Wetton Lara, Kwei Johnny, Kippen John, Nicklin Sean, Gillies Mark, Walsh William R
Research Laboritories, University of New South Wales, The Prince of Wales Hospital, Australia.
Eplasty. 2010 Feb 23;10:e19.
Successful skin grafting requires multiple factors for success. An even distribution of constant pressure exerted upon the graft is necessary for successful graft take. It is well known that excessive pressure on a graft causes ischemia and may result in the failure of graft take. The aim of this study was to demonstrate the variation in skin pressure (tension) on curved surfaces, particularly relating to apical pressure on such surfaces at standard atmospheric pressure.
A synthetic Sawbone skull model was used to determine skin tension over a curved surface. A 10-cm diameter circle was centered on the parietal eminence, the area of maximum curvature. Peripheral screws gave fixed reproducible points to secure the foam dressing. Open-cell VAC dressing foam was used and calibrated Tekscan sensors were used to determine pressure variation under the foam dressing.
Five hundred pressure readings were obtained for the unscored foam, and an additional 500 for the cross-scored foam. In the unscored foam, the pressure under the dressing was significantly higher at the apex. Cross-scoring the foam reduced the pressure, with the greatest reduction being at the apex. The pressure under the foam dressing was maximal at the apical point (95% confidence interval).
Higher contact force at the apex of a curved graft bed may explain skin graft loss. Unequal pressure distribution can be reduced and equalized by scoring the foam.
成功的皮肤移植需要多种因素才能成功。移植片上施加均匀的恒定压力是移植成功所必需的。众所周知，移植片上的压力过大会导致局部缺血，并可能导致移植失败。本研究的目的是证明曲面上皮肤压力（张力）的变化，特别是在标准大气压下此类曲面上的顶点压力。
使用合成的Sawbone颅骨模型来确定曲面上的皮肤张力。以顶骨隆起（最大曲率区域）为中心画一个直径10厘米的圆。周边螺丝提供固定的可重复点，以固定泡沫敷料。使用开孔的负压伤口治疗（VAC）敷料泡沫，并使用经过校准的Tekscan传感器来确定泡沫敷料下的压力变化。
未划刻的泡沫获得了500次压力读数，划刻的泡沫又获得了500次压力读数。在未划刻的泡沫中，敷料下顶点处的压力明显更高。对泡沫进行划刻可降低压力，其中顶点处的压力降低最大。泡沫敷料下的压力在顶点处最大（95%置信区间）。
弯曲移植床顶点处较高的接触力可能解释皮肤移植失败的原因。通过对泡沫进行划刻，可以减少并均衡不均匀的压力分布。
