Association of Dutch Burn Centres, Beverwijk, The Netherlands.
Wound Repair Regen. 2012 Sep-Oct;20(5):658-66. doi: 10.1111/j.1524-475X.2012.00827.x. Epub 2012 Aug 10.
Surgeons are often faced with large defects that are difficult to close. Stretching adjacent skin can facilitate wound closure. In clinical practice, intraoperative stretching is performed in a cyclical or continuous fashion. However, exact mechanisms of tissue adaptation to stretch remain unclear. Therefore, we investigated collagen and elastin orientation and morphology of stretched and nonstretched healthy skin and scars. Tissue samples were stretched, fixed in stretched-out position, and processed for histology. Objective methods were used to quantify the collagen orientation index (COI), bundle thickness, and bundle spacing. Also sections were analyzed for elastin orientation and quantity. Significantly more parallel aligned collagen bundles were found after cyclical (COI = 0.57) and continuous stretch (COI = 0.57) compared with nonstretched skin (COI = 0.40). Similarly, more parallel aligned elastin was found after stretch. Also, significantly thicker collagen bundles and more bundle spacing were found after stretch. For stretched scars, significantly more parallel aligned collagen was found (COI = 0.61) compared with nonstretched scars (COI = 0.49). In conclusion, both elastin and collagen realign in a parallel fashion in response to stretch. For healthy skin, thicker bundles and more space between the bundles were found. Rapid changes in extension, alignment, and collagen morphology appear to be the underlying mechanisms of adaptation to stretching.
外科医生经常面临难以闭合的大面积缺损。拉伸相邻的皮肤可以促进伤口闭合。在临床实践中,术中拉伸是周期性或连续性进行的。然而,组织适应拉伸的确切机制仍不清楚。因此,我们研究了拉伸和未拉伸的健康皮肤和疤痕中的胶原和弹性蛋白的取向和形态。组织样本被拉伸,在拉伸位置固定,并进行组织学处理。使用客观方法来量化胶原取向指数(COI)、束厚度和束间距。还分析了弹性蛋白的取向和数量。与未拉伸的皮肤(COI=0.40)相比,周期性拉伸(COI=0.57)和连续拉伸(COI=0.57)后,明显发现更多平行排列的胶原束。同样,拉伸后发现更多平行排列的弹性蛋白。而且,拉伸后发现胶原束更厚,束间距更大。对于拉伸的疤痕,与未拉伸的疤痕(COI=0.49)相比,明显发现更多平行排列的胶原(COI=0.61)。总之,弹性蛋白和胶原在拉伸作用下都以平行的方式重新排列。对于健康的皮肤,发现束更厚,束之间的空间更大。延伸、对齐和胶原形态的快速变化似乎是适应拉伸的潜在机制。
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