Ardeshirpour Farhad, Hurliman Elisabeth, Wendelschafer-Crabb Gwen, McAdams Brian, Hilger Peter A, Kennedy William R, Lassig Amy Anne D, Brenner Michael J
Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle.
Department of Dermatology, University of Minnesota Medical Center, Minneapolis.
JAMA Facial Plast Surg. 2017 Sep 1;19(5):379-385. doi: 10.1001/jamafacial.2017.0007.
Wound healing influences both the cosmetic and functional outcomes of facial surgery. Study of cutaneous innervation may afford insight into patients' preoperative wound healing potential and aid in their selection of appropriate surgical procedures.
To present the quantitative and qualitative differences of epidermal nerve fibers (ENFs), neurotransmitters, vasculature, and mast cells in facial skin among patients after primary and revision rhytidectomies.
DESIGN, SETTING, AND PARTICIPANTS: This pilot study collected cutaneous specimens from 8 female patients aged 42 to 66 years who underwent primary rhytidectomy (n = 5) and revision rhytidectomy (n = 3) at Centennial Lakes Surgery Center, Edina, Minnesota, from July 2010 to March 2014. Tissue was processed for confocal/epifluorescence microscopy and indirect immunofluorescent localization of several neural and tissue antigens as well as basement membrane and mast cell markers.
Primary rhytidectomy vs revision rhytidectomy with selection of a small area of redundant, otherwise disposed of tissue anterior to the tragus for ENF study.
Demographic characteristics included smoking status; 10-point rating scales for facial sensation, pain, and paresthesias; and confocal/epifluorescence microscopy to quantify ENFs, neurotransmitters, vasculature, and mast cells.
Patients in the primary rhytidectomy group had a mean (SD) of 54.4 (31.6) ENFs/mm (range, 14.2-99.2 ENFs/mm), and those in the revision rhytidectomy group had a mean (SD) of 18.6 (5.8) ENFs/mm (range, 13.8-25.0 ENFs/mm). A patient in the primary rhytidectomy group was a 25-pack-year smoker and had 14.2 ENFs/mm, the lowest in both groups. In addition to these structural neural changes, functional neural changes in revision rhytidectomy samples included qualitative changes in normal neural antigen prevalence (substance P, calcitonin gene-related peptide, and vasoactive intestinal peptide). Capillary loops appeared less robust and were less common in dermal papilla among samples from both the primary and revision groups, and mast cells were more degranulated. No differences were found in subjective, self-reported postoperative facial sensation.
Previous skin elevation was associated with decreased epidermal nerve fiber density and qualitative changes in dermal nerves, capillaries, and mast cells in a clinical sample of patients undergoing rhytidectomy. Future research is needed to determine whether histological findings predict wound healing and to better understand the effects of surgery on regenerative capacity of epidermal nerve fibers.
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伤口愈合会影响面部手术的美容和功能效果。对皮肤神经支配的研究可能有助于深入了解患者术前的伤口愈合潜力，并有助于选择合适的手术方法。
呈现初次和修复性除皱术后患者面部皮肤中表皮神经纤维（ENF）、神经递质、血管和肥大细胞的定量和定性差异。
设计、地点和参与者：这项初步研究收集了2010年7月至2014年3月在明尼苏达州伊代纳市百年湖手术中心接受初次除皱术（n = 5）和修复性除皱术（n = 3）的8名年龄在42至66岁之间的女性患者的皮肤标本。对组织进行处理，用于共聚焦/落射荧光显微镜检查以及几种神经和组织抗原以及基底膜和肥大细胞标志物的间接免疫荧光定位。
初次除皱术与修复性除皱术，并选择耳屏前一小片多余的、原本会被丢弃的组织进行ENF研究。
人口统计学特征包括吸烟状况；面部感觉、疼痛和感觉异常的10分制评分量表；以及共聚焦/落射荧光显微镜检查以量化ENF、神经递质、血管和肥大细胞。
初次除皱术组患者的ENF平均（标准差）为54.4（31.6）条/mm（范围为14.2 - 99.2条/mm），修复性除皱术组患者的ENF平均（标准差）为18.6（5.8）条/mm（范围为13.8 - 25.0条/mm）。初次除皱术组的一名患者吸烟史为25包年，其ENF为14.2条/mm，是两组中最低的。除了这些结构性神经变化外，修复性除皱术样本中的功能性神经变化包括正常神经抗原患病率（P物质、降钙素基因相关肽和血管活性肠肽）的定性变化。在初次和修复组的样本中，毛细血管袢看起来不那么粗壮，在真皮乳头中也不那么常见，并且肥大细胞脱颗粒更明显。在主观的、自我报告的术后面部感觉方面未发现差异。
在接受除皱术的患者临床样本中，先前的皮肤提升与表皮神经纤维密度降低以及真皮神经、毛细血管和肥大细胞的定性变化有关。需要进一步研究以确定组织学发现是否能预测伤口愈合，并更好地理解手术对表皮神经纤维再生能力的影响。
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