Biomedical Engineering Research Group, School of Engineering and Applied Science, Aston University, Birmingham, UK.
Aston Research Centre for Healthy Ageing, School of Life and Health Science, Aston University, Birmingham, UK.
Proc Inst Mech Eng H. 2024 Apr;238(4):403-411. doi: 10.1177/09544119241234154. Epub 2024 Mar 3.
External fixation is an essential surgical technique for treating trauma, limb lengthening and deformity correction, however infection is common, with infection rates ranging from 4.5 to 100% of cases. Throughout the literature researchers and clinicians have highlighted a relationship between excessive movement of the pin and skin and an increase in the patient's risk of infection, however, currently no studies have addressed this role of pin-movement on pin-site wounds. This preliminary study describes a novel in vitro pin-site model, developed using a full-thickness human skin equivalent (HSE) model in conjunction with a bespoke mechanical system which simulates pin-movement. The effect of pin-movement on the wound healing response of the skin equivalents was assessed by measuring the expression of pro-inflammatory cytokines. Six human skin equivalent models were divided into three test groups: no pin as the control, static pin-site wound and dynamic pin-site wound ( = 3). On day 3 concentrations of IL-1α and IL-8 showed a significant increase compared to the control when a static fixation pin was implanted into the skin equivalent ( < 0.05) and ( < 0.005) respectively. Levels of IL-1α and IL-8 increased further in the dynamic sample compared to the static sample ( < 0.05) and ( < 0.0005). This study demonstrates for the first time the application of HSE model to study external-fixation pin-movement in vitro. The results of this study demonstrated pin-movement has a negative effect on soft-tissue wound-healing, supporting the anecdotal evidence reported in the literature, however further analysis of wound heading would be required to verify this hypothesis.
外固定术是治疗创伤、肢体延长和畸形矫正的重要手术技术,但感染很常见,感染率为 4.5%至 100%。在整个文献中,研究人员和临床医生都强调了针的过度运动与皮肤之间的关系以及患者感染风险的增加,然而,目前尚无研究探讨针运动对针部位伤口的作用。本初步研究描述了一种新颖的体外针部位模型,该模型使用全厚度人皮肤等效物(HSE)模型与模拟针运动的定制机械系统相结合开发。通过测量促炎细胞因子的表达来评估针运动对皮肤等效物伤口愈合反应的影响。六个人类皮肤等效物模型分为三组:无针作为对照、静态针部位伤口和动态针部位伤口(n=3)。第 3 天,当将固定针植入皮肤等效物时,与对照组相比,IL-1α 和 IL-8 的浓度明显增加(p<0.05)和(p<0.005)。与静态样本相比,动态样本中 IL-1α 和 IL-8 的水平进一步升高(p<0.05)和(p<0.0005)。本研究首次将 HSE 模型应用于体外研究外固定针运动。本研究的结果表明,针运动对软组织伤口愈合有负面影响,支持文献中报道的轶事证据,但需要进一步分析伤口愈合以验证这一假设。
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