Mackay D R, Saggers G C, Kotwal N, Manders E K
Division of Plastic and Reconstructive Surgery, Milton S. Hershey Medical Center, Hershey, Pa.
Plast Reconstr Surg. 1990 Oct;86(4):722-30.
The efficacy of intraoperative expansion in reducing the tension of wound closure was tested in young pigs. The young piglet as a model for studying human skin was characterized by finding a close similarity between the modulus of elasticity of young piglet skin and human abdominoplasty and mammaplasty skin (range 12.8 to 23.7 N/mm2 for piglet skin, 14.3 to 19 N/mm2 for human skin). The tension required to close a standardized wound was determined before undermining, after undermining, and finally after intraoperative expansion. These measurements were performed in 10 young pigs with an average weight of 11.5 kg. Undermining the wound edges resulted in a significant decrease in the force required to close the wounds (p less than 0.0001). Intraoperative expansion did not significantly decrease the tension. Previous work showing the importance of site and direction of pull on the tension for wound closure was confirmed in this study. Analysis of variance demonstrated that the tension required to close a standard wound is greater high on the pig's back than near the belly and near the shoulder as opposed to the hip for midflank wounds (p less than 0.0001). Increasing the extent of undermining from 62 to 136 cm2 significantly decreased the tension for wound closure (p less than 0.05). Further undermining did not result in a significant decrease in wound closure tension. In this model, intraoperative expansion offers no advantage over simple undermining. We suggest that the benefit reported by clinicians using intraoperative expansion may derive from an increase in the extent of undermining required to place expanders under the wound margins.
在幼猪身上测试了术中扩张在降低伤口闭合张力方面的效果。以幼猪作为研究人类皮肤的模型，其特点是发现幼猪皮肤的弹性模量与人类腹部整形术和乳房整形术皮肤的弹性模量非常相似（幼猪皮肤的弹性模量范围为12.8至23.7N/mm²，人类皮肤为14.3至19N/mm²）。在进行皮瓣下分离前、皮瓣下分离后以及最后术中扩张后，测定闭合标准化伤口所需的张力。这些测量在10只平均体重为11.5kg的幼猪身上进行。皮瓣下分离伤口边缘导致闭合伤口所需的力显著降低（p小于0.0001）。术中扩张并没有显著降低张力。本研究证实了先前关于牵拉部位和方向对伤口闭合张力重要性的研究结果。方差分析表明，闭合标准伤口所需的张力在猪背部比腹部附近和肩部附近更高，而对于侧腹部中部伤口，与髋部附近相比情况相反（p小于0.0001）。将皮瓣下分离范围从62cm²增加到136cm²可显著降低伤口闭合张力（p小于0.05）。进一步的皮瓣下分离并没有导致伤口闭合张力显著降低。在这个模型中，术中扩张相对于单纯的皮瓣下分离没有优势。我们认为，临床医生报告的术中扩张的益处可能源于为将扩张器放置在伤口边缘下方而需要增加的皮瓣下分离范围。
