Alex J C, Bhattacharyya T K, Smyrniotis G, O'Grady K, Konior R J, Toriumi D M
Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago, USA.
Laryngoscope. 2001 Jan;111(1):36-43. doi: 10.1097/00005537-200101000-00007.
OBJECTIVE: Recently, a two-dimensional Silastic Dacron stretching skin device has been developed for scalp reduction surgery. Attached subgaleally, this device stretches skin over time, while avoiding the visible volumetric distention that is typical of three-dimensional tissue expanders. Unlike three-dimensional expanders, the histological changes observed with a two-dimensional stretching device have not been described in the literature. The present study compares the histological effects of two-dimensional and three-dimensional skin tissue expansion in the porcine model. STUDY DESIGN: A university Institutional Review Board-approved study in which 16 domestic piglets were used. The 16 piglets were divided evenly into four cohorts as follows: 1, 1-week control cohort; 2, 1-week experimental cohort; 3, 4-week control cohort; and 4, 4-week experimental cohort. METHODS: Tissue expanders (three-dimensional) and Dacron Silastic tissue stretchers (two-dimensional) were surgically inserted into the lateral skin of 16 domestic pigs. Animals were killed at either 1 or 4 weeks based on group assignment. Light microscopic ocular micrometry and stereological point counting were used to determine the depth of the epidermis, dermis, and subdermal adipose tissue layer; width of the panniculus muscle; diameter of sweat gland follicles; percentage ratio of dermal collagen, blood vessels, and tissue space; and epidermal mitotic index in 100 specimens. One-way ANOVA was used to evaluate statistical differences. RESULTS: Both tissue expanders yielded increased values compared with control subjects, with respect to epidermal, dermal, and fat widths and blood vessel counts, whereas adnexal structures in the panniculus muscle width were unaltered. CONCLUSIONS: Although statistically the two types of expansion produced histologically similar changes, the degree of change varied according to the type of expander that was used and the duration of tissue expansion. Most notably, three-dimensional expansion produced more tissue gain per unit area expanded at both the 1-week and the 4-week time intervals, and early (1-week) two-dimensional tissue expansion stimulated a greater angiogenic response than three-dimensional expansion. These findings will assist the surgeon in understanding the physical changes that occur with these two forms of tissue expansion, as well as the potential clinical advantages and shortcomings of each method.
目的：最近，一种用于头皮缩减手术的二维硅橡胶涤纶拉伸皮肤装置已被研发出来。该装置附着于帽状腱膜下，随着时间推移可拉伸皮肤，同时避免了三维组织扩张器典型的明显体积膨胀。与三维扩张器不同，二维拉伸装置所观察到的组织学变化在文献中尚未有描述。本研究比较了猪模型中二维和三维皮肤组织扩张的组织学效应。 研究设计：一项经大学机构审查委员会批准的研究，使用了16头家猪幼崽。这16头猪被平均分为四个队列，如下：1. 1周对照组；2. 1周实验组；3. 4周对照组；4. 4周实验组。 方法：将组织扩张器（三维）和涤纶硅橡胶组织拉伸器（二维）手术植入16头家猪的侧方皮肤。根据分组安排，动物在1周或4周时被处死。使用光学显微镜目镜测微法和体视学点计数法来确定100个标本中表皮、真皮和皮下脂肪组织层的深度； panniculus肌的宽度；汗腺毛囊的直径；真皮胶原蛋白、血管和组织间隙的百分比；以及表皮有丝分裂指数。采用单因素方差分析来评估统计学差异。 结果：与对照组相比，两种组织扩张器在表皮、真皮和脂肪宽度以及血管计数方面的值均有所增加，而panniculus肌宽度中的附属结构未改变。 结论：尽管从统计学角度来看，两种类型的扩张产生了组织学上相似的变化，但变化程度根据所使用的扩张器类型和组织扩张持续时间而有所不同。最显著的是，在1周和4周时间间隔时，三维扩张在每单位扩张面积上产生了更多的组织增加，并且早期（1周）二维组织扩张比三维扩张刺激了更大的血管生成反应。这些发现将有助于外科医生理解这两种组织扩张形式所发生的物理变化，以及每种方法潜在的临床优缺点。
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