
对21只雌性Wistar大鼠左侧颈总动脉先前切除并重新吻合的部分在手术后4周进行取材。通过免疫组织化学在灌注固定标本中鉴定III型和IV型胶原蛋白。
胶原蛋白的鉴定和分布反映了每种缝合操作的质量。存在肌内膜增生，延伸至血管腔，并与血管段的末端密切相关。肌内膜增生的程度取决于血管段的长度和活力。就轴向的再生潜能而言，中膜是组织层中最薄弱的部分。吻合口周围外膜的明显袖口富含III型胶原蛋白阳性的血管滋养管。IV型胶原蛋白在中膜呈网状分布。在吻合不完整和坏死段末端的吻合口中未观察到中膜的这种分布模式。由于部分坏死，动脉瘤中IV型胶原蛋白阳性的内皮下基底膜不完整。
实验结果支持微血管手术中进行无创伤缝合的必要性。胶原蛋白的免疫组织化学检测可以成为研究伤口愈合的基本过程以及微血管皮瓣与受区整合的有价值工具。
