Melis Paris, Noorlander Maril L, van der Horst Chantal M A M, van Noorden Cornelis J F
Department of Surgical Research, Academic Medical Center, University of Amsterdam, The Netherlands.
Plast Reconstr Surg. 2002 Feb;109(2):674-80; discussion 681-2. doi: 10.1097/00006534-200202000-00038.
A controlled, quantitative histochemical study was performed in five piglets to establish changes in undermined and not undermined stretched skin. The skin was stretched with a stretching device for 30 minutes to close a large skin defect. On each flank of the piglet, at a standard position, 9 x 9-cm wounds were created under general anesthesia. On one flank, the surrounding skin was undermined cranially and caudally over a 10-centimeter area. Sections of skin biopsies obtained during stretching were stained with picrosirius red and studied with routine light microscopy and polarized light microscopy in combination with image analysis. The length of collagen fibers was analyzed as a parameter of changes in the dermis resulting from skin stretching. This newly developed quantitative method appeared to be valid, specific, and reproducible, allowing for objective determination of changes in the length of the fibers in the plain of the sections. Changes in the orientation of collagen fibers in the dermis as a result of skin stretching were thereby determined. Epidermal thickness did not change significantly under the influence of stretching forces in both undermined and not undermined skin. However, the orientation of the collagen fibers changed significantly as a result of skin stretching. In undermined wounds, parallel alignment and elongation of the fibers in the plane of the sections was already observed after 15 minutes of stretching. The fibers became aligned in the direction of the stretching force, perpendicular to the wound margin. After 30 minutes of stretching, the mean major axes of the collagen fibers were longest in the plane of the sections (p < 0.001). This meant that elongation and parallel alignment of the collagen fibers had occurred. Stretching of not undermined skin for 15 minutes resulted in significantly stronger parallel alignment in the plane of the sections as compared with undermined skin. This was less well defined after 30 minutes of stretching in not undermined skin. It is concluded that skin stretching with a skin-stretching device for 30 minutes results in significant histomorphological changes of collagen fibers in the dermis of both undermined and not undermined skin. The fibers realign rapidly as a result of stretching forces and become aligned in the direction of the stretching force, perpendicular to the wound margin. These dynamic changes in collagen fibers explain the significantly decreased wound closing tension resulting from skin stretching and explain how skin stretches beyond its inherent extensibility.
对5只仔猪进行了一项对照定量组织化学研究,以确定潜行分离和未潜行分离的拉伸皮肤的变化。使用拉伸装置将皮肤拉伸30分钟以闭合一个大的皮肤缺损。在仔猪的每一侧腹,在标准位置,于全身麻醉下创建9×9厘米的伤口。在一侧腹,在10厘米区域内对伤口周围的皮肤进行头侧和尾侧的潜行分离。在拉伸过程中获取的皮肤活检切片用苦味酸天狼星红染色,并结合图像分析,用常规光学显微镜和偏振光显微镜进行研究。分析胶原纤维的长度,作为皮肤拉伸导致真皮变化的一个参数。这种新开发的定量方法似乎是有效、特异且可重复的,能够客观地确定切片平面内纤维长度的变化。由此确定了皮肤拉伸导致真皮中胶原纤维方向的变化。在潜行分离和未潜行分离的皮肤中,表皮厚度在拉伸力的影响下均未发生显著变化。然而,胶原纤维的方向因皮肤拉伸而发生了显著变化。在潜行分离的伤口中,拉伸15分钟后即可观察到切片平面内纤维的平行排列和伸长。纤维沿拉伸力方向排列,垂直于伤口边缘。拉伸30分钟后,胶原纤维的平均长轴在切片平面内最长(p<0.001)。这意味着胶原纤维发生了伸长和平行排列。与潜行分离的皮肤相比,未潜行分离的皮肤拉伸15分钟后,在切片平面内产生了明显更强的平行排列。在未潜行分离的皮肤中拉伸30分钟后,这种情况不太明显。结论是,使用皮肤拉伸装置将皮肤拉伸30分钟会导致潜行分离和未潜行分离皮肤的真皮中胶原纤维发生显著的组织形态学变化。由于拉伸力的作用,纤维迅速重新排列,并沿拉伸力方向排列,垂直于伤口边缘。胶原纤维的这些动态变化解释了皮肤拉伸导致伤口闭合张力显著降低的原因,并解释了皮肤如何伸展超过其固有伸展性。
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