Scott P G, Chambers M, Johnson B W, Williams H T
Br J Surg. 1985 Oct;72(10):777-9. doi: 10.1002/bjs.1800721003.
Delayed primary closure or secondary closure of skin and subcutaneous fat in contaminated laparotomy incisions virtually eliminates the risk of wound abscess in clinical practice. Incisional hernias rarely develop in these wounds. This experimental study offers a possible explanation. Longitudinal incisions in the linea alba of female Wistar rats healed under skin incisions which were either sutured ('closed' subgroup) or left to close by secondary intention ('open' subgroup). Postoperative breaking strengths and collagen contents (measured as hydroxyproline) were studied at intervals of 3-120 days. Measurable strength developed by 5 days, at which time 'open' subgroup wounds were found to be weaker and to have less collagen. At all other times, however, 'open' subgroup wounds were stronger, a property which could be ascribed at earlier, but not at later, periods (42 or 120 days), to a higher content and concentration of collagen. At 3 days the rate of collagen production was significantly (P less than 0.025) lower in 'open' than in 'closed' subgroup wounds but the converse was true at 6 and 9 days (P less than 0.025), thus accounting for the changes in biomechanical properties. It is suggested that initially the stimulus for collagen synthesis is greater in the 'open' wounds and this leads to the development of a collagenous structure which is better adapted to resist tensile forces.
在临床实践中，对污染的剖腹手术切口进行延迟一期缝合或二期缝合皮肤及皮下脂肪，实际上可消除伤口脓肿的风险。这些伤口很少发生切口疝。本实验研究提供了一种可能的解释。对雌性Wistar大鼠白线处的纵向切口，在皮肤切口缝合（“闭合”亚组）或任其二期愈合（“开放”亚组）的情况下进行愈合观察。在术后3 - 120天的间隔时间内研究其抗张强度和胶原蛋白含量（以羟脯氨酸衡量）。5天时可测得强度，此时发现“开放”亚组伤口较弱且胶原蛋白较少。然而，在所有其他时间，“开放”亚组伤口更强，在早期（42天或120天）但非后期，这种特性可归因于胶原蛋白含量和浓度较高。在3天时，“开放”亚组伤口的胶原蛋白生成速率显著低于（P < 0.025）“闭合”亚组伤口，但在6天和9天时情况相反（P < 0.025），从而解释了生物力学特性的变化。研究表明，最初“开放”伤口中胶原蛋白合成的刺激更大，这导致形成一种更能抵抗拉力的胶原结构。
