Kumar Naveen, Kumar Pramod, Nayak B Satheesha, Aithal P Ashwini, Guru Anitha
Drs. N. Kumar, Nayak, Aithal, and Ms. Guru are with the Department of Anatomy at Melaka Manipal Medical College, Manipal Campus, at the Manipal Academy of Higher Education in Manipal, Karnataka, India.
Dr. P. Kumar is with King Fahad Central Hospital in Jazan, Saudi Arabia.
J Clin Aesthet Dermatol. 2019 Dec;12(12):21-24. Epub 2019 Dec 1.
Stretching force on the skin leads to the widening of scars and/or hypertrophy. The uneven distribution profile of collagen and elastic fibers in the human dermis (evaluated based on their topographic areas) might determine the direction of incision for a more pleasing aesthetic result. Full-thickness skin samples were collected in the horizontal and vertical directions from 15 areas of 32 human cadavers. The histological preparation of the skin samples was performed using special Verhoeff-van Gieson staining. Image analysis in the TissueQuant software was performed using photomicrographs. Quantitative fraction measures for collagen and elastic fibers were completed. From the data obtained, various ratios between collagen in the horizontal (CH) and vertical (CV) directions and elastic fibers in the horizontal (EH) and vertical (EV) directions were established and expressed as CH:CV and EH:EV. In the areas where CV:CH was less than 1 (low ratio of significance), the collagen content was significantly higher in the horizontal direction than the vertical direction (CH>CV). However, this finding is reversed (CV>CH) in areas where CV:CH is greater than 1 (high ratio of significance). Similarly, in areas where EV:EH is less than 1 (low ratio of significance), the elastic fiber content was significantly higher in the horizontal direction than the vertical direction (EH>EV), whereas such is reversed (EV>EH) where EV:EH is greater than 1 (high ratio of significance). The evaluation of ratios of dermal collagen and elastic fibers in different directions together with the data of asymmetric distribution provide a useful guideline for aesthetic surgeons looking to place elective incisions in the direction that will ensure an improved aesthetically pleasing result.
皮肤表面的拉伸力会导致疤痕变宽和/或增生。人类真皮中胶原蛋白和弹性纤维的分布不均匀（根据其拓扑区域评估）可能决定切口方向，以获得更美观的效果。从32具人类尸体的15个区域水平和垂直方向采集全层皮肤样本。使用特殊的Verhoeff-van Gieson染色法对皮肤样本进行组织学制备。使用组织显微镜照片在TissueQuant软件中进行图像分析。完成了胶原蛋白和弹性纤维的定量分数测量。根据获得的数据，确定了水平方向（CH）和垂直方向（CV）的胶原蛋白以及水平方向（EH）和垂直方向（EV）的弹性纤维之间的各种比率，并表示为CH:CV和EH:EV。在CV:CH小于1的区域（低显著性比率），水平方向的胶原蛋白含量显著高于垂直方向（CH>CV）。然而，在CV:CH大于1的区域（高显著性比率），这一发现则相反（CV>CH）。同样，在EV:EH小于1的区域（低显著性比率），水平方向的弹性纤维含量显著高于垂直方向（EH>EV），而在EV:EH大于1的区域（高显著性比率）则相反（EV>EH）。评估不同方向的真皮胶原蛋白和弹性纤维比率以及不对称分布的数据，为整形外科医生在确保获得更美观效果的方向上进行选择性切口提供了有用的指导。
